Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project “support and consultation in euthanasia in Amsterdam” which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the (...) general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. (shrink)

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.

BackgroundIn many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholic beverages, and ever stricter smoke-free policies. Such interventions can enhance healthier behaviour, but when they become too intrusive, an unfree society can emerge. Which lifestyle interventions that use pressure or coercion are justifiable and which are not? We tried to develop an assessment model that can be used for answering this question, (...) on a generally acceptable way, for all sorts of lifestyle interventions.MethodsThe intended assessment model was developed in three phases. In the first phase the model was theoretically developed on the basis of literature study and reasoning. In the second phase the model was empirically tested by assessing two detailed cases from everyday practice using the model. The model was improved again and again. In the third phase the 10th version of the model was developed while writing this article.ResultsAn assessment model for the justification of intrusive lifestyle interventions. It comprises three components: 12 assessment criteria ; an assessment structure with three filters ; a way of assessing.ConclusionsWe have developed an assessment model for the justification of lifestyle interventions that use pressure or coercion to promote health. The correctness, completeness and practicality of the model are likely. Important principles for the justification are the logic and completeness of the underlying argumentation and the proper use of the available scientific information. Parties for and against a particular intervention could use the model to test and strengthen their argumentation and to improve the quality of the intervention. (shrink)

It is a rare patient who always does everything healthcare providers advise. Sometimes no harm comes from this; sometimes good does. But occasionally, great harm comes from not listening, as when it results in patients returning time and again for costly and invasive treatments of, say, infections, valve replacements, pressure ulcers, and so forth. No class of patients arouses more anger and resentment in healthcare providers, who often put out a call to invoke some version of the three strikes rule (...) and refuse care. And if the patients are also unemployed substance abusers who live in a local park, impolite or dangerous to staff, disruptive to other patients, and have intimidating visitors, the call to say “No” is louder. Can care ever be refused? If so, when? These are the questions we take up in this article. The answers we provide were developed as part of a Paraplegics and Quadriplegics with Pressure Ulcers Project carried out at Vancouver Hospital and Health Sciences Centre. Following an established usage, we refer to patients who exhibit a cluster of the above characteristics, the dominant one of which is a reluctance to heed medical advice, as “noncompliant patients.” This term is offensive to some, but the politically correct lexicon does not provide any alternative which is as short and clear or substantially different. We use the term as a convenient way of referring to a familiar class of patients and without any imputation of blame. (shrink)

In many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholi..

In the Netherlands, in 1995 approximately 9700 people explicitly requested euthanasia or assisted suicide, and EAS was performed approximately 3600 times. The most important reasons for not performing EAS when requested by a patient were that the patient died before EAS was performed, or that the physician refused the request.

Looking back at the twentieth century the question is what we have 'learned' in the field of philosophy in that century. In the case of philosophy 'learning' is understood as getting a more adequate insight into the frameworks in terms of which we spell our experience, in particular as getting an eye for aspects of it that were overlooked or insufficiently noticed in the philosophy of earlier periods. In that connection four themes are discussed: 1. subjectivity and inwardness, i.e. the (...) issue of the special mode of being of the subject ; 2. intersubjectivity and connectedness, i.e. the 'discovery' that by the relation between subjects a very special dimension of reality is indicated that cannot be adequately characterized in terms of the subject-object relationship ; 3. mediation, the issue that meanings are always context and tradition bound, that subjectivity, mind, etc., manifest themselves only as 'incarnated', mediated by nature ; and 4. the evolution from a uniform to a manifold concept of rationality and experience. (shrink)

