ObjectivesMany older adults with visual impairment also have significant hearing loss. The aim was to investigate the effectiveness of a newly developed Dual Sensory Loss protocol on communication and wellbeing of older persons with DSL and their communication partners in the Netherlands and Belgium.MethodsParticipants and their communication partners were randomized in the “DSL-protocol” intervention group or a waiting-list control group. The intervention took 3 to 5 weeks. Occupational therapists focused on optimal use of hearing aids, home-environment modifications and effective communication (...) strategies. The primary outcome was the Communication Strategies domain of the Communication Profile for the Hearing Impaired. Secondary outcomes measured in participants were the Low Vision Quality Of Life Adjustment subscale, the Center for Epidemiological Studies - Depression Scale, De Jong Gierveld Loneliness Scale and the Fatigue Assessment Scale. The Hearing Handicap and Disability Inventory - Reaction of Others subscale and the Care-related Quality of Life - 7 Dimensions was measured in communication partners. Measurements were taken at baseline and 3-month follow-up. Linear mixed models were used to analyze effects between groups over time for every outcome measure.ResultsIntention-to-treat analyses showed a significant effect of the DSL-protocol on the use of verbal strategies in favor of the control group, however, this effect was non-significant after adjustment for confounding. Effect sizes of other outcomes varied between −0.23 [−0.57, 0.12] and 0.30 [−0.05, 0.64]. The LMM showed a significant effect on the HHDI-Reaction of others scale in favor of communication partners in the treatment group, however, the effect did not remain significant at a 0.01 significance level and the effect size was very small and non-significant 0.12, 95% CI [−0.27 to 0.51]. Adjusted analyses did not reveal treatment effects.ConclusionThe DSL-protocol did not clearly contribute to the enhancement of communication and wellbeing in DSL-patients. Possible reasons for the lack of effects are OTs not being comfortable giving advice on communication and psychosocial issues or the short-term treatment and follow-up period. Further study is warranted to find out how the protocol may be adapted or whether it is necessary to involve mental healthcare professionals.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NTR2843. (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

Van der Henst argues that the theory of mental models lacks a pragmatic component. He fills the gap with the notion that reasoners draw the most relevant conclusions. We agree, but argue that theories need an element of “nondeterminism.” It is often impossible to predict either what will be most relevant or which particular conclusion an individual will draw.

A letter to The Times of London, May 9, 1992 protesting the Cambridge University proposal to award an honorary degree to M. Jacques Derrida.

Objectives: Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study’s objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whether deviating from standard informed consent procedures could be morally justified. Design: A survey among nursing home physicians. Setting & Participants: We sent a questionnaire to all (356) nursing (...) homes in the Netherlands, to be completed by one of the physicians. Results: We received 245 completed questionnaires. As 21 institutions appeared to be closed or merged into other institutions, the response was 73.1% (245/335). Of all respondents 81.9% reported a vaccination rate above 80%. Almost 50% reported a vaccination rate above 90%. Most respondents considered herd immunity to be an important consideration for institutional policy. Freedom of choice for residents was considered important by almost all. Nevertheless, 106 out of 245 respondents follow a tacit consent procedure, according to which vaccination will be administered unless the resident or her proxy refuses. These institutions show significantly higher vaccination rates (p < 0.03). Conclusions: In our discussion we focus on the question whether tacit consent procedures can be morally justifiable. Such procedures assume that vaccination is good for residents either as individuals or as a group. Even though this assumption may be true for most residents, there are good reasons for preferring express consent procedures. (shrink)

ABSTRACTHumiliation lacks an empirically derived definition, sometimes simply being equated with shame. We approached the conceptualisation of humiliation from a prototype perspective, identifying 61 features of humiliation, some of which are more central to humiliation than others. Prototypical humiliation involved feeling powerless, small, and inferior in a situation in which one was brought down and in which an audience was present, leading the person to appraise the situation as unfair and resulting in a mix of emotions, most notably disappointment, anger, (...) and shame. Some of the features overlapped with those of shame whereas other features overlapped with those of anger. Which specific features are present may determine whether the humiliation experience becomes more shame- or anger-like. (shrink)

ABSTRACTBoth auditory and visual emotional memories can be made less emotional by loading working memory during memory recall. Taxing WM during recall can be modality specific (giving an audit...

