This article reports on a survey of the moral problems that Dutch nurses experience during their everyday practice. A questionnaire was developed, based on published literature, panel discussions, in-depth interviews and participation observations. The instrument was tested in a pilot study and proved to be useful. A total of 2122 questionnaires were sent to 91 institutions in seven different health care settings. The results showed that nurses were not experiencing important societal issues such as abortion and euthanasia as morally the (...) most problematic, but rather situations such as verbally aggressive behaviour of colleagues towards patients, keeping silent about errors, and medical treatment given against the wishes of patients. Moral problems occurred especially when nurses experienced feelings of powerlessness with regard to the well-being of patients. Moreover, these moral problems proved to be related to institutional organization, leadership, and collaboration with colleagues and other disciplines. Nurses appeared to have a limited awareness of the moral dimensions of their practice. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half (...) of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% were suitable for analysis. The results show that in about half of (...) the cases nurses were involved in the decision making by the physician and that nurses were frequently involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

Background: Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes.Aim: This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. The findings for hospitals, (...) home care and nursing homes are described and compared.Method: A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%.Results: In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals and nursing homes and less frequently in home care situations . In some cases , nurses administered the euthanatics.Conclusions: The results show substantial differences between the intramural sector and the extramural sector , which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians. (shrink)

Hereditary structural completeness is established for a range of substructural logics, mainly without the weakening rule, including fragments of various relevant or many-valued logics. Also, structural completeness is disproved for a range of systems, settling some previously open questions.

This article reports on a survey of the moral problems that Dutch nurses experience during their everyday practice. A questionnaire was developed, based on published literature, panel discussions, in-depth interviews and participation observations. The instrument was tested in a pilot study and proved to be useful. A total of 2122 questionnaires were sent to 91 institutions in seven different health care settings. The results showed that nurses were not experiencing important societal issues such as abortion and euthanasia as morally the (...) most problematic, but rather situations such as verbally aggressive behaviour of colleagues towards patients, keeping silent about errors, and medical treatment given against the wishes of patients. Moral problems occurred especially when nurses experienced feelings of powerlessness with regard to the well-being of patients. Moreover, these moral problems proved to be related to institutional organization, leadership, and collaboration with colleagues and other disciplines. Nurses appeared to have a limited awareness of the moral dimensions of their practice. (shrink)

OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case (...) characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

This paper investigates connectionism's potential to solve the frame problem. The frame problem arises in the context of modelling the human ability to see the relevant consequences of events in a situation. It has been claimed to be unsolvable for classical cognitive science, but easily manageable for connectionism. We will focus on a representational approach to the frame problem which advocates the use of intrinsic representations. We argue that although connectionism's distributed representations may look promising from this perspective, doubts can (...) be raised about the potential of distributed representations to allow large amounts of complexly structured information to be adequately encoded and processed. It is questionable whether connectionist models that are claimed to effectively represent structured information can be scaled up to a realistic extent. We conclude that the frame problem provides a difficulty to connectionism that is no less serious than the obstacle it constitutes for classical cognitive science. (shrink)

Recent accounts on the global workspace theory suggest that consciousness involves transient formations of functional connections in thalamo-cortico-cortical networks. The level of connectivity in these networks is argued to determine the state of consciousness. Emotions are suggested to play a role in shaping consciousness, but their involvement in the global workspace theory remains elusive. In the present study, the role of emotion in the neural workspace theory of consciousness was scrutinized by investigating, whether unconscious and conscious display of emotional compared (...) to neutral facial expressions would differentially modulate EEG coherence. EEG coherence was measured by means of computing an average EEG coherence value between the frontal, parietal, and midline scalp sites. Objective awareness checks evidenced that conscious identification of the masked facial expressions was precluded. Analyses revealed reductions in EEG coherence in the lower frequency range for the masked as compared to unmasked neutral facial expressions. Crucially, a decline in EEG coherence was not observed for the emotional facial expressions. In other words, the level of EEG coherence did apparently vary as a function of awareness, but not when emotion was involved. The current finding suggests that EEG coherence is modulated by unconscious emotional processes, which extends common views on the global workspace architecture of consciousness. (shrink)

