When information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it becomes (...) part of a socio-technical network in an Intensive Care Unit. Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on the way patient outcomes are constructed, the kind of decision support these outcomes provide, and how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for (...) dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

What is ethics? -- How the Bible guides Christian ethics -- Moral agent -- Sin -- Virtue -- Conscience -- Moral norms -- Biblical norms -- Moral consequences -- Ultimate ends.

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral (...) Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. (shrink)

Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

This study investigated potential risk factors (coping, perfectionism and self-regulation) for substantial injuries in contemporary dance students using a prospective cohort design, as high-quality studies focusing on mental risk factors for dance injuries are lacking. Student characteristics (age, sex, BMI, educational program and history of injury) and psychological constructs (coping, perfectionism and self-regulation) were assessed using the Performing artist and Athlete Health Monitor (PAHM), a web-based system. Substantial injuries were measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on (...) Health Problems and recorded on a monthly basis as part of the PAHM system. Univariate and multivariate logistic regression analyses were conducted to test the associations between potential risk factors (i.e. student characteristics and psychological constructs) and substantial injuries. 99 students were included in the analyses. During the academic year 2016-2017, 48 students (48.5%) reported at least one substantial injury. Of all factors included, coping skills (OR: 0.91; 95% CI: 0.84–0.98), age (OR: 0.67; 95% CI: 0.46–0.98) and BMI (OR: 1.38; 95% CI: 1.05–1.80) were identified as significant risk factors in the multivariate analysis. The model explained 24% of the variance in the substantial injury group. Further prospective research into mental risk factors for dance injuries with larger samples sizes is needed to develop preventive strategies. Yet, dance schools could consider including coping skills training as part of injury prevention programs and, perhaps, providing special attention to younger dancers and those with a higher BMI through transitional programs to assist them in managing the stress they experience throughout their (academic) career. (shrink)

For most of us, learning to communicate is as effortless as breathing, and like air, communication skills are elemental; integral to our human existence in this world. Our communicative competencies might be seen as a bridge, facilitating our relationship with the world we are immersed in. But what happens when a child has difficulty learning to communicate effectively? What happens when their most basic messages of hunger or thirst fail to be understood or they are unable to jointly share in (...) everyday experiences of curiosity, joy, frustration, or anger? In these situations, it is the role of the Speech-Language Pathologist (SLP) to span the distance between a child and their family, a child and the world, building a route for life experiences and understandings to cross over. An SLP often begins with assessment and after a brief interaction, an SLP may come to a ‘naming’ such as delay or disorder. While the caring professional may intend this naming to be helpful in better understanding a child or facilitating access to valuable support, this naming may also place an immeasurable weight upon the child and their family. The act of naming is therefore an ethical concern. Through observation and interviews, this paper presentation explores SLP’s experiences of coming to a diagnosis through the human lens of phenomenological inquiry. It seeks to enhance thoughtful and conscientious practice by considering the ‘ethical experience of caring responsibility’ as applied to SLP (van Manen, 2016). (shrink)

I argue that the epistemology underlying Cornelius Van Til’s presuppositional apologetic methodology is quasi-fideist. According to this view, the rationality of religious belief is dependent on absolutely certain ungrounded grounds, called hinges. I further argue that the quasi-fideist epistemology of presuppositional apologetics explains why Van Til’s method is neither fideist nor problematically circular: hinges are rational in the sense that they are partly constitutive of rationality, and all beliefs (not just religious ones) depend on hinges. In addition, it illuminates something (...) of why it may strike one as a misguided or uncompelling apologetic method: instead of starting by tackling the comparatively minor epistemic commitments of the nonbeliever, it directly approaches their deepest and surest commitments. (shrink)

