Surveys carried out among palliative care physicians have shown that most participants do not support euthanasia and assisted suicide. Belgium, however, is one of the few countries in the world in which voluntary euthanasia is allowed by law. The potential influence of this legal dimension thus warranted a study of the attitudes of Belgian palliative care physicians toward euthanasia and assisted suicide. To this end, an anonymous self-administered questionnaire in Dutch was sent to all physicians working in Flemish palliative care. (...) 99 physicians responded .A majority of the physicians who responded are of the opinion that voluntary euthanasia can be ethically justified . Most physicians believe, nonetheless, that non-voluntary euthanasia is always unethical . More than three quarters of the respondents favour the inclusion of a ‘palliative filter’ in the law on euthanasia. Using a traditional cluster algorithm, the following three clusters were obtained: staunch advocates of euthanasia , opponents of euthanasia , and an intermediate group . There were no significant differences between the clusters on the level of gender, age, and years of experience in palliative care. A statistically significant association exists, however, between the euthanasia clusters and the religious or ideological clusters we had obtained in an earlier study. Church attending respondents are least likely to be staunch advocates of euthanasia. The majority of the physicians favour legalisation on assisted suicide. There is no significant association between the euthanasia clusters and attitudes toward assisted suicide.We conclude that although most Flemish palliative care physicians agree that there may be circumstances in which a euthanasia request is justified, they also strongly believe in the effects of good palliative care and want the ‘palliative filter’ to be included in the law on euthanasia. Religion and worldview are an important factor determining attitudes towards euthanasia. (shrink)

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses’ attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n = 415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated patient and considered it generally better (...) not to administer artificial floods or fluids to such a patient. Two clusters were found: 58.5% belonged to the cluster of advocates of deep and continuous sedation and 41.5% belonged to the cluster of nurses restricting the application of deep and continuous sedation. These differences notwithstanding, overall the attitudes of the nurses are in accordance with the practice and policy of palliative sedation in Flemish palliative-care units. (shrink)

The article puts into question the idea that the nucleus of religion - the God-talk - is peaceful , whereas all aggression should be located on the side of humankind, through differentiating a conceptual model of relating war to the concept of God in the Jewish-Christian tradition. He urges a more complex model of connecting God to issues of war and peace.

Life-science phenomena are often explained by specifying the mechanisms that bring them about. The new mechanistic philosophers have done much to substantiate this claim and to provide us with a better understanding of what mechanisms are and how they explain. Although there is disagreement among current mechanists on various issues, they share a common core position and a seeming commitment to some form of scientific realism. But is such a commitment necessary? Is it the best way to go about mechanistic (...) explanation? In this article, we propose an alternative antirealist account that also fits explanatory practice in the life sciences. We pay special attention to mechanistic models, i.e. scientific models that involve a mechanism, and to the role of coherence considerations in building such models. To illustrate our points, we consider the mechanism for the action potential. 1 Introduction2 Some Core Features of Mechanistic Explanation3 Scientific Realism and Mechanistic Explanation4 Antirealist Mechanistic Explanation: The Case of the Action Potential5 Some Outstanding Issues for the Antirealist Mechanist6 Two Problems for the Realist Mechanist7 Conclusions. (shrink)

Background Clients are invited to play a role in decisions about their care. Collaborative deliberation comprises constructive engagement, recognition of alternative actions, comparative learning, construction and elicitation of preferences and preference integration. Collaborative deliberation between clients and professionals is a process that requires an interest in each other, sharing of views on alternatives and preferences and integrating into decisions. The aim is to gain insight into collaborative deliberation in consultations and the clients’ perception of arranging long-term care. Design A descriptive (...) qualitative study to explore collaborative deliberation in consultations between clients and professionals. Six organisations providing long-term care were included. Data collection of nine clients involved observations of consultation with field notes and audio-records, interviews with clients and professionals shortly and 3–6 months after the consultation and questionnaires to collect background information. The data were analysed by deductive content analysis. Findings Constructive engagement was visible in all consultations. Clients and professionals showed respect, empathy and curiosity towards each other. In most consultations, two or more alternative actions are recognised and discussed. Comparative learning appears to be two sided, the client and the professional learn from each other's knowledge and experiences. Construction and elicitation of preference, and preference integration, seems to be present, but difficult to recognise in all consultations. Discussion/conclusion Although all propositions could be identified, there seems room for improvement in preference elicitation and integration of these preferences in the discussions on courses of action. Assistance seems needed with preference elicitation, both for the clients and for the professional. (shrink)

