Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical (...) practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment. (shrink)

Parents’ perception of having no choice and strong emotions like fear about the prospect of living liver donation can lead professionals to question the voluntariness of their decision. We discuss the relation of these experiences (no choice and emotions), as they are communicated by parents in our study, to the requirement of voluntariness. The perceived lack of choice, and emotions are two themes we found in the interviews conducted within the “Living Related Donation; a Qualitative-Ethical Study” research program. As a (...) framework for the interpretation of these themes we discuss views of moral agency. We adopt a view in which relations are seen as constitutive of moral agency. Judging from this view, the perceived lack of choice can best be understood as a sign of commitment. We argue in this article that neither seeing no choice, nor emotions in themselves should be seen as compromises of a voluntary consent. However both experiences draw attention to aspects that are important to come to an evaluation of consent to donation. We discuss the story of one mother as an exemplary case to show how both themes can intertwine. (shrink)

Until recently, moral case deliberation (MCD) sessions have mostly been facilitated by external experts, mainly professional ethicists. We have developed a train the facilitator programme for healthcare professionals aimed at providing them with the competences needed for being an MCD facilitator. In this paper, we present the first results of a study in which we evaluated the programme. We used a mixed methods design. One hundred and twenty trained healthcare professionals and five trainers from 16 training groups working in different (...) healthcare organisations throughout the Netherlands were included. After completion of the programme, participants feel sufficiently confident and equipped to facilitate an MCD session. Feeling competent does not mean that participants have no doubts or questions left. Rather, they are aware of their limitations and see the need for continuous learning. According to the respondents, the actual exercise of facilitating MCD during and in between the training sessions contributed most to the development of competences necessary for being an MCD facilitator. Respondents without prior experience of participating in MCD sessions felt less competent after the training than those who had participated in MCD sessions before. Self-attributed competence varied between participants with different professional backgrounds. (shrink)

Being attentive to the needs of others, feeling responsible for each other, and taking care are necessary elements for the good life. Care, however, is a fragile activity: it is hard to predict its results. In this article, Homer's story of the Phaeacians bringing Odysseus back to Ithaca is interpreted to investigate what care could be when we admit the fragility of care. We consider two theoretical perspectives on care to interpret the story, namely Martha Nussbaum’s Aristotelian ethics, and the (...) Ethics of Care approach of authors like Ruddick, Sevenhuijsen, Tronto, Verkerk and others. In the first approach, the emphasis is on the attitude of care; in the second, on care as a social practice. Following Nussbaum, the caring response of the Phaeacians can be understood as an example of what Aristotle called ‘practical rationality’. The unexpected result of their care – they come into conflict with Poseidon – shows the fragility of human life and the tragic condition of humanity. According to Nussbaum, one should take responsibility for the fact that choosing for the one implies neglecting the other . From the perspective of Ethics of Care, the caring response is not so much the result of individual virtues; it is rather an element of a care practice that motivates people to act in conformity with basic values like solidarity and responsibility. The fragility of care is regarded as an ordinary quality of praxis and humanity rather than something essentially tragic. In the process of caring, misfortunes can never be totally prevented. Whenever they happen, they should be used as a way to learn and develop more adequate ways of handling the situation. The comparison of the two perspectives, both inspired by Aristotle's philosophy, gives rise to a richer view of the fragility of care. (shrink)

In Computer Science stepwise refinement of algebraic specifications is a well-known formal methodology for rigorous program development. This paper illustrates how techniques from Algebraic Logic, in particular that of interpretation, understood as a multifunction that preserves and reflects logical consequence, capture a number of relevant transformations in the context of software design, reuse, and adaptation, difficult to deal with in classical approaches. Examples include data encapsulation and the decomposition of operations into atomic transactions. But if interpretations open such a new (...) research avenue in program refinement, (conceptual) tools are needed to reason about them. In this line, the paper’s main contribution is a study of the correspondence between logical interpretations and morphisms of a particular kind of coalgebras. This opens way to the use of coalgebraic constructions, such as simulation and bisimulation, in the study of interpretations between (abstract) logics. (shrink)

