Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a (...) questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. (shrink)

The paper argues that intensional phenomena can be explained without appealing to "exotic" entities: one that don't exist, are merely possible, or are essentially abstract.

Two years ago in two articles in a thematic issue of this journal the three of us engaged in a critique of principlism. In a subsequent issue, B. Andrew Lustig defended aspects of principlism we had criticized and argued against our own account of morality. Our reply to Lustig's critique is also in two parts, corresponding with his own. Our first part shows how Lustig's criticisms are seriously misdirected. Our second and philosophically more important part picks up on Lustig's challenge (...) to us to show that our account of morality is more adequate than principlism. In particular we show that recognition of morality as public and systematic enables us to provide a far better description of morality than does principlism. This explains why we adopt the label “Dartmouth Descriptivism.”. (shrink)

The paper evaluates Hume's alleged projectivism about causation and moral values.

Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea.Gasping respiration is also referred to (...) as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated.We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death. (shrink)

The ontological argument of Saint Anselm, one of the most famous in the entire history of philosophy, has fascinated men’s minds for centuries. And yet, as Hartshorne makes abundantly clear, much of its subtlety has been missed by some of the keenest commentators. Although it has been discussed again and again, little work seems to have been done, even up to the moment, in exploring the logical forms or deep structures needed for an exact statement. Part of this is due (...) no doubt to the subtlety of the argument itself, but part of it is due to that fact that the key ideas involved are not of the kind that easily lend themselves to being handled within the standard kinds of logic. (shrink)

It is shown, in a large variety of manifestations, that the Aharonov—Bohm effect has classical counterparts in aspects concerning energy and momentum balance. No counterexamples are found in the cases considered, although whenever image charges shield the magnetic field region from the electric field of the passing electron the classical momentum effects, while present, would not be observable. Similarly, if the magnetic flux is maintained by superconductors, magnetic shielding will also render the classical energy effect unobservable. Partial shieldings of either (...) type will reduce but not totally eliminate the corresponding observable classical manifestations of these effects. (shrink)

THIS BOOK is, in effect, a sequel to the author’s Models for Modalities and purports to carry forward the case for the feasibility of a "possible-worlds" semantics. The main contention of the book is that such a semantics has its chief application in the study of propositional attitudes. But a good deal more than this is claimed, namely, applicability to the study of epistemic notions in general, to the study of causality and the language of the sciences, to the exact (...) study of phenomenology, to the linguistics, to the problem of "representation" in the arts, and even to the foundations of statistics and probability theory. (shrink)