Involving patients in decisions on primary prevention can be questioned from an ethical perspective, due to a tension between health promotion activities and patient autonomy. A nurse-led intervention for prevention of cardiovascular diseases, including counselling (risk communication, and elements of shared decision-making and motivational interviewing) and supportive tools such as a decision aid, was implemented in primary care. The aim of this study was to evaluate the nurse-led intervention from an ethical perspective by exploring in detail the experiences of patients (...) with the intervention, and their views on the role of both the nurse and patient. The study had a qualitative design. 18 patients who had received the intervention participated. Data were gathered by in-depth interviews. The interviews were analysed using directed content analysis. The findings revealed that patients perceived the consultations not as an infringement on their autonomy, but as supportive to risk reduction efforts they tried but found hard to realise. They specifically emphasised the role of the nurse, and appreciated the nurse's realistic advice, encouragement, and help in understanding. Patients' views on and experiences with risk management are in line with notions of relational autonomy, caring cooperation and communicative action found in the literature. We conclude that patients define the relationship with the nurse as shared work in the process of developing a healthier lifestyle. (shrink)

‘Waar blijven de intellectuelen?’ vroeg Balkenende in het najaar van 2006 . Waar blijven die maatschappelijke wetenschappers die eens in de zoveel jaar met een nieuw boek komen dat Nederland een Spiegel voorhoudt en aan het Denken zet? Een doorwrocht wetenschappelijk, maar toch uitstekend leesbaar boek dat de opiniepagina's wekenlang beheerst en ons zelfbegrip voor altijd verandert. Waar blijven de nieuwe Bram de Swaan, Trudy Dehue, Cees Schuyt, Hans Achterhuis, Christien Brinkgreve, Anton Zijderveld of Lolle Nauta? Wie gaat ons waarschuwen (...) voor de gevaren van utopieën of protoprofessionalisering of ons aansporen tot kleine deugden ? (shrink)

Meta-arguments are arguments about one or more arguments, or argumentation in general. They contrast to ground-level arguments, which are about natural phenomena, historical events, human actions, abstract entities, etc. Although meta-arguments are common in all areas of human cognitive practice, and although implicit studies of them are found in many works, and although a few explicit scholarly contributions exist, meta-argumentation has never been examined explicitly, directly, and systematically in book-length treatment. This lacuna is especially unfortunate because such treatment can offer (...) not only an understanding of a special class of arguments, but also a promising way of doing logic and argumentation theory. This is the first book that attempts a systematic treatment of meta-arguments, providing both an illustration of the meta-argumentational approach to logical theory, and an analysis of an especially rich collection of meta-arguments. First, it elaborates an empirical methodology derived partly from a critical appreciation of Stephen Toulmin's applied-logic approach, and partly from a novel application of the author's historical-textual approach. Then it examines theoretical meta-arguments, by such scholars as Tony Blair, Robert Fogelin, Alvin Goldman, Trudy Govier, David Hitchcock, Ralph Johnson, Henry Johnstone, Erik Krabbe, Frans van Eemeren, Carl Wellman, and John Woods, on such topics as defining argument, methods of criticism, deep disagreements, and conductive or pro-and-con arguments. Thirdly, it studies famous meta-arguments by such classics as John Stuart Mill, David Hume, and Galileo Galilei, on such topics as freedom of discussion, women's liberation, the existence of God and intelligent design, and the motion of the earth. (shrink)

Dantis, Trudy As a 'definite community of Christian faithful', every parish is called to embody the presence of the church in the wider community. It does this by being a place of living communion and participation that is wholly mission-oriented, an environment conducive to hearing God's word and growing in the Christian life, and one that is engaged in dialogue, proclamation, outreach, worship and celebration. In doing so, a parish becomes 'salt' and 'light' for the community it is located in. (...) Parish vitality can therefore be likened to the 'saltiness' or 'luminosity' of a parish community. It is imperative for every parish community to grow in health and strength if it is to be an effective source of evangelisation and an authentic witness of the Gospel. As Wittberg notes, 'To the extent that their communal "salt" loses its flavor, parishes - are worse than irrelevant, because they no longer image God'. (shrink)

We are pleased to publish this WSIA edition of Trudy’s Govier’s seminal volume, Problems in Argument Analysis and Evaluation. Originally published in 1987 by Foris Publications, this was a pioneering work that played a major role in establishing argumentation theory as a discipline. Today, it is as relevant to the field as when it first appeared, with discussions of questions and issues that remain central to the study of argument. It has defined the main approaches to many of those issues (...) and guided the ways in which we might respond to them. From this foundation, it sets the stage for further investigations and emerging research. This is a second edition of the book that is corrected and updated by the author, with new prefaces to each chapter. (shrink)

The purpose of this paper is to explore how nurses are enrolled into and take part in programmes of efficiency and effectiveness. Using the philosophical theorizing about desire as a force or power, I focus specifically on what is understood as relations between desire and productivity in current Westernized health‐care systems. Use is made of the idea from Spinoza that human emotions consist only of pleasure, pain, and desire as these act as a motive force. This is then linked with (...) more contemporary work on the politics and discourses of desire. A report on the implementation of a productivity programme in the United Kingdom, The Productive Ward: Releasing time to care™, is explored for the ways its developers set about motivating nurses to endorse and enact the programme. In exploring the mechanics of desire in these processes, a view of desire as productive is promoted. Looking at desire as assembling actions, and an assemblage, moves the analysis to an interrogation of actions and practices used to enable and bring nurses to the process. Moreover, in working through the various modalities and operations of desire, the potential and limits of such projects are abstracted. Such potentials and limits are necessarily set by the intensification of power and desire in the capitalist economy, saturating areas of nursing, and health‐care provision. (shrink)

The book also comes with an exhaustive array of study aids that enable the reader to monitor and enhance the learning process.