This study reports on the hierarchy of organizational values in public and private sector organizations in Slovenia and the Netherlands. We surveyed 400 managers in Slovenia and 382 in the Netherlands using an identical questionnaire on the importance of a selection of values in everyday decision making. In Slovenia, impartiality, incorruptibility, and transparency were rated significantly higher in the public sector, while profitability, obedience, and reliability were rated more important in business organizations. In contrast, in the Netherlands, 11 values differed (...) significantly between the sectors. Thus, a greater value congruence exists between the sectors in Slovenia than in the Netherlands, with a larger “common core” of values in Slovenia (14) compared with the Netherlands (9), just as we hypothesized. Historical and cultural developments, such as the communist rule in Slovenia and the different influences of the Protestant work ethic in both countries, led to more similarities between business and government organizations in the “new” EU member state, Slovenia. (shrink)

The target article's evolutionary approach provides an excellent framework for understanding when and why people retaliate or forgive. We argue that recent findings on the basic processes in forgiveness can further refine the authors' proposed model. Specifically, the lack of executive control may restrict the explanatory power of relationship value and exploitation risk.

Aanleiding voor dit nummer over 'democratie en representatie' is het overlijden, op 3 oktober van vorig jaar, van een van de belangrijkste naoorlogse politieke denkers in Frankrijk, Claude Lefort . Omdat we niet zozeer de man, maar des te meer zijn ideeën willen memoreren hebben we ervoor geopteerd om de kern van zijn politiek-filosofische nalatenschap onder de aandacht te brengen. Zonder twijfel is dat het inzicht in de onlosmakelijke verwevenheid van democratie en representatie.

How do work motivations and sector perceptions differ between graduate students at prestigious Business Schools and Public Policy in Asia? Where do Asia’s future business and government leaders want to work, and why? To answer these questions, we compare Asian Master of Business Administration students with Master of Public Policy and Master of Public Administration students from three leading Schools based in Singapore through a survey study and a series of seven focus groups. Our findings indicate that work motivations, sector (...) perceptions, and career preferences differ between both groups but slightly less so than between their Western counterparts. Moreover, future Asian leaders equally value being successful while many view government as bureaucratic and prone to cronyism regardless of degree program and employment preference. We discuss how our findings may advance a more robust management and leadership research agenda for Asia. (shrink)

Otto Duintjer is one of the philosophers who have anew put the theme of spirituality on the philosophical agenda. Indeed, philosophy understood as striving for wisdom has had a spiritual dimension from the outset. But in modern time that dimension has eclipsed ever more, especially in academic philosophy. An important reason is that philosophy has adapted itself to a model of science, for which a 'disinterested' and 'neutral' attitude of the knowing subject and a hypothetical form of thinking are charasteristic. (...) In the logic of this type of science, and hence of a corresponding philosophy, existential and metaphysical questions and the theme of transcendence, which are essential for spirituality, fundamentally have no place. An important line of modern thinking, of which Kant and Wittgenstein are leading representatives and that Duintjer also takes as his starting-point, acknowledges the significance of these questions. But it also thinks that they can only be handled in a negative and indirect way. At the basis of that is an epistemological conception that understands knowledge exclusively as fully explicit knowledge. But if knowledge can also comprise all sorts of partially explicated or 'tacit' knowledge, as twentieth century philosophy has come to think, perspectives are opened for forms of spiritual knowledge that are not solely dependent on negative or indirect ways of reaching them. (shrink)

In his very interesting paper Harry Kunneman argues for an alternative view on voluntary work which not so much stresses the economic aspect but primarily its existentially meaningful aspect. To underpin this, Kunneman makes use of a broad range of hermeneutical, social-philosophical, complexity theoretical, biological and other ideas. This multipolar structure of the article might also prove to be its very weakness, because the rich train of thought remains highly abstract. This could be overcome by using examples and casuistry to (...) elucidate and specify the many distinctions in the article. (shrink)