In this article, after arguing that present approaches to improving problem-solving discussions for various reasons are not satisfactory, I turn to the pragma-dialectic approach to argumentative discourse to derive a normative framework that can serve as a point of departure to enhance the quality of problem-solving discussions. I then show how this approach can be used as analytical and evaluative instrument that can help the analyst to establish whether participants in actual practice act in a fashion that is in accord (...) with the norms posited. Two real-life problem-solving discussions provide the material for this demonstration. (shrink)

Journal Name: Apeiron Issue: Ahead of print.

In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on (...) these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme. (shrink)

Michael Bonnett; Education in a Destitute Time[1], Journal of Philosophy of Education, Volume 17, Issue 1, 30 May 2006, Pages 21–33, https://doi.org/10.1111/j.1.

In the opening sections of this paper, we defined ambiguity in terms of distinct sentences (for a single sentence-string) with, in particular, distinct sets of truth conditions for the corresponding negative sentence-string. Lexical vagueness was defined as equivalent to disjunction, for under conditions of the negation of a sentence-string containing such an expression, all the relevant more specific interpretations of the string had also to be negated. Yet in the case of mixed quantification sentences, the strengthened, more specific, interpretations of (...) some such positive string are not all of them necessarily implied to be false if the corresponding negative sentence-string is asserted. On the contrary, as we saw in section 6, a negative sentence-string can be used to deny one of the more specific interpretations of the corresponding positive string without also denying other weaker interpretations of that same string. One might therefore argue that the only empirical evidence availble for assessing quantified sentences suggests clearly that these sentence-strings are ambiguous. Indeed logicians, many of whom restrict their attention to propositions, MUST recognise logical ambiguity at this point. For the contextualisation of the negative sentences in section 6 showed that it was possible to assert the falsity of some proposition P expressed by the sentence S while asserting a further proposition which was compatible with the truth of S. However the corresponding conclusion that such sentence-strings are sententially ambiguous is not a necessary conclusion for the linguist: for the alternative account of postulating a single semantic representation plus a set of semantic procedures is also compatible with the negation evidence. Moreover we have seen independent reasons for thinking that if sentential ambiguity is assumed to be in one-to-one correspondence with what we should now call logical ambiguity, a considerable body of generalisations is lost. For the maximal ambiguity account, it should be recalled, is committed to assigning at least thirteen distinct propositions and hence thirteen distinct sentence outputs for every sentence-string containing no more than two quantifiers, for three out of the four interpretations originally outlined in this paper can be understood with each numeral taken either in an ’exactly’ sense or in an ’at least’ sense. Moreover there is no explanation of why just these interpretations are available-they are merely an arbitrary list, no more connected than are the two interpretations of John saw her duck, with no reason to predict that the ambiguity would carry over from language to language. If then it is granted that an ambiguity account fails to capture appropriate generalisations, only two alternative accounts of mixed quantification sentence-strings remain viable-an analysis proposing an initial co-ordinate logical form like the logical form III, which is the strongest form compatible with each of the propositional interpretations of sentence-string Two examiners marked six scripts, and the radically weak form in which only existential quantification (both over sets and over members of those sets) is invoked. Since there are strong arguments to suggest that the procedures which both analyses require are semantic, there seems no reason not to adopt the radical vagueness account, with its considerably greater simplicity. (shrink)