The study aimed at measuring the dominant pattern of leadership and its relation to the performance of the administrative staff in the Palestinian universities. The study community consists of all the administrative staff from Al-Azhar University and the Islamic University, and through the census of the study society it was found to consist of (655) administrative staff. In order to achieve the objectives of the study, the researchers used the method of random sample in the study, and the study was (...) conducted on a sample of (221) administrative staff of the surveyed universities and the response rate was (82.35%). The study found that there is a high degree of satisfaction with the Dominant Pattern of Leadership in the Palestinian universities in Gaza Strip from the point of view of the administrative staff, which reached (71.67%). There is a high level of performance from the point of view of administrative staff, with a percentage of (82.53%). There is a direct correlation between the dominant pattern of leadership and the functional Performance of Administrative Staff, the absence of differences between the sample according to the gender variable in their perception of the dominant pattern of leadership and the functional Performance of Administrative Staff, the absence of differences in the perception of employees of the dominant pattern of leadership and the functional Performance of Administrative Staff depending on the age variable. There are differences of statistical significance according to the variable of scientific qualification in the Dominant Pattern of Leadership, while there were no differences in performance, the differences in the dominant pattern of leadership according to the scientific qualification were in favor of those who obtained the diploma degree compared to other practical qualifications, the absence of differences in the perception of employees of the dominant pattern of leadership and the functional Performance of Administrative Staff depending on the variable years of service, the absence of differences in the perception of employees of the dominant pattern of leadership and the functional Performance of Administrative Staff depending on the variable level of career (Director, Head of Department, and Administrative Officer). There were differences in the perception of workers to the dominant pattern of leadership depending on the variable of the workplace, where there were differences in favor of workers in deanships and colleges compared with the workers in the technical departments. While there were no differences in job performance according to the workplace variable, the existence of differences in the perception of workers to the dominant pattern of leadership depending on the university in which they work in favor of the Islamic University and the absence of differences in performance between the Islamic University and Al-Azhar University. The study reached a number of recommendations, the most important of which is that the interest of the managements of the Palestinian universities in improving the dominant pattern of leadership, to give universities the opportunity to participate in decision-making, the continued administration of universities interest and continuous improvement of the performance of its employees, enhance the periodic evaluation of job performance and to inform employees and express their opinion, solving workers' problems and giving them the opportunity to contribute to solving their own problems, the use of the staff rotation method periodically and strengthening the democratic the dominant pattern of leadership and empowering university staff. -/- . (shrink)

In this article I wish to show how care ethics puts forward a fundamental critique on the ideal of independency in human life without thereby discounting autonomy as a moral value altogether. In care ethics, a relational account of autonomy is developed instead. Because care ethics is sometimes criticized in the literature as hopelessly vague and ambiguous, I shall begin by elaborating on how care ethics and its place in ethical theory can be understood. I shall stipulate a definition of (...) care ethics as a moral perspective or orientation from which ethical theorizing can take place. This will mean that care ethics is more a stance from which we can theorize ethically, than ready-made theory in itself. In conceiving care ethics in this way, it becomes possible to make clear that, for instance, a moral concept of autonomy is not abandoned, but instead is given a particular place and interpretation. In the final part of this article I will show how ‘relational autonomy’ can be applied fruitfully in the practice of psychiatric care. (shrink)

In this paper, I plan to show that the use of a specific population concept—Millstein’s Causal Interactionist Population Concept (CIPC)—has interesting and counter-intuitive ramifications for discussions of the reality of biological race in human beings. These peculiar ramifications apply to human beings writ large and to individuals. While this in and of itself may not be problematic, I plan to show that the ramifications that follow from applying Millstein’s CIPC to human beings complicates specific biological racial realist accounts—naïve or otherwise. (...) I conclude with the notion that even if biological races do exist—by fulfilling all of the criteria needed for Millstein’s population concept (which, given particular worries raised by Gannett (Synthese 177:363–385, 2010), and Winther and Kaplan (Theoria 60:54–80, 2013) may not)—the lower-bound limit for the scope of biological racial realism is at the level of populations, and as such they cannot say anything about whether or not individual organisms themselves have races. (shrink)

Deception is part of the natural repertoire of adaptive behaviours in many organisms. In humans we see it in all domains of human activity including health care. Within health care, deception can be a matter of concern, but it is also used to protect patients, for instance against overwhelming and negative diagnostics. This paper demonstrates that deception and self‐deception are closely interlinked and that self‐deception facilitates deception. Furthermore, self‐deception tends to be used to reduce the discomfort we feel when we (...) are dishonest (cognitive dissonance). The paper includes references to core psychological mechanisms and ethical aspects. (shrink)

This chapter aims to bring to the fore some of the ontological presuppositions that undergird the concepts of race and racism as they are used in public health. Included are discussions of differing accounts for race in public health, the ways in which racism is understood to be a public health issue, and where future research in public health, as it relates to the concepts of race and racism, is headed.

First published in 1995. Routledge is an imprint of Taylor & Francis, an informa company.

First published in 1995. Routledge is an imprint of Taylor & Francis, an informa company.