In this paper we engage in a conversation speaking from three different perspectives and discuss the ways literature and our personal life experiences can inform policy and practice in relation to the concepts of well-being, education, and culture. We gathered around a metaphorical kitchen table, bringing to it our life experiences, as well as the literature that informed our individual research programs (positive psychology, Indigenous world view, and narrative inquiry) and we began to unpack the questions: “What role does culture (...) play in understanding and educating for well-being and why should an education system be concerned about it?”. (shrink)

In 1995, the Dutch Minister of Health proposed that a randomized clinical trial (RCT) with heroin-maintenance for severe abusers be conducted. It took nearly four years of lengthy debates before the Dutch Parliament consented to the plan. Apart from the idea of prescribing heroin, the minister and her scientific advisers had to defend the quite high material and non-material costs that would arise from employing the randomized controlled design. They argued that the RCT represented the truly scientific approach and was (...) the royal way to unambiguous results. In the present article, I question this common dual justification of RCTs. First, I situate the historical origins and the basic assumptions of the ideal experiment in 20th-century economic liberalism. Secondly, using the Dutch heroin experiment as an example, I discuss human-science experimentation as an attempt to create reality rather than merely record it. Finally, I discuss some surprising responses by heroin users. These responses display the assumptions of RCTs discussed in the historical section, and underline the importance of the culture of heroin use. In the epilogue, I suggest that cultural aspects of heroin consumption can best be studied by thorough ethnographic research. (shrink)

An aim of all of the management of healthcare systems is the smooth provision of services. A great deal of effort is put into ensuring processes will obtain this ideal – the well‐run system. The central argument in this paper is that these processes result in a system that perpetrates violence and coercion on its clients and workers. This violence is structural and personalizing in its effects. Moreover, time and effort is taken away from the actual work of the system (...) for its management. Under such managerialist control, the idea of chaos and the need to ensure order are used to fuel an apparatus that takes the focus from other aspects of the system such as the power relations that keep the system as it is. In such an ordering, the clinical audit is promoted as a method to ensure order by keeping ahead of, or removing the potential for chaos. In using Žižek's ideas about violence it is possible to identify how efforts and attempts to correct the system are doomed to fail just as they hide how nurses' enrolment in the service of the system leads to alienation and subjectification. A central aim of this paper is to rethink how power and implicit violence are practised in such processes. To overcome the inherent violence of the audit culture, this paper suggests an interruption of audit cultures with a promotion of more radical positions for nursing practice and clinically based research. The hope is to recalculate and interrupt how nurses are to operate in the management structures that organize healthcare. (shrink)

It is rare to find honest accounts of the difficulties and dilemmas encountered when conducting sensitive research with vulnerable research populations. This account explores some of the ethical issues raised by a qualitative interview study with lesbians and gay men about their experiences of nursing care. There is tension between the moral duty to conduct research with vulnerable and stigmatized groups in order to improve care, and the inevitable lack of resources that go with such a venture. This increases the (...) risk of harm during the process of research. The risk of harm to both the researchers and the researched is explored and the need for a support structure for both groups is raised. There is a pressing need to develop further understanding about the ways in which the dissemination of research can potentially harm already vulnerable research populations. (shrink)

Cerebral Visual Impairment is an umbrella term which includes abnormalities in visual acuity, or contrast sensitivity or colour; ocular motility; visual field and the conscious and unconscious filtering or processing of visual input. Children with CVI have specific needs and problems relating to their development from infancy to adulthood which can impact on their wellbeing. Recent research indicates the complexities of living with CVI but there remains limited information of the full impact of CVI on families’ everyday lives. The qualitative (...) interviews reported here explored families’ experiences to discover the impact of CVI on all aspects of everyday life. Parents and children were invited to participate in semi-structured interviews, either face to face, by phone or video call between January 2018 and February 2019. Topics covered everyday practicalities of living with CVI, focusing on challenges and what worked well at school and home. Interviews were audio-recorded and subject to thematic analysis to look for patterns across the data. Twenty families took part in interviews, with eight children/young people within those families contributing interviews of their own. Four themes were developed from the interviews: Assessment and understanding implications of CVI, Education, Family life, Psychological wellbeing and quality of life. The interviews provide valuable insights into the impact of living with CVI and highlight the need for more awareness of the condition among professionals in both health and education settings. (shrink)