Metaphysics and language: Quine, W. V. O. On the individuation of attributes. Körner, S. On some relations between logic and metaphysics. Marcus, R. B. Does the principle of substitutivity rest on a mistake? Van Fraassen, B. C. Platonism's pyrrhic victory. Martin, R. M. On some prepositional relations. Kearns, J. T. Sentences and propositions.--Basic and combinatorial logic: Orgass, R. J. Extended basic logic and ordinal numbers. Curry, H. B. Representation of Markov algorithms by combinators.--Implication and consistency: Anderson, A. R. Fitch on (...) consistency. Belnap, N. D., Jr. Grammatical propaedeutic. Thomason, R. H. Decidability in the logic of conditionals. Myhill, J. Levels of implication.--Deontic, epistemic, and erotetic logic: Bacon, J. Belief as relative knowledge. Wu, K. J. Believing and disbelieving. Kordig, C. R. Relativized deontic modalities. Harrah, D. A system for erotetic sentences. (shrink)

Recent policy developments in the area of livestock husbandry have suggested that, from the perspective of optimizing animal welfare, new animal husbandry systems should be developed that provide opportunities for livestock animals to be raised in environments where they are permitted to engage in “natural behavior.” It is not known whether consumers regard animal husbandry issues as important, and whether they differentiate between animal husbandry and other animal welfare issues. The responsibility for the development of such systems is allocated jointly (...) between farmers, regulators, different actors in the food chain, and consumers. This research focuses on understanding consumer attitudes and preferences regarding the development and introduction of such systems, to ensure that they are acceptable to consumers as well as producers, regulators, and scientists. Consumer perceptions of animal welfare and animal husbandry practices were evaluated using quantitative consumer survey, which focused on two animal husbandry issues – farmed pigs and farmed fish. Following pilot work, 1000 representative Dutch consumers were sampled about their attitudes to either pig or fish husbandry. The results indicated that consumers think about animal welfare in terms of two broad categories related to their health and living environment, but do not think about welfare issues at a more detailed level. Greater concern was expressed about the welfare of pigs compared to fish. Consumer trust in labeling also emerged as an important issue, since consumers need to trust different food chain actors with responsibility for promoting animal welfare, and are reluctant to consider the details of animal husbandry systems. As a consequence, a transparent, enforceable, and traceable monitoring system for animal welfare friendly products is likely to be important for consumers. (shrink)

This article presents a fundamental advance in the theory of mental models as an explanation of reasoning about facts, possibilities, and probabilities. It postulates that the meanings of compound assertions, such as conditionals (if) and disjunctions (or), unlike those in logic, refer to conjunctions of epistemic possibilities that hold in default of information to the contrary. Various factors such as general knowledge can modulate these interpretations. New information can always override sentential inferences; that is, reasoning in daily life is defeasible (...) (or nonmonotonic). The theory is a dual process one: It distinguishes between intuitive inferences (based on system 1) and deliberative inferences (based on system 2). The article describes a computer implementation of the theory, including its two systems of reasoning, and it shows how the program simulates crucial predictions that evidence corroborates. It concludes with a discussion of how the theory contrasts with those based on logic or on probabilities. (shrink)