In an age of global capitalism, pandemics, far-flung biobanks, multinational drug trials and telemedicine it is impossible for bioethicists to ignore the global dimensions of their field. However, if they are to do good work on the issues that globalisation requires of them, they need theoretical resources that are up to the task. This paper identifies four distinct understandings of ‘globalised’ in the bioethics literature: a focus on global issues; an attempt to develop a universal ethical theory that can transcend (...) cultural differences; an awareness of how bioethics itself has expanded, with new centres and journals emerging in nearly every corner of the globe; a concern to avoid cultural imperialism in encounters with other societies. Each of these approaches to globalisation has some merit, as will be shown. The difficulty with them is that the standard theoretical tools on which they rely are not designed for cross-cultural ethical reflection. As a result, they leave important considerations hidden. A set of theoretical resources is proposed to deal with the moral puzzles of globalisation. Abandoning idealised moral theory, a normative framework is developed that is sensitive enough to account for differences without losing the broader context in which ethical issues arise. An empirically nourished, self-reflexive, socially inquisitive, politically critical and inclusive ethics allows bioethicists the flexibility they need to pick up on the morally relevant particulars of this situation here without losing sight of the broader cultural contexts in which it all takes place. (shrink)

A new characterization of tabularity in tense logic is established, namely, a tense logic L is tabular if and only if $\mathsf {tab}_n^T\in L$ for some $n\geq 1$. Two characterization theorems for the Post-completeness in tabular tense logics are given. Furthermore, a characterization of the Post-completeness in the lattice of all tense logics is established. Post numbers of some tense logics are shown.

The vast majority of contributions to the literature on spirituality in nursing make extravagant claims about transcendence, eternity, the numinous, higher powers, higher levels of existence, invisible forces, cosmic unity, the essence of humanity, or other supernatural concepts. Typically, these assertions are made without the support of argument or evidence; and, as a consequence, alternative ways of theorizing ‘spirituality’ have been closed off, while the lack of consistent scholarship has turned the topic into a metaphysical backwater. In this paper, I (...) adopt a different premise, rejecting unsupported claims, and surveying the ‘spirituality’ terrain from a naturalistic and reductionist perspective. I argue that, if we rid ourselves of non‐naturalistic assumptions, we will discover theoretical and clinical resources in health psychology, social psychology, neuropsychology, and pharmacopsychology – resources which confirm that it is possible to conceptualize the study of existential concerns, and how health professionals might respond to them, in a properly scientific manner. In order to illustrate the potential usefulness of these resources, I will take palliative care as an example. (shrink)

When people engage in conversation, they tailor their utterances to their conversational partners, whether these partners are other humans or computational systems. This tailoring, or adaptation to the partner takes place in all facets of human language use, and is based on a mental model or a user model of the conversational partner. Such adaptation has been shown to improve listeners' comprehension, their satisfaction with an interactive system, the efficiency with which they execute conversational tasks, and the likelihood of achieving (...) higher level goals such as changing the listener's beliefs and attitudes. We focus on one aspect of adaptation, namely the tailoring of the content of dialogue system utterances for the higher level processes of persuasion, argumentation and advice-giving. Our hypothesis is that algorithms that adapt content for these processes, according to a user model, will improve the usability, efficiency, and effectiveness of dialogue systems. We describe a multimodal dialogue system and algorithms for adaptive content selection based on multi-attribute decision theory. We demonstrate experimentally the improved efficacy of system responses through the use of user models to both tailor the content of system utterances and to manipulate their conciseness. (shrink)

It is not uncommon that nurses are unable to meet the normative expectations of chronically ill patients. The purpose of this article is to describe and illustrate Walker’s expressive-collaborative view of morality to interpret the normative expectations of two women with multiple sclerosis. Both women present themselves as autonomous persons who make their own choices, but who also have to rely on others for many aspects of their lives, for example, to find a new balance between work and social contacts (...) or to find work. We show that their narratives of identity, relationship and value differ from the narratives that others use to understand and identify them. Since identities, relationships and values give rise to normative expectations, in both cases there is a conflict between what the women expect of their caregivers and vice-versa. The narratives also show that two similar persons with multiple sclerosis may need very different care. This implies that nurses caring for such persons should listen carefully to their stories and reflect on their own perceptions of self. (shrink)

Positive changes or transformations have been the subject of study within spiritual traditions as well as humanistic and transpersonal psychology. The aim of the current study is to understand the process of transformation among Moslems in Indonesia, who follow spiritual practices, to achieve the nafs al-muṭma ínnah [tranquil self]. Ten participants in Yogyakarta province were involved in this study. They were recruited using nafs al-muṭmaʾinnah scale developed by the authors. In-depth interviews of both the participants and their significant others were (...) conducted. To analyse the data, an interpretative phenomenological analysis was employed. Five themes emerged from the data, including deviation from the basis of religious environment, spiritual discipline, transformative experiences, new characters and a continuous process. We conclude that participants experience spiritual-religious transformation and achieve the state of nafs al-muṭma ínnah [tranquil self]. The process of transformation occurs gradually after a sudden experience, and it continuously happens throughout the course of life. Three factors contribute to the transformation, including the role of predisposition, the role of a spiritual guide and the role of spiritual experiences.Contribution: As the study of spiritual-religious transformation is mainly conducted within a Judea-Christian tradition, this study significantly contributes to the literature by providing spiritual-religious transformation from an Islamic-Sufi perspective. (shrink)

This text explores how human beings construe experience: experience as a resource, as a potential for understanding, representing and acting on reality.