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)

BackgroundA patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suffering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ. Organ donation after euthanasia is a so-called donation after circulatory death (DCD), (...) Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no-touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital. Case presentationThis article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.ConclusionsOrgan donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital. (shrink)

In this article, we want to reply to the recent article by Buturovic, to be able to correct some statements and allegations about this combined procedure. Organ donation after euthanasia is an extremely difficult procedure from an ethical point of view. On the one hand, we see a suffering patient who wants to die but who also wants to make an altruistic effort to donate his organs. On the other hand, we visualise a patient in need of an organ but (...) who is wary of the fact that someone else needs to die in order to potentially receive a transplant organ. Healthcare professionals seem to walk a tightrope when balancing between the interests of the patients at these two extremes: while facilitating the dying patient’s last wish on the one hand and abiding by all regulations regarding donation and transplantation on the other. Yet, these physicians, nurses and transplant coordinators do their utmost best to keep a strict line between euthanasia and organ donation, to avoid any external pressure on the patient, and to respect his autonomy. They really make an utmost attempt to make the process bearable for the donating patient. However, undeniably the patient who is about to undergo organ donation after euthanasia is nevertheless confronted with dozens of feelings and thoughts. However, this does not imply that procedural safeguards are failing to disentangle organ donation from euthanasia. (shrink)

We would like to respond to the comment we received from our colleagues on our case report about organ donation after euthanasia starting at home. We reply to their statements on medical and legal aspects, and provide more information on our view of informed consent.

In language evolution research, the use of computational and experimental methods to investigate the emergence of structure in language is exploding. In this review, we look exclusively at work exploring the emergence of structure in speech, on both a categorical level, and a combinatorial level. We show that computational and experimental methods for investigating population-level processes can be effectively used to explore and measure the effects of learning, communication and transmission on the emergence of structure in speech. We also look (...) at work on child language acquisition as a tool for generating and validating hypotheses for the emergence of speech categories. Further, we review the effects of noise, iconicity and production effects. (shrink)

The aim of this review is to show the fruitfulness of using images of facial expressions as experimental stimuli in order to study how neural systems support biologically relevant learning as it relates to social interactions. Here we consider facial expressions as naturally conditioned stimuli which, when presented in experimental paradigms, evoke activation in amygdala–prefrontal neural circuits that serve to decipher the predictive meaning of the expressions. Facial expressions offer a relatively innocuous strategy with which to investigate these normal variations (...) in affective information processing, as well as the promise of elucidating what role the aberrance of such processing might play in emotional disorders. (shrink)

The objective of Working Group 4 of the COST Action NET4Age-Friendly is to examine existing policies, advocacy, and funding opportunities and to build up relations with policy makers and funding organisations. Also, to synthesize and improve existing knowledge and models to develop from effective business and evaluation models, as well as to guarantee quality and education, proper dissemination and ensure the future of the Action. The Working Group further aims to enable capacity building to improve interdisciplinary participation, to promote knowledge (...) exchange and to foster a cross-European interdisciplinary research capacity, to improve cooperation and co-creation with cross-sectors stakeholders and to introduce and educate students SHAFE implementation and sustainability. To enable the achievement of the objectives of Working Group 4, the Leader of the Working Group, the Chair and Vice-Chair, in close cooperation with the Science Communication Coordinator, developed a template to map the current state of SHAFE policies, funding opportunities and networking in the COST member countries of the Action. On invitation, the Working Group lead received contributions from 37 countries, in a total of 85 Action members. The contributions provide an overview of the diversity of SHAFE policies and opportunities in Europe and beyond. These were not edited or revised and are a result of the main areas of expertise and knowledge of the contributors; thus, gaps in areas or content are possible and these shall be further explored in the following works and reports of this WG. But this preliminary mapping is of huge importance to proceed with the WG activities. In the following chapters, an introduction on the need of SHAFE policies is presented, followed by a summary of the main approaches to be pursued for the next period of work. The deliverable finishes with the opportunities of capacity building, networking and funding that will be relevant to undertake within the frame of Working Group 4 and the total COST Action. The total of country contributions is presented in the annex of this deliverable. (shrink)