The book is an “introductory” reconstruction of Davidson on interpretation —a claim to be taken with a grain of salt. Writing introductory books has become an idol of the tribe. This is a concise book and reflects much study. It has many virtues along with some flaws. Ramberg assembles themes and puzzles from Davidson into a more or less coherent viewpoint. A special virtue is the innovative treatment of incommensurability and of the relation of Davidson’s work to hermeneutic themes. The (...) weakness comes in a certain unevenness. While generally convincing and well written, the book has low points which may leave the reader confused or unconvinced. Davidson is the hero in this book, and our hero is sometimes over idealized. (shrink)

The term "stakeholder engagement" has gained increasing prominence over the last few years. This prominence is fueled by a range of issues such as an increased dissatisfaction with business's focus on stockholder/shareholder interests and the demands for greater transparency from business following major business scandals. A perceived response to this issue in South Africa has been the inclusion of guidelines on stakeholder engagement in the King II Report on Corporate Governance. Despite this growing interest, there has not been clarity on (...) how companies engage with their stakeholders and specifically with how they identify and prioritize their stakeholders. The study sought to establish the reporting practices of South African business in relation to stakeholder identification and prioritization through a content analysis of their annual reports. The findings are discussed and recommendations on the two aspects of stakeholder engagement presented. (shrink)

Transcranial magnetic stimulation (TMS) is a method capable of transiently modulating neural excitability. Depending on the stimulation parameters information processing in the brain can be either enhanced or disrupted. This way the contribution of different brain areas involved in mental processes can be studied, allowing a functional decomposition of cognitive behavior both in the temporal and spatial domain, hence providing a functional resolution of brain/mind processes. The aim of the present paper is to argue that TMS with its ability to (...) draw causal inferences on function and its neural representations is a valuable neurophysiological tool for investigating the causal basis of neuronal functions and can provide substantive insight into the modern interdisciplinary and (anti)reductionist neurophilosophical debates concerning the relationships between brain functions and mental abilities. Thus, TMS can serve as a heuristic method for resolving causal issues in an arena where only correlative tools have traditionally been available. (shrink)

On the basis of ethnographic and historical material this article makes a comparative analysis of the relationship between public events, ceremonies and academic rituals, institutional identity, and processes of transition and power at two universities, one in Mexico and the other in South Africa. The public events examined here play a major role in imagining and bringing about political shifts within universities as well as between universities and external actors. It shows how decisive local histories and constituencies are in mediating (...) and transfiguring identity projects initiated from above. (shrink)

Behrendt & Young (B&Y) propose an explanation for schizophrenia in terms of a cortical default in the interaction between consciousness and cognition. However, schizophrenia more likely involves miscommunication between subcortical and cortical affective circuits in the brain, a default in the interaction between consciousness and emotion. The typical “affective” nature of hallucinations in schizophrenia provides compelling evidence for subcortical involvement.

This study addresses two questions: (1) what visions of nature do lay people subscribe to? (2) to what extent do these visions reflect those of professional philosophers? Four philosophical images of the human-nature relationship were discussed with respondents; Master, Steward, Partner and Participant. Respondents recognise these images, but prefer to construct their own. Elements of their images are (1) that humans are part of nature, but (2) that they are responsible for nature as well. This study indicates that empirical philosophy (...) can contribute to the further development of environmental philosophy. Through an empirical turn we can discover people's own voice. (shrink)

What role do nurses play in euthanasia? How do they experience this role and what should be their ideal role? These are the questions of a study undertaken to gain insight into the role of nurses in euthanasia. Answers to these questions were derived from 20 semistructured in-depth interviews with nurses employed in a Dutch hospital. To make clear the role of nurses in euthanasia, the issue was split up into four phases: observation of a request for euthanasia; decision making; (...) carrying out of the request; and after-care. This article is a brief report on the most important results regarding these four phases. Special attention will be paid to nurses who have conscientious objections. To evaluate the study results, an unambiguous interpretation of the concept of ‘euthanasia’ is of most importance. For that reason, Dutch laws and other regulations concerning euthanasia will be explained. (shrink)