This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC and the (...) reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts. (shrink)

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed. The (...) questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive. (shrink)

Evolutionary psychology is put forward by its defenders as an extension of evolutionary biology, bringing psychology within the integrated causal chain of the hard sciences. It is extolled as a new paradigm for integrating psychology with the rest of science. We argue that such claims misrepresent the methods and explanations of evolutionary biology, and present a distorted view of the consequences that might be drawn from evolutionary biology for views of human nature. General theses about adaptation in biology are empty (...) schemata, not laws of nature allowing the subsumption of mind under biology. Functional thinking is an indispensable tool for psychology, mostly of value in abstractive unification and as a heuristic, but it gains little from association with evolutionary notions of selection. Thus, we argue, the cherished integrative causal model evaporates, and evolutionary phraseology serves no more than rhetorical purposes. Moreover, the universality of human nature and the evolutionary irrelevance of individual variation are presented as biological truths that psychologists should respect in their approach to mind. On closer inspection, this turns out to be rather dubious biology. Psychology might conceivably be better off as a continuation of biology by different means, but evolutionary psychology does not provide the conceptual integration leading to such a happy union. (shrink)

This systematic review aimed to provide an overview of earlier research on the relationships between age conceptualizations and indicators of employability. We have conducted a systematic literature search using PsycINFO, Academic Search Premier, Business Source Complete, CINAHL, ERIC, MEDLINE, and Science Direct. Two raters evaluated the articles and subsequently distinguished k = 41 studies that met the inclusion criteria for this systematic review. Our review revealed that many researchers adopted different operationalizations to measure employability. Moreover, most studies included calendar age (...) as indicator of aging at work, and were based on a cross-sectional design. Based on the Standardized Index of Convergence method, different types of evidence were found for the relationships between age and the employability measures. For relationships between psychosocial age and lifespan age, on the one hand, and employability measures, on the other hand, too few studies were found to draw conclusions. Yet, for relationships between calendar age and labor market-based measures strong consistent negative relationships were found across the studies, and moderately strong positive relationships were found for functional age and labor market- based measures. For organizational age and both competence-based as well as labor market-based measures moderately strong negative relationships were found. We discuss the implications of these results and propose a research agenda for future studies. (shrink)

This article addresses the research question: “How do Dutch highly educated Muslim women of Moroccan descent use prayer in dealing with problems?” The theoretical framework was mainly based on the work of Pargament et al. regarding religious coping. The empirical part of the study consisted of a quantitative and a qualitative part. This article presents results of the quantitative part. For the quantitative part of our research, 177 questionnaires were collected using snowball sampling. We asked respondents about their praying practices (...) and their ways of religious coping, using the Brief RCOPE. The connection and communication in their prayer with a loving, caring, benevolent God is the main religious way in which these Muslim women of Moroccan descent cope with all kinds of problems. This use of prayer as a way of coping can be clarified through the psychological functions of religiosity and prayer that are suggested by Pargament, Koenig, and Perez. Prayer could help them in: finding meaning, being master over their circumstances and controlling their emotions, finding comfort and closeness to God, experiencing intimacy with others and closeness to God, and transforming their way of life. We did find few negative religious coping strategies, such as negative feelings towards God or alienation. This is in line with research results of Abu Raiya and Pargament. As Islam implies surrender to God, it may be difficult for Muslims to admit their religious distress, doubts, and struggles. (shrink)

Group-based emotions have been conceptualised as being rooted in perceivers' social identity. Consistent with this idea, previous research has shown that social identity salience affects group-based emotions, but no research to date has directly examined the role of group-based appraisals in comparison with individual appraisals. In the present studies, we measured group-based appraisals through a thought-listing procedure. In Experiment 1, we explicitly reminded people of their group identity, which led to the predicted change in group-based anger. This effect was mediated (...) by group-based appraisals. In Experiment 2, participants either discussed a group-relevant scenario in small groups or a related topic irrelevant to the group. The group-relevant condition not only led to stronger indignation but the perceived presence of group-based appraisals was also related to participants' reports of indignation. These results provide further evidence for the importance of group-based appraisals as components of group-based emotions. (shrink)