Three experiments are reported which show that in certain contexts subjects reject instances of the valid modus ponens and modus tollens inference form in conditional arguments. For example, when a conditional premise, such as: If she meets her friend then she will go to a play, is accompanied by a conditional containing an additional requirement: If she has enough money then she will go to a play, subjects reject the inference from the categorical premise: She meets her friend, to the (...) conclusion: She will go to a play. Other contexts suppress the conditional fallacies. The first experiment demonstrates the effects of context on conditional reasoning. The second experiment shows that the inference suppression disappears when the categorical premise refers to both of the antecedents, such as: She meets her friend and she has enough money. In this case, subjects make both the valid inferences and the fallacies, regardless of the contextual information. The third experiment establishes that when subjects are given general information about the duration of a situation in which a conditional inducement was uttered, such as: If you shout then I will shoot you, they reject both the valid inferences and the fallacies. The results suggest that the interpretation of premises plays an even more central role in reasoning than has previously been admitted. Trois expériences montrent que dans certains contextes les sujets rejettent des instances valides de modus ponens et de modus tollens dans des énoncés conditionnels. Par exemple, quand une prémisse conditionnelle comme: Si elle rencontre son ami, alors elle ira jouer, est accompagnée par une phrase contenant une condition supplémentaire: Si elle a assez d'argent, alors elle ira jouer, les sujets rejettent l'inférence liant la prémisse catégorielle: Elle rencontre son ami, à la conclusion: Elle ira jouer. D'autres contextes éliminent également les inférences conditionnelles fallacieuses. La premiére expérience démontre l'effet du contexte sur la raisonnement conditionnel. La deuxiéme expérience montre que la suppression de l'inférence disparait quand la prémisse catégorielle fait référence aux deux antécédants, comme: Elle rencontre son ami et elle a assez d'argent. Dans ce cas, les sujets font aussi bien les inférences valides et fallacieuses, quelle que soit l'information contextuelle. La troisiéme expérience établit que quand l'on donne aux sujets des informations générales à propos de la durée d'une situation dans laquelle une conditionnelle a été prononcée, comme Si tu cries, alors je te tire dessus, ils rejettent autant les inférences valides que les inférences fallacieuses. Ces résultats suggèrent que l'interprétation des prémisses joue un rŏle encore plus central dans le raisonnement que l'on admettait auparavant. (shrink)

In this book, first published in 1975, Dr Kempson argues that previous work on presupposition - whether in philosophy or linguistics - has been mistakenly based on a conflation of two different disciplines: semantics, the study of the meanings assigned to the formal system which constitutes a language, and pragmatics, the study of the use of that system in communication. The first part of the book deals generally with the nature of semantics in linguistic theory and its formal representation within (...) a transformational grammar; Dr Kempson argues against incorporating the relation of presupposition within such a grammar. The second part provides a pragmatic account of the foundations of a theory of communication and its detailed application to the problems raised by presupposition. The book is intended for those studying both philosophy and linguistics and also for those sociolinguists and psychologists with a more general interest in the theory of communication. (shrink)