The current study investigates whether self-talk phrases can influence behavior in Ultimatum Games. In our three self-talk treatments, participants were instructed to tell themselves (i) to keep their own interests in mind, (ii) to also think of the other person, or (iii) to take some time to contemplate their decision. We investigate how such so-called experimenter-determined strategic self-talk phrases affect behavior and emotions in comparison to a control treatment without instructed self-talk. The results demonstrate that other-focused self-talk can nudge proposers (...) towards fair behavior, as offers were higher in this group than in the other conditions. For responders, self-talk tended to increase acceptance rates of unfair offers as compared to the condition without self-talk. This effect is significant for both other-focused and contemplation-inducing self-talk but not for self-focused self-talk. In the self-focused condition, responders were most dissatisfied with unfair offers. These findings suggest that use of self-talk can increase acceptance rates in responders, and that focusing on personal interests can undermine this effect as it negatively impacts the responders’ emotional experience. In sum, our study shows that strategic self-talk interventions can be used to affect behavior in bargaining situations. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

In his original metabletic research on the nature of neurosis. Van den Berg revealed how, towards the 19th century, the increasingly complex and dividing nature of Western society led to the emergence of neurosis as a form of divided existence. By the mid 20th century, the manifestations of neurosis itself changed from a crystalized disorder to vague neurotic disturbances which Van den Berg related to the societal disorder, incoherence and instability which followed the second world war. He identified a series (...) of neuroticizing factors at the time including the ambivalence of society, the increased mobility, a changed sense of time, the disappearance of small groups, the weakening of family ties and the fear of death. In our postmodern world today, the nature of neurosis has changed once again and awaits a new metabletic investigation to reveal its nature and its particular manifestations. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Antimicrobial resistance is one of the greatest public health crises of our time. The natural biological process that causes microbes to become resistant to antimicrobial drugs presents a complex social challenge requiring more effective and sustainable management of the global antimicrobial commons—the common pool of effective antimicrobials. This special issue of Health Care Analysis explores the potential of two legal approaches—one long-term and one short-term—for managing the antimicrobial commons. The first article explores the lessons for antimicrobial resistance that can be (...) learned from recent climate change agreements, and the second article explores how existing international laws can be adapted to better support global action in the short-term. (shrink)

Our think tank tasked by the Dutch Health Council, consisting of Radboud University Nijmegen Honours Academy students with various backgrounds, investigated the implications of Deep Brain Stimulation for psychiatric patients. During this investigation, a number of methodological, ethical and societal difficulties were identified. We consider these difficulties to be a reflection of a still fragmented field of research that can be overcome with improved organization and communication. To this effect, we suggest that it would be useful to found a centralized (...) DBS organization. Such an organization makes it possible to 1) set up and maintain a repository, 2) facilitate DBS studies with a larger sample size, 3) improve communication amongst researchers, clinicians and ethical committees, and 4) improve communication between DBS experts and the public at large. (shrink)

This discussion centers on two desiderata: the role of measurement in information-gathering and physical interaction in scientific practice. By taking inspiration from van Fraassen’s view, we present a methodological account of perspectival measurement that addresses empirical practice where there is complex intervention, disagreeing results, and limited theory. The specific aim of our account is to provide a methodological prescription for developing measurement processes in the context of limited theory. The account should be useful to philosophers of science, who are interested (...) in the intersection between representation and intervention; scientists, who are interested in methodological suggestions for theory-development and reliability; and interdisciplinary researchers, who are interested in the intersections between the pandemic, built environments, and social processes. We apply the process-view of measurement to COVID-19, specifically, measuring replication in the SARS-CoV-2 virus. The aim is to show that our account tracks key elements—manipulation/intervention, independence, invariance, and theory-development—by organizing unfolding measurement processes. Additionally, we use our account to make prescriptive suggestions for measurement practice in the COVID-19 context by discussing the need to broaden measurement perspective on interaction, manipulation, and production. (shrink)

Superfluous People describes Hannah Arendt's political and philosophical views on Nazi totalitarianism and the Shoah. In her contemplation of evil, Arendt initially spoke of the Shoah as a "radical evil," a term used by Kant. However, unlike Kant, Arendt's radical evil cannot be explained by human motives. Many years later she changed her mind and spoke of "the banality of evil," characterized by an inability to think and judge. Superfluous People seriously considers the question of whether thinking and judging (...) can prevent evil. (shrink)