This contribution is a gentle introduction to so-called dynamic epistemic logics, that can describe how agents change their knowledge and beliefs. We start with a concise introduction to epistemic logic, through the example of one, two and finally three players holding cards; and, mainly for the purpose of motivating the dynamics, we also very summarily introduce the concepts of general and common knowledge. We then pay ample attention to the logic of public announcements, wherein agents change their knowledge as the (...) result of public announcements. One crucial topic in that setting is that of unsuccessful updates: formulas that become false when announced. The Moore-sentences that were already extensively discussed at the conception of epistemic logic in Hintikka’s ‘Knowledge and Belief’ give rise to such unsuccessful updates. After that, we present a few examples of more complex epistemic updates. Our closing observations are on recent developments that link the ‘standard’ topic of belief revision, as in ‘On the Logic of Theory Change: partial meet contraction and revision functions’, by Alchourron et al. , to the dynamic epistemic logics introduced here. (shrink)

Results of two survey studies are presented. It is shown that attitudes of the public about "technology in general" are not stable and can easily be affected by how the subject is introduced. Eight areas of technology are compared on the basis of empirical relations in attitudinal judgments, in attribute ratings, in self- assigned importance weights of attributes, and in importance of reference groups and persons. On the basis of similarities in these four kinds of judgments, three clusters of technology (...) areas were identified: a cluster of modern reproductive technologies, an information cluster containing automation, computer, and communication technologies, and a cluster containing nuclear energy and military technology. The attitude toward "technology in general" can not be considered as an aggregation of attitudes toward these areas of technology: The relations between general attitude and specific attitudes are only moderate to negligible. (shrink)

Inleiding vanuit historisch perspectief tot de rechtsfilosofie.

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)

Thanks to the exchange of arguments, groups outperform individuals on some tasks, such as solving logical problems. However, these results stem from experiments conducted among Westerners and they could be due to cultural particularities such as tolerance of contradiction and approval of public debate. Other cultures, collectivistic cultures in particular, are said to frown on argumentation. Moreover, some influential intellectual movements, such as Confucianism, disapprove of argumentation. In two experiments, the hypothesis that Easterners might not share the benefits of argumentation (...) was tested. In Experiment 1, Japanese participants had to solve a standard logical problem individually and then in groups. They performed significantly better in groups. In Experiment 2, Japanese participants had to estimate the weight of various animals. They did so individually, then after learning of another participant's estimates, then after discussing these estimates with the other participant, and then indi.. (shrink)

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

We identify two aspects of the problem of maintaining perceptual stability despite an observer's eye movements. The first, visual direction constancy, is the (egocentric) stability of apparent positions of objects in the visual world relative to the perceiver. The second, visual position constancy, is the (exocentric) stability of positions of objects relative to each other. We analyze the constancy of visual direction despite saccadic eye movements.Three information sources have been proposed to enable the visual system to achieve stability: the structure (...) of the visual field, proprioceptive inflow, and a copy of neural efference or outflow to the extraocular muscles. None of these sources by itself provides adequate information to achieve visual direction constancy; present evidence indicates that all three are used.Our final question concerns how information processing operations result in a stable world. The three traditionally suggested means have been elimination, translation, or evaluation. All are rejected. From a review of the physiological and psychological evidence we conclude that no subtraction, compensation, or evaluation need take place. The problem for which these solutions were developed turns out to be a false one. We propose a “calibration” solution: correct spatiotopic positions are calculated anew for each fixation. Inflow, outflow, and retinal sources are used in this calculation: saccadic suppression of displacement bridges the errors between these sources and the actual extent of movement. (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)

Colour has been shown to facilitate the recognition of scene images, but only when these images contain natural scenes, for which colour is ‘diagnostic’. Here we investigate whether colour can also facilitate memory for scene images, and whether this would hold for natural scenes in particular. In the first experiment participants first studied a set of colour and greyscale natural and man-made scene images. Next, the same images were presented, randomly mixed with a different set. Participants were asked to indicate (...) whether they had seen the images during the study phase. Surprisingly, performance was better for greyscale than for coloured images, and this difference is due to the higher false alarm rate for both natural and man-made coloured scenes. We hypothesized that this increase in false alarm rate was due to a shift from scrutinizing details of the image to recognition of the gist of the image. A second experiment, utilizing images without a nameable gist, confirmed this hypothesis as participants now performed equally on greyscale and coloured images. In the final experiment we specifically targeted the more detail-based perception and recognition for greyscale images versus the more gist-based perception and recognition for coloured images with a change detection paradigm. The results show that changes to images are detected faster when image-pairs were presented in greyscale than in colour. This counterintuitive result held for both natural and man-made scenes and thus corroborates the shift from more detailed processing of images in greyscale to more gist-based processing of coloured images. (shrink)