This inaugural volume of the Journal of the History of Women Philosophers and Scientists aims with its Issue 1 to clarify methodological issues that emerge when we rediscover the history of women philosophers. It is devoted to the questions which go hand in hand with the rediscovery of the history of women philosophers and scientists, asking whether and how we should place these newly discovered texts within the traditional patriarchal context. We do not know yet whether women are making different (...) ways into canonical thought, or whether we should abandon the idea of canonical thought at all. Submissions that we received for the first call for papers are subsumed under the theme “Beyond Borders.” Each article deals in some way with the writing or rewriting of women’s history, filling in lapsus in the historical canons of philosophy and related disciplines, addressing the gendered political intellectual tradition from modern India, engaging with the works and ideas of women thinkers. The light-hearted title of Karen Green’s article belies the seriousness of the question it poses. In “The Human in Feminist Philosophy: Or Woman Is a Social Animal, I’m Not So Sure about Man”, Green questions the adequacy of the structuralist account of language after critically assessing its role in feminist theory since the 1970s. Green argues that the hegemony of structuralism is as much a Western hegemony as the Enlightenment tradition of a transcendent subject. Texts historically written and published by women provide the raw material for an archaeology of the female subject, which, Green argues, leads to the discovery and exploration of the female subject. She offers an initial sketch of the results of such an exploration, concluding that many male theorists have portrayed humans as inherently self-centred and egoistic, while most female philosophers have assumed that humans are inherently social. Laura Kotevska’s contribution “Writing Women into the History of Philosophy: Contextualism Re-Examined” examines the advantages and disadvantages of contextualism as used as a methodology. Philosophical works by women have been neglected by historians of philosophy until recent decades. When such works were discussed, it was usually in the context of male philosophers with whom a female philosopher was associated in some way. Kotevska explores how different options for a contextualist history of philosophy can help explain a woman’s involvement in philosophy, or how they can undermine her intellectual authority and cloud our understanding of her work. To avoid some of the epistemically damaging results that can arise when a woman’s work is placed in her patriarchal context, Kotevska concludes with three suggestions for writing and teaching works produced by women, suggestions informed by the methodological considerations addressed in the essay. Priyanka Jha’s contribution addresses “The Shaping of the ‘Political’: Gendered Intellectual History of Ideas in Modern India (1880s–1940s)”. Her premise is that in most societies, women’s thought has been reflected in a significant and robust ‘political’ tradition, that this tradition of women’s political thought is situated in a larger universe of ideas than is commonly thought. Women have been and continue to be important interlocutors in debates about concerns and values that are central to the human condition. However, the kind of centrality and attention that should have been given to this school of thought as a “political tradition” has either been barely noticed or marginalized in comparison to other ideational currents. This act is not peculiar to postcolonial societies like India but has a global resonance and a universal scope. There are very few women who have been active as political thinkers or political philosophers worldwide. This paper locates the gendered tradition of political intellectuals in modern India by examining the works and ideas of women thinkers. In the paper on “Women and Freedom of Canonical Thought: A Propaedeutics”, Christine Lopes starts from the observation that in male or patriarchal canonical thinking there is no unified image and representation of women. She uses this broad space of presentation and calls this “the ways of women”. At the same time, she notes that even today we do not know whether women will bring different ways or possibly femininely coherent ways to canonical thought, or whether we can create women’s canonical thought or abandon the idea of canonical thought. For all, therefore, it can be stated that we are given the freedom to judge canonical thinking, to include or exclude ourselves, to adapt or not. The paper discusses some basic epistemological assumptions about such freedom. Bodil Hvass Kjems begins her reflections on “The Inclusion of Women in the Curriculum of Philosophy: Challenges and Solutions” with the fact that recent decades have made accessible an overwhelming number of philosophical works by women, but that the original conflict is still present. The sheer abundance of material is far from being adequately reflected in the curricula of philosophy departments. It therefore raises the question, as many do, of what the best argumentative strategy would be to make such inclusion successful. In doing so, the author references proposals, such as those of Sarah Tyson (2014), to frame the debate in the following way. For the author, the question is whether misogyny is an intrinsic feature of the (Western) philosophical tradition or merely an unfortunate development. That is, whether the response to the integration of women’s texts is corrective or transformative to the dominant model. In doing so, it assumes that both strategies, regardless of the ontological status of the philosophical discipline, promote engagement with women’s work in ways that revolutionise contemporary philosophical practice. In her article “Privacy, Feminism, and Moral Responsibility in the Work of Elizabeth Lane Beardsley”, Julie van Camp looks at the work of an important moral philosopher, Elizabeth Lane Beardsley. The article highlights Beardsley’s philosophical contributions. Using Beardsley as a case study, van Camp points to more general problems in recognizing the work of women philosophers and ensuring their rightful place in our professional dialogue. Van Camp considers sociological and professional factors that may partly explain why the work of women philosophers has not always received the attention it seems to deserve in professional dialogue. The article concludes with suggestions about efforts we can make to address these problems, including the selection of readings for our courses and the sources we consult for our own research and writings, as well as the preservation of records of conferences and other public gatherings that honor women philosophers. (shrink)