Workplace aggression has been established as a prevalent and detrimental issue in organizations. While numerous studies have documented the important role of leaders in inhibiting or accelerating workplace aggression, a systematic overview of the associations between different leadership styles and workplace aggression as well as its boundary conditions is still lacking. This study reports a meta-analysis investigating the associations between leadership and workplace aggression. Drawing on data from 165 samples, our results revealed that change-oriented, relational-oriented, and values-based and moral leadership (...) were associated with reduced workplace aggression. In contrast, passive and destructive leadership were associated with increased workplace aggression. Importantly, relative weights analyses revealed that ethical leadership was most strongly negatively associated with workplace aggression. Additionally, moderation analyses revealed that the associations between leadership and workplace aggression were, in some cases, moderated by power distance and rating sources, but independent of measurement time lag. Overall, the findings of this meta-analysis highlight the important associations between leadership and workplace aggression. Implications for future research and policy recommendations aiming to reduce workplace aggression are discussed. (shrink)

A comprehensive assessment of a health technology requires that a wide variety of questions are addressed. These range from whether the use of a technology results in achievement of its intended effects (e.g., better tumour control, pain relief, improved mobility, etc.) at acceptable costs and without incurring undue risks to the patient, to whether its use may challenge existing social arrangements and values (e.g., individual responsibility for preserving good health, the value of human life, etc.). Clearly, this is a major (...) challenge, since it requires the use of quite different methods of inquiry. In the past decades, we have rarely witnessed assessments where both types of questions were addressed in a balanced way. Rather, a wide gap exists between inquiries with a strong empirical focus and an almost complete neglect of underlying normative issues, and inquiries which are largely discursive, but with a serious disregard of relevant empirical data. The complex interplay between normative frameworks and empirical data in the assessment of health technologies is illustrated in two case studies: the assessment of surgical management of children with glue ears, and the assessment of Extra Corporeal Membrane Oxygenation in neonates. (shrink)

Biodiversity informatics produces global biodiversity knowledge through the collection and analysis of biodiversity data using informatics techniques. To do so, biodiversity informatics relies upon data accrual, standardization, transferability, openness, and “invisible” infrastructure. What biodiversity informatics mean to society, however, cannot be adequately understood without recognizing what organizes biodiversity data. Using insights from science and technology studies, we story the organizing “visions” behind the growth of biodiversity informatics infrastructures in Sweden—an early adopter of digital technologies and significant contributor to global biodiversity (...) data—through interviews, scientific literature, governmental reports and popular publications. This case story discloses the organizational formation of Swedish biodiversity informatics infrastructures from the 1970s to the present day, illustrating how situated perspectives or “visions” shaped the philosophies, directions and infrastructures of its biodiversity informatics communities. Specifically, visions related to scientific progress and species loss, their institutionalization, and the need to negotiate external interests from governmental organizations led to unequal development across multiple infrastructures that contribute differently to biodiversity knowledge. We argue that such difference highlights that the social and organizational hurdles for combining biodiversity data are just as significant as the technological challenges and that the seemingly inconsequential organizational aspects of its infrastructure shape what biodiversity data can be brought together, modelled and visualised. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that it indeed has the potential (...) of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)

Inleiding vanuit historisch perspectief tot de rechtsfilosofie.

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and were organized (...) apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other. (shrink)

This article reviews the development of social quality indicators and the challenges ahead. First, through a review of recent Asian and Australian work carried out on social quality indicators, and the World Bank related work on “social development indicators,” the article argues that social quality indicators research should move beyond the empirical level of particular policy areas. Therefore, it should be guided by a clear methodological perspective regarding the role of indicators as part of a social quality theory (SQT) and (...) their relation to the social quality approach (SQA). Second, the article opens a debate about the rationale behind distinguishing between three different functions of social quality indicators. Indicators should address the change in the conditional factors in daily life, as manifested in its economic, socio-political, socio-cultural and environmental dimensions, in order to examine the consequences of general trends and contradictions in (1) societal circumstances, (2) the development (or lack of development) toward sustainability, and (3) the related issue of sustainable urban development. Before 2010 social quality scholars mainly concentrated on the first issue. Recently, however, they are approaching all three issues. It is essential to delve deeper into SQT and the SQA for understanding these three issues separately and integrally. This has implications for the nature of social quality indicators and their comparison to those of other mainstream approaches; the article introduces this agenda of work. (shrink)