Cornelius Van Til and Alvin Plantinga represent two strands of American Protestant philosophical thought influenced by Dutch neo-Calvinism. This paper compares and synthetizes their models of knowledge in non-Christians given the noetic effects of sin and non-Christian worldview commitments. The paper argues that Van Til’s distinction between the partial realization of the antithesis in practice and its absolute nature in principle correlates with Plantinga’s insistence on prima facie–warranted common-sense beliefs and their ultimate defeasibility given certain metaphysical commitments. Van Til endorsed (...) more radical claims than Plantinga on epistemic defeat in non-Christian worldviews, the status of the sensus divinitatis, and conceptual accuracy in knowledge of the world. Finally, an approach to the use of evidence in apologetics is developed based on the proposed synthesis. This approach seeks to make more room for evidence than is generally recognized in Van Tilianism, while remaining consistent with the founder’s principles. (shrink)

After the challenges of the Enlightenment from philosophers such as David Hume, contemporary philosophers of religion tend to think that proof is not possible and that at best humans have arguments for the probability or plausibility of belief in God. But, Christianity maintains that humans should know God. This book explores attempts to respond to the Enlightenment challenges by thinkers at Princeton Theological like Benjamin Warfield. It considers Warfield's view of reason and knowledge of God, his debate with Abraham Kuyper, (...) and the attempt to reconcile differences between these two by Cornelius Van Til. It also considers Reformed Epistemology, which has become popular in recent decades and is credited for a renewed interest in Christian philosophy. (shrink)

The Polish logician Jan Lukasiewicz and the American theologian Cornelius Van Til are famous for challenging Aristotle’s Principle of Contradiction.Whereas apparent contradictions such as God and physical reality being both One and Not One (Many) are accepted in terms of an idealism held by Van Til, the Principle’s violations in theology and science reflect a realism held by Lukasiewicz. Lukasiewicz is favored for explaining why the Principle’s violation may be rational for a scientific and theological realism.

This book investigates for the first time key theological and philosophical convictions of an influential, yet hitherto neglected, Dutch theologian who developed his ideas on the threshold between the age of Protestant orthodoxy and the emerging Enlightenment.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:An Introduction to Christian Ethics: Goals, Duties, and Virtues by Robin W. Lovin, and: The Moral Disciple: An Introduction to Christian Ethics by Kent A. Van TilPaul J. WadellAn Introduction to Christian Ethics: Goals, Duties, and Virtues ROBIN W. LOVIN Nashville: Abingdon Press, 2011. 288 pp. $29.00The Moral Disciple: An Introduction to Christian Ethics KENT A. VAN TIL Grand Rapids, MI: Eerdmans, 2012. 160 pp. $18.00Over the last (...) several years a number of introductory texts in Christian ethics have been published. Robin Lovin’s An Introduction to Christian Ethics and Kent Van Til’s The Moral Disciple are impressive and worthy additions to that growing collection. Both are intended for undergraduate students—an audience, these authors realize, whose upbringing, history, and experiences are very different from their own. How can professors guide students through the thicket of choices and decisions that confront them every day, especially when they are bombarded with seemingly endlessly diverse answers about what is true, good, worthwhile, or fulfilling? When so much is constantly changing, how can professors help students understand what it means to live wisely, responsibly, and with integrity? How can they use the manifold traditions and resources of Christian ethics to help students discern the contours of a life that is truly worth living as well as the attitudes, dispositions, and choices that will enable them to achieve that? And, perhaps most challengingly, how can they do this when their students come to the study of ethics, as Lovin observes, with little more than “mere fragments of a moral vocabulary that has lost its meaning”? (238) With these questions in mind, Lovin and Van Til, wise and compassionate guides, lead the reader through the history of Christian ethics to illustrate how those who have gone before us, in all the different ways they understood the moral life, can assist us on our journey today.Both texts are structured around the customary focal points of goals and consequences (teleology), laws and norms (deontology), and character and virtue (areteology). In investigating each of these models for understanding ethics, [End Page 213] Van Til and Lovin give special attention to the influence of Aristotle, Augustine, Aquinas, and Kant. And both offer an insightful, balanced overview of the natural law, the moral and theological virtues, and the abiding but sometimes overlooked influence of utilitarianism on our moral reasoning. Moreover, both texts offer ample examples or case studies along with clear, succinct definitions that help students connect the material to their lives and appreciate important differences among varied accounts of the moral life.But there are also interesting differences between these two books. Because Van Til is primarily concerned with what ethics means in a life of faithful discipleship, he places how one’s relationship with Christ shapes her identity, understanding of the world, and sense of moral agency more at the forefront of his analysis than does Lovin in his Introduction to Christian Ethics. This is not a shortcoming of Lovin’s text, but it indicates an important difference in their methodologies. For example, because Van Til emphasizes that the lives of Christians are primarily guided by the biblical narrative, he moves from asking in the opening chapter “What is ethics?” to considering in chapter 2 the role of the scriptures for illuminating how Christians understand God, themselves, and their place in the world. “Christians believe that the Bible is God’s true and complete revelation,” Van Til writes, “and we also trust that the moral guidance we receive from Scripture is the truest and most complete moral guidance available to us” (18). Nonetheless, Van Til rightly cautions that because the Bible is “not an ethics textbook … problems may arise if we try to make the Bible guide our morality in ways that the Bible itself does not intend” (18). Thus, determining how biblical teaching should inform moral decisions demands ongoing personal and communal discernment.By contrast, after an expansive and very helpful overview of the origin of ethics in his opening chapter, Lovin adopts Charles Curran’s well-known fivefold “Christian stance” to provide the overarching framework for understanding the distinctiveness of Christian ethics. He then probes four... (shrink)

When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key (...) questions. I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a “think list” of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution. (shrink)

In the wake of the most recent financial crisis, corporations have been criticized as being self-interested and unmindful of their relationship to society. Indeed, the blame is sometimes placed on the corporate legal form, which can exacerbate the tension between duties to shareholders and interests of stakeholders. In comparison, the Benefit Corporation (BC) is a new legal business entity that is obligated to pursue public benefit in addition to the responsibility to return profits to shareholders. It is legally a for-profit, (...) socially obligated, corporate form of business, with all the traditional corporate characteristics combined with societal responsibilities. Considering the history and perception of shareholder primacy in United States law, it is argued that this new business structure is an ethical step toward empowering socially committed commercial entities. The contribution of this research is to provide a fundamental base of knowledge about the new legal form of business, the BC, upon which further study may rely. First, the legal history of the corporation is briefly reviewed in order to provide context to the relationship of the corporate form to society, including exploration of the premise that shareholder wealth maximization is its best and only purpose. Second, the BC is described in detail, and state statutes are compared. Third, the BC is placed within the context of corporate social responsibility. Finally, opportunities for future research are discussed. (shrink)

En prenant pour exemple mon parcours personnel allant du travail de la cure à celui de l’écriture, des violences politiques reflétées dans celles de la famille à la douleur de leurs inscriptions psychiques et textuelles, la première partie de l’exposé montrera en quoi le travail d’élaboration et d’écriture que doit effectuer un descendant de survivants, s’il cherche à psychiser, historiciser et inscrire le trauma de ses ascendants, constitue une démarche violente et transgressive. La seconde partie dégagera quelques aspects des déterminants (...) psychiques qui affectent les descendants de survivants : le caractère double du vécu traumatique, l’expérience d’une délocalisation psychique en l’absence d’image narcissisante, le souvenir de la terreur dans le rapport aux autres, la mutilation ou l’incapacité d’être. (shrink)

This paper examines the impact of integrated reporting on the integration of environmental, social, and governance issues into the business model and the related economic and ESG performance changes. To investigate these internal and external transformational effects of IR, important differences between IR and alternative ESG reporting strategies are worked out. Using three matched samples of companies from around the world for the sample period 2002–2011, IR companies are matched with companies applying no ESG reporting, stand-alone ESG reporting, or ESG (...) reporting in the annual report. The results suggest that IR is a superior mechanism only for the integration of ESG issues into the core business model when comparing IR with the ESG reporting strategies of no ESG reporting and ESG reporting in annual reports. In comparison with, stand-alone ESG reporting, the results indicate that IR is negatively associated with the ESG integration level and with the economic and ESG performance. Moreover, this negative impact is lower for companies that have already implemented ESG management tools prior to the initiation of IR and is stronger for companies residing in countries with legal requirements for the disclosure of ESG information. A separate change analysis reveals that companies do not benefit from a switch from stand-alone ESG reporting to IR. Thus, this paper provides empirical evidence that contradicts the general notion of IR as a superior reporting mechanism, as the benefits of IR are driven by several factors. (shrink)

Stories of young children who make up exaggerated stories provide questions for a discussion about lying.

What is empiricism and what could it be? Bas . van Fraassen, one of the world’s foremost contributors to philosophical logic and the philosophy of science, here undertakes a fresh consideration of these questions and offers a program for renewal of the empiricist tradition. The empiricist tradition is not and could not be defined by common doctrines, but embodies a certain stance in philosophy, van Fraassen says. This stance is displayed first of all in a searing, recurrent critique of metaphysics, (...) and secondly in a focus on experience that requires a voluntarist view of belief and opinion. Van Fraassen focuses on the philosophical problems of scientific and conceptual revolutions and on the not unrelated ruptures between religious and secular ways of seeing or conceiving of ourselves. He explores what it is to be or not be secular and points the way toward a new relationship between secularism and science within philosophy. (shrink)

This article unfolds in three stages. First, it locates the emergence of modern conceptions of social justice in industrializing Europe, and especially in the discovery of the “social,” which provided a particular idiom for the liberal democratic politics for most of the twentieth century. Second, the article links this particular conception of the social to the political rationalities of the postwar welfare state and the identity of the social citizen. Finally, the article discusses the myriad ways in which this legacy (...) of the social and social justice has been disrupted, although not yet fully displaced, by the economic orthodoxies and individualization that inform the contemporary neoliberal governing project in Canada. The result, the article concludes, has been the institutionalization of insecurity, which demands the renewal of a social way of seeing and a politics of social justice on local and global scales. (shrink)

Reports of children participating in hunger strikes while detained in offshore detention centres raise interrelated ethical issues and recognizable challenges for the medical decision-makers at these sites. A composite case study, informed by reports in the public domain, is employed to explore the unique challenges of consent and decision-making in these circumstances and the perennial issues inherent in adolescents’ developing capacity and autonomy. We present an amalgamated case of a fourteen-year-old adolescent who refused to consent to medical reversal of her (...) hunger strike protest. The medical team became the final arbiter when her parents, who were also in detention, could not agree with each other even after mediation. The case explores the complexity of evaluating the adolescent’s capacity to provide informed consent while influenced by the opinions of co-detainees in this extreme setting. We argue that the parents and the child had compromised decisional capacity due to the effects of detention. The challenges to the medical team are recognized and discussed. The team members faced a difficult dilemma and considered the competing values of the multiple cultural and ethical factors. Each team member integrated his or her own roles, duties, and discipline-specific professional guidelines with the primary goal of mitigating potential harms. (shrink)

The dominant theory of elite power, grounded in Weberian bureaucracy, has analyzed elites in terms of stable positions at the top of enduring institutions. Today, many conditions that spawned these stable ‘command posts’ no longer prevail, and elite power thus warrants rethinking. This article advances an argument about contemporary ‘influence elites’. The way they are organized and the modus operandi they employ to wield influence enable them to evade public accountability, a hallmark of a democratic society. Three cases are presented, (...) first to investigate changes in how elites operate and, second, to examine varying configurations in which the new elites are organized. The cases demonstrate that influence elites intermesh hierarchies and networks, serve as connectors, and coordinate influence from multiple, moving perches, inside and outside official structures. Their flexible and multi-positioned organizing modes call for reconsidering elite theory and grappling with the implications of these elites for democratic society. (shrink)