BackgroundMoral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice.MethodsIn this paper we present a case-study of a Moral Case Deliberation with (...) the dilemma method in a health care institution for people with an intellectual disability, describing the theoretical background and the practical application of the dilemma method. The dilemma method focuses on moral experiences of participants concerning a concrete dilemma in practice. By an in-depth description of each of the steps of the deliberation process, we elucidate the educational value and didactics of this specific method.ResultsThe didactics and methodical steps of the dilemma method both supported and structured the dialogical reflection process of the participants. The process shows that the participants learned to recognize the moral dimension of the issue at stake and were able to distinguish various perspectives and reasons in a systematic manner. The facilitator played an important role in the learning process of the participants, by assisting them in focusing on and exploring moral aspects of the case.DiscussionThe reflection and learning process, experienced by the participants, shows competency-based characteristics. The role of the facilitator is that of a Socratic teacher with specific knowledge and skills, fostering reflection, inquiry and dialogue.ConclusionThe specific didactics of the dilemma method is well suited for teaching bioethics in clinical settings. The dilemma method follows an inductive learning approach through a dialogical moral inquiry in which participants develop not only knowledge but also skills, attitude and character. The role of a trained facilitator and a specific view on teaching and practicing ethics are essential when using the dilemma method in teaching health care professionals how to reflect on their own moral issues in practice. (shrink)

Moral case deliberation is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to acquire (...) expertise in dealing with moral questions independent of the expertise of an ethicist. Over the past 10 years, we developed a training program with a specific mix of theory and practice, aiming to foster the right attitude, skills and knowledge of the trainee. The content and the didactics of the training developed in line with the philosophy of MCD: pragmatic hermeneutics, dialogical ethics and Socratic epistemology. Central principles are: ‘learning by doing’, ‘reflection instead of ready made knowledge’, and ‘dialogue on dialogue’. This paper describes the theoretical background and the didactic content of the current training. Furthermore, we present didactic tools which we developed for stimulating active learning. We also go into lessons we learned in developing the training. Next, we provide some preliminary data from evaluation research of the training program by participants. The discussion highlights crucial aspects of educating professionals to become facilitators of MCD. The paper ends with concluding remarks and a plea for more evaluative evidence of the effectiveness and meaning of this training program for doing MCD in institutions. (shrink)

Volume 20, Issue 6, June 2020, Page 70-72.

The attention for Moral case deliberation has increased over the past years. Previous research on MCD is often written from the perspective of MCD experts or MCD participants and we lack a more distant view to the role of MCD in Dutch health care institutions in general. The purpose of this paper is to provide an overview of the state of the art concerning MCD in the Netherlands. As part of a larger national study on clinical ethics support in the (...) Netherlands, we will focus on the prevalence and characteristics of MCD in Dutch health. A mixed methods design was used in which we combined two survey questionnaires, two focus groups and 17 individual interviews with top managers or ethics support staff. The findings demonstrate that the prevalence of MCD is relatively high in Dutch health care, especially in mental health care. Institutions with MCD differ from institutions without MCD concerning size, kind of problems and importance of ideological background. Characteristic of MCD is that it often exists for 3 years or more, has a high participation of health professionals and middle managers and is both organized scheduled as unscheduled. As well integration in existing policy as key persons emerge as important issues in relation to the positioning of MCD. We conclude that MCD is a part of an integrated ethics policy and serves as a catalyst for such an integrated ethics policy. (shrink)

Universities and other research institutions are increasingly providing additional training in research integrity to improve the quality and reliability of research. Various training courses have been developed, with diverse learning goals and content. Despite the importance of training that focuses on moral character and professional virtues, there remains a lack of training that adopts a virtue ethics approach. To address this, we, a European Commission-funded consortium, have designed a train-the-trainer programme for research integrity. The programme is based on (1) virtue (...) ethics, (2) the ethos of science, (3) learning by doing and (4) learner-centred teaching. The blended learning programme combines e-learning modules with participatory group sessions. Trainers are taught how to guide researchers through a series of structured exercises for fostering reflection on scientific virtues, and how to promote understanding and application of the European Code of Conduct for Research Integrity. Trainers are provided with adaptable tools and resources that can be used and combined in different ways. The programme implementation began in Spring 2020 and 470 trainers have participated to date. When trainers were asked to grade – between 0 (very bad) and 10 (excellent) – the e-learning modules and the participatory exercises, 60% scored a grade 8 or higher (median = 8, IQR = 2) for the e-learning modules, whereas 80% scored a grade 8 or higher (median = 9, IQR = 1) for the participatory exercises. A majority felt that the training helped them as a trainer to learn about ways to organise and teach a research integrity course (82%) and would recommend the interactive exercises to others (92%). Trainers have educated over 3300 researchers in Europe using our virtue-based approach. The VIRT2UE train-the-trainer programme fosters research integrity by providing trainers with exercises and tools which enable them to stimulate the development of good researchers across Europe. (shrink)

Volume 20, Issue 3, March 2020, Page 42-44.

In healthcare practice, care providers are confronted with tragic situations, in which they are expected to make choices and decisions that can have far-reaching consequences. This article investigates the role of moral case deliberation in dealing with tragic situations. It focuses on experiences of care givers involved in the treatment of a pregnant woman with a brain tumour, and their evaluation of a series of MCD meetings in which the dilemmas around care were discussed. The study was qualitative, focusing on (...) the views and experiences of the participants. A case study design is used by conducting semi-structured interviews with health care professionals who both played a role in the treatment of the patient and attended the MCD. The results show that MCD helps people to deal with tragic situations. An important element of MCD in this respect is making explicit the dilemma and the damage, demonstrating that there is no simple solution. MCD prompts participants to formulate and share personal experiences with one another and thus helps to create a shared perception of the situation as tragic. The article concludes that MCD contributes to the sharing of tragic experiences, and fosters mutual interaction during a tragedy. Its value could be increased through explicit reflection on the aspect of contingency that characterises tragedy. (shrink)

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

Much of what we know and see of ethics support, in literature and during trainings, workshops and conferences, derives from clinical ethicists working at academic medical centers. Besides the probl...

In 2020, due to the Nightingale year and COVID‐19 crisis, nursing is in the public eye more than ever. Nurses often are being seen as compassionate helpers. The public image of nursing, however, also consists of stereotypes such as nursing being a ‘doing’ profession and care being a ‘female’ characteristic. Next to that, nursing is associated with images from the past, such as ‘the lady with the lamp’. Therefore, in the public eye at least, the nursing identity seems a simple (...) and straightforward enough construct, but nothing less is true. Looking at what a professional identity consists of, historic and social developments influence a group identity as a construct. In addition, individual, professional and contemporary societal moralities, including stereotypes, play its role. Nurses themselves reinforce stereotypes in order to fit into what is expected, even when they believe professional behaviour encompasses other features. They may do so individually as well as in a group context. But nursing actually seems to be better off when viewed upon as a diverse, autonomous profession. Moral values such as compassion motivate nurses to enter the profession. Research shows that if such values are addressed in daily practice, nursing could perhaps be saved from nurses leaving the profession because of feeling unfulfilled. Another aspect concerns the huge nursing body of knowledge. If seen as the ground on which nursing behaviour is standing, it would contribute to a different image of nursing than simplified stereotypes, which do not acknowledge the complex nature of the profession. This paper challenges the idea that the nursing identity is unchangeable and the notion that ‘a nurse will always be a nurse’. By doing so, the paper contributes to a debate on the supposed ‘true’ nature of the nursing identity and opens a discussion on the need for it to change. (shrink)

Instead of technological policyprescriptions, the search for solutions to managementproblems in irrigation systems is increasingly soughtin organizational and institutional reforms. Thereseems to be an emerging consensus that water and moneysavings can be brought about by (1) treating water asan economic good; and (2) decentralizing themanagement of irrigation water. Policies based on thisconsensus are being implemented in a large number ofcountries. On the basis of insights derived fromfeminist economics, the paper identifies and discussesgender biases of new irrigation management policies.The paper shows (...) that policies do not explicitlyconsider the possibility that women are water users,and are implicitly based on a belief that all usersare equally able to pay for water. Calculations aboutexpected increases in efficiency may be wrong, becausethey do not take women‘s unpaid contributions tothe economy into account. Existing evidence about theimpacts of irrigation programs shows that these haveprovoked changes in the costs of irrigation or users,in water use practices, and in the accountabilitybetween users and providers of water. No empiricalinformation exists to ascertain whether these changesare gender specific. Impact studies do not addressgender concerns, and methods employed in impactstudies do not allow a critical re-assessment of thetheories underlying new irrigation policies. Thisreinforces the idea that gender or women do not matterand seriously limits the understanding of thedeterminants of irrigation management performance. (shrink)

Reduced forms such as the pronoun he provide little information about their intended meaning compared to more elaborate descriptions such as the lead singer of Coldplay. Listeners must therefore use contextual information to recover their meaning. Across languages, there appears to be a trade‐off between the informativity of a form and the prominence of its referent. For example, Italian adults generally interpret informationally empty null pronouns as in the sentence Corre (meaning “He/She/It runs”) as referring to the most prominent referent (...) in the discourse, and more informative overt pronouns (e.g., lui in Lui corre, “He runs”) as referring to less prominent referents. Although children acquiring Italian are known to experience difficulties interpreting pronouns, it is unclear how they acquire this division of pragmatic labor between null and overt subject pronouns, and how this relates to the development of their cognitive capacities. Here we show that cognitive development can account for the general interpretation patterns displayed by Italian‐speaking children and adults. Using experimental studies and computational simulations in a framework modeling bounded‐rational behavior, we argue that null pronoun interpretation is influenced by working memory capacity and thus appears to depend on discourse context, whereas overt pronoun interpretation is influenced by processing speed, suggesting that listeners must reason about the speaker's choices. Our results demonstrate that cognitive capacities may constrