This article deals with the question of how ethicists respond to practical moral problems emerging in health care practices. Do they remain distanced, taking on the role of an expert, or do they become engaged with nurses and other participants in practice and jointly develop contextualized insights about good care? A basic assumption of dialogical ethics entails that the definition of good care and what it means to be a good nurse is a collaborative product of ongoing dialogues among various (...) stakeholders engaged in the practice. This article discusses the value of a dialogical approach to ethics by drawing on the work of various nursing scholars. We present a case example concerning the quality of freedom restrictions for intellectually disabled people. Issues for discussion include the role and required competences of the ethicist and dealing with asymmetrical relationships between stakeholders. (shrink)

This article presents the attitudes of nurses towards three issues concerning their role in euthanasia and physician-assisted suicide. A questionnaire survey was conducted with 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The study was conducted in the Netherlands between January 2001 and August 2004. The results show that less than half of nurses would be willing to serve on committees reviewing cases of euthanasia and physician-assisted suicide. More than half of the nurses found it (...) too far-reaching to oblige physicians to consult a nurse in the decision-making process. The majority of the nurses stated that preparing euthanatics and inserting an infusion needle to administer the euthanatics should not be accepted as nursing tasks. The findings are discussed in the context of common practices and policies in the Netherlands, and a recommendation is made not to include these three issues in new regulations on the role of nurses in euthanasia and physician-assisted suicide. (shrink)

This article presents the attitudes of nurses towards three issues concerning their role in euthanasia and physician-assisted suicide. A questionnaire survey was conducted with 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The study was conducted in the Netherlands between January 2001 and August 2004. The results show that less than half (45%) of nurses would be willing to serve on committees reviewing cases of euthanasia and physician-assisted suicide. More than half of the nurses (58.2%) (...) found it too far-reaching to oblige physicians to consult a nurse in the decision-making process. The majority of the nurses stated that preparing euthanatics (62.9%) and inserting an infusion needle to administer the euthanatics (54.1%) should not be accepted as nursing tasks. The findings are discussed in the context of common practices and policies in the Netherlands, and a recommendation is made not to include these three issues in new regulations on the role of nurses in euthanasia and physician-assisted suicide. (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)

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)

Is guidance by social norms compatible with rationality? Jon Elster has argued inThe Cement of Societythat there is a fundamental contrast between rationality and conformity to social norms. The context of study is the problem of collective action, with special emphasis on collective wage bargaining. In such negotiations, the appeal to social norms rather than to self-interest can block agreement. Suppose one union is committed to the norm of equal pay for equal work; another one appeals to the norm of (...) equal pay for everybody, regardless of the type of work. ‘In the presence of competing norms that favor different groups, the self-righteousness conferred by belief in a norm can lead to a bargaining impasse.'In confrontations between individuals, codes of honor can produce similar problems. It is in no one's interest to face a colleague over the barrel of a gun because one has made a nasty remark about his latest book, but if the code demands that one fight it out, the challenge must be accepted. (shrink)

Over the last few decades there have been several calls for a “big picture” of the history of science. There is a general need for a concise overview of the rise of modern science, with a clear structure allowing for a rough division into periods. This essay proposes such a scheme, one that is both elementary and comprehensive. It focuses on four machines, which can be seen to have mediated between science and society during successive periods of time: the clock, (...) the balance, the steam engine, and the computer. Following an extended developmental phase, each of these machines came to play a highly visible role in Western societies, both socially and economically. Each of these machines, moreover, was used as a powerful resource for the understanding of both inorganic and organic nature. More specifically, their metaphorical use helped to construe and refine some key concepts that would play a prominent role in such understanding. In each case the key concept would at some point be considered to represent the ultimate building block of reality. Finally, in a refined form, each of these machines would eventually make its entry in scientific research, thereby strengthening the ties between these machines and nature. (shrink)

ABSTRACTResearch Objective: This study focuses on ADs in the Netherlands and introduces a cross‐cultural perspective by comparing it with other countries.Methods: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%.Results: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive . Both low education and the (...) presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD.Discussion: This study shows that the subjects of palliative care and end‐of‐life‐decision‐making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings. (shrink)

Some conspicuous characteristics of argumentation as we all know this phenomenon from our shared everyday experiences are in my view vital to its theoretical treatment because they should have methodological consequences for the way in which argumentation research is conducted. To start with, argumentation is in the first place a communicative act complex, which is realized by making functional verbal communicative moves.

How do Dutch people let each other know that they disagree? What do they say when they want to resolve their difference of opinion by way of an argumentative discussion? In what way do they convey that they are convinced by each other’s argumentation? How do they criticize each other’s argumentative moves? Which words and expressions do they use in these endeavors? By answering these questions this short essay provides a brief inventory of the language of argumentation in Dutch.

Research Objective: This study focuses on ADs in the Netherlands and introduces a cross-cultural perspective by comparing it with other countries. Methods: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%. Results: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive (AED, 64%). Both low (...) education and the presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD. Discussion: This study shows that the subjects of palliative care and end-of-life-decision-making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings. (shrink)

The study of argumentation is prospering. After its brilliant start in Antiquity, highlighted in the classical works of Aristotle, after an alternation of ups and downs during the following millennia, in the post-Renaissance period its gradual decline set in. Revitalization took place only after Toulmin and Perelman published in the same year their landmark works The Uses of Argument and La nouvelle rhétorique. The model of argumentation presented by Toulmin and Perelman’s inventory of argumentation techniques inspired a great many scholars (...) in various ways to take up the study of argumentation in a serious manner. Nowadays there are well-established logical approaches to argumentation, but also social and socio-psychological, linguistic, juridical and other approaches. In most of these approaches traces can be found of the influence of the classical and neo-classical argumentation theories just mentioned. (shrink)