With technological possibilities in healthcare steadily increasing, more tools for digital cognitive rehabilitation become available. Acceptance of such technological advances is crucial for successful implementation. Therefore, we examined technology acceptance specifically for this form of rehabilitation in a sample of healthcare providers involved in cognitive rehabilitation. An adjusted version of the Technology Acceptance Model questionnaire was used, including the subscales for perceived usefulness, perceived ease of use, subjective norm, and intention to use, which all contribute to actual use of a (...) specific technology. Results indicate a generally favorable attitude toward the use of digital cognitive rehabilitation and positive responses toward the TAM constructs. Only for subjective norm, a neutral mean response was found, indicating that this could pose a potential obstacle toward implementation. Potential differences between subgroups of different age, gender, and professional background were assessed. Age and gender did not affect the attitude toward digital cognitive rehabilitation. Occupational therapists showed lower scores than healthcare psychologists and physiatrists with regard to perceived usefulness, possibly linked to a difference in operational and managerial tasks. The findings of his study stimulate further implementation of digital cognitive rehabilitation, where the role of subjective norms should be specifically considered. (shrink)

In this article, the pragma-dialectical model of a critical discussion is demonstrated to provide a useful instrument for discovering causes of an unsatisfactory development of problem-solving discussions. First a sketch is given of the development of a problem-solving discussion which, in the opinion of the participants themselves, developed in an unsatisfactory fashion. Then it is argued that this development can be traced back to flaws in the execution of the stages of a critical discussion.

ABSTRACTMajor depressive disorder is a prevalent condition with high relapse rates. There is evidence that cognitive reactivity is an important vulnerability factor for the recurrence of depression. Mindfulness-based interventions are designed to reduce relapse rates, with cognitive reactivity as one of the proposed working mechanisms. In a randomised controlled trial we compared the effect of mindfulness-based cognitive therapy with treatment-as-usual on cognitive reactivity in recurrently depressed patients. Depressive symptoms, cognitive reactivity, and mindfulness skills were assessed pre and post treatment. Patients (...) in the MBCT group reported a significantly greater reduction in cognitive reactivity than those in the TAU group. The reduction of cognitive reactivity appeared to mediate the association between MBCT/TAU and decrease of depressive symptoms, using pre and post scores. The current study provides evidence that MBCT reduces cognitive reactivity and preliminar... (shrink)

Ruth M Jonathan; Two Concepts of Education? A reply to D. J. O’Connor, Journal of Philosophy of Education, Volume 16, Issue 2, 30 May 2006, Pages 147–154, https.

Resumen: El artículo contribuye al esfuerzo colectivo de mostrar que la tutela judicial de los derechos sociales es posible analizando la jurisprudencia reciente del TEDH. Propone la reconstrucción de una teoría unitaria de los derechos y analiza dos de los obstáculos para consolidarla: la diferencia entre las obligaciones que establecen los derechos civiles y los sociales, y la tesis de la justiciabilidad débil. Para contrastarlos, por un lado, se identifican algunos caminos que el TEDH ha elaborado a través de una (...) interpretación creativa del Pacto, y por otro, se descartan otros mecanismos de tutela a la luz de la jurisprudencia reciente. Abstract: This work aims at contributing to the collective effort of demonstrating that protecting social rights is possible under the ECHR. Departing from a unitary theory of rights, it provides evidences about how the ECTHR has recognised the posibility of judicial adjudication of social rights either through new forms of litigation or a creative interpretation of the Convention. Finally, it evaluates the posibilities of protecting social rights through the general prohibition of discrimination by analysing recent case law of the ECTHR. (shrink)

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

Contractualism conceives of firm-stakeholder relations as cooperative schemes for mutual benefit. In essence, contractualism holds that these schemes, as well as the normative principles that guide and constrain them, are ultimately ratified by the consent and endorsement of those subject to them. This paper explores the empirical validity of a contractualist perspective on firm-stakeholder relations. It first develops a typology of firm-stakeholder contracting problems. It subsequently confronts this typology with empirical data collected in an interview study of concrete stakeholder management (...) practices, involving in-depth research interviews with forty-four managers working in the Dutch financial services industry. The findings of this theory-building study suggest that there are limits to the applicability of the contract model in the context of stakeholder management, and that disregarding either the model or its limitations may lead to highly ineffective firm-stakeholder relations. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a “high‐stakes endeavor” that can acutely affect patient (...) care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues?To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician‐gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine. (shrink)