To what extent can politics be part of education? Recent incidents indicate how educational activities aimed at raising political awareness are perceived by some as forms of ‘indoctrination’. This article explores, firstly, how philosophical perspectives might help us understand the notion of indoctrination in education. Drawing on the work of Hannah Arendt and Michael Hand, two notions of ‘indoctrination’ are discussed and subsequently problematized in light of classroom practices. Expanding our perspective to the larger historical context of reflections on (...) education and democracy, we then show how the dilemma of indoctrination should be understood as part of a tradition in pedagogical thinking that emphasizes the complex dynamics of socialization and critical thinking in education. Finally, we argue that from a pedagogical perspective, the issue is not whether or not certain educational activities might be forms of indoctrination, but to what extent these activities provide students an opportunity for both socialization and critical inquiry. (shrink)

This article offers an interpretation of theories of management and organisation from the perspective of Hannah Arendt’s theory of free action. This endeavour will contribute to criticism and eventually improvement of the conceptual framework of management and organisation theory. We discuss conceptual tensions in this field, for instance with respect to the relationship between human action and the constraints of an organisation. To the extent that management and organisation theory are practiceoriented, such an analysis can help to understand tensions (...) and ambiguities in practice. Some of the optimism and high hopes found in the literature may have to be tempered as a consequence of a more adequate analysis of free action. The analysis therefore provides a critical point of view on the problems of managing freely acting people. (shrink)

ABSTRACTTaking its cue from Hannah Arendt’s comment that ‘truth gets lost in the Enlightenment’ and Lessing’s parable of God’s ‘left hand’, this paper traces a historical shift in moral and religious thought: roughly from truth to sincerity. From traditional conceptions of conscience as conditional on the objective truth of its content, the paper moves on, via the Reformation and seventeenth-century Augustinian turn, to early modern debates on toleration and the ‘erring conscience’. It is argued that Pierre Bayle’s Commentaire Philosophique (...) of 1686 can be read as a crucial catalogue for understanding the substitution of truth with sincerity : so that not truth but truthfulness is considered to be essential for moral and religious justification. Moving from Bayle to Immanuel Kant, the paper then shows how many of the same questions rise in Kant’s late essay on theodicy, which is also an essay on sincerity or integrity, via the Book of Job. Through these two thinkers, various themes are connected: from conscience and sincerity to the problem of the conscientious persecutor. Finally, these themes of truth, error and integrity are linked to the modern debate on authenticity, and a framework is proposed for conceptualising these various shifts. (shrink)

Though the Christian faith has in recent years increasingly shown itself to be a truly African religion, a variety of African authors such as Kä Mana, George Kinoti, Hannah Kinoti, August Shutte and Efoé Julien Penoukou have noted that sub-Saharan Africa is facing a moral crisis. This article explores this crisis in as far as it is caused by difficulties in the reception of the Christian ethic by African Christian communities. It points out that this crisis is visible in (...) double morality, immorality and legalism. It shows that it is both caused by rapid social change in contemporary Africa and by the way the Christian ethic was introduced with a lack of attention for the relationship between worldview and ethics, the social impact of changing cultural practices and the importance of virtue ethics. In this way it also points to the shape Christian moral education for present-day Africa should take. (shrink)

This paper turns to Hannah Arendt’s brief, poignant remarks about the advent of a biotechnological revolution as a starting point for a renewed reflection on her concept of natality. By expanding on Arendt's significant, but often overlooked, reference to the work of the German anthropologist Arnold Gehlen, it will be argued that that natality is a concept that subverts any rigid opposition between zoe and bios, biological birth and politico-linguistic birth. Consequently, it will be shown that Jürgen Habermas and (...) Michael Sandel are mistaken to appeal to the concept of natality in their arguments against genetic enhancement. (shrink)

This article offers an interpretation of theories of management and organisation from the perspective of Hannah Arendt’s theory of free action. This endeavour will contribute to criticism and eventually improvement of the conceptual framework of management and organisation theory. We discuss conceptual tensions in this field, for instance with respect to the relationship between human action and the constraints of an organisation. To the extent that management and organisation theory are practiceoriented, such an analysis can help to understand tensions (...) and ambiguities in practice. Some of the optimism and high hopes found in the literature may have to be tempered as a consequence of a more adequate analysis of free action. The analysis therefore provides a critical point of view on the problems of managing freely acting people. (shrink)

This article offers an interpretation of theories of management and organisation from the perspective of Hannah Arendt’s theory of free action. This endeavour will contribute to criticism and eventually improvement of the conceptual framework of management and organisation theory. We discuss conceptual tensions in this field, for instance with respect to the relationship between human action and the constraints of an organisation. To the extent that management and organisation theory are practiceoriented, such an analysis can help to understand tensions (...) and ambiguities in practice. Some of the optimism and high hopes found in the literature may have to be tempered as a consequence of a more adequate analysis of free action. The analysis therefore provides a critical point of view on the problems of managing freely acting people. (shrink)

Hannah Arendt calls “natality,” the fact that human beings enter the world through birth, the centralcategory of political thought. But how can she assert that being born conditions one to act freely if shealso seems to maintain that is through labor, not action, that human beings deal with biologicallyconditioned processes? Expanding on Arendt’s largely neglected footnote to Arnold Gehlen in TheHuman Condition, this paper will argue that the concept of natality precisely undoes any strict divisionbetween freedom and necessity because (...) it names the radical co-implication of biological and politicolinguisticbirths, the conditioned and the spontaneous. (shrink)

Review of Joke J. Hermsen. 2022. A Good & Dignified Life: The Political Advice of Hannah Arendt & Rosa Luxemburg (translated from the Dutch by Brendan Monaghan). New Haven & London: Yale University Press.

Studie over het werk van de Amerikaanse politicologe Hannah Arendt (1906-1975).

(2006). Performativity and self-revelation as key concepts in Hannah Arendt's ethic of virtue. South African Journal of Philosophy: Vol. 25, No. 3, pp. 189-205.

(2006). Performativity and self-revelation as key concepts in Hannah Arendt's ethic of virtue. South African Journal of Philosophy: Vol. 25, No. 3, pp. 189-205.

Studie over de politieke ideeën van de Amerikaanse, uit Duitsland afkomstige filosofe (1906-1975).

Discusses the nature of thought and volition, examines past philosophical theories, and clarifies the relation between will and freedom.

-- Met voorwoord van Peter-Paul Verbeek -- Onze wereld wordt alsmaar digitaler. Informatie- en communicatietechnologie (ICT) heeft een ongekende invloed op ons dagelijks leven. We raken gewend aan omgevingen die op onze voorkeuren en zoekgeschiedenis zijn afgestemd, en verliezen daardoor de gemeenschappelijke wereld langzaam maar zeker uit het oog. De toename van ICT maakt het publieke gesprek steeds lastiger. De smartphone slokt de samenleving op. De publieke sfeer, van oudsher de vrijhaven voor democratisch overleg, staat onder druk. Filosoof Henriëtta Joosten (...) zwengelt met dit boek het publieke gesprek aan over de wereld die we met de inzet van technologie aan het creëren zijn. Dit leidt tot een prikkelende visie vol handreikingen aan professionals, geïnspireerd door het gedachtegoed van de politieke denker Hannah Arendt. (shrink)

Each of the books that Hannah Arendt published in her lifetime was unique, and to this day each continues to provoke fresh thought and interpretations. This was never more true than for Eichmann in Jerusalem, her account of the trial of Adolf Eichmann, where she first used the phrase “the banality of evil.” Her consternation over how a man who was neither a monster nor a demon could nevertheless be an agent of the most extreme evil evoked derision, outrage, (...) and misunderstanding. The firestorm of controversy prompted Arendt to readdress fundamental questions and concerns about the nature of evil and the making of moral choices. Responsibility and Judgment gathers together unpublished writings from the last decade of Arendt’s life, as she struggled to explicate the meaning of Eichmann in Jerusalem. At the heart of this book is a profound ethical investigation, “Some Questions of Moral Philosophy”; in it Arendt confronts the inadequacy of traditional moral “truths” as standards to judge what we are capable of doing, and she examines anew our ability to distinguish good from evil and right from wrong. We see how Arendt comes to understand that alongside the radical evil she had addressed in earlier analyses of totalitarianism, there exists a more pernicious evil, independent of political ideology, whose execution is limitless when the perpetrator feels no remorse and can forget his acts as soon as they are committed. Responsibility and Judgment is an essential work for understanding Arendt’s conception of morality; it is also an indispensable investigation into some of the most troubling and important issues of our time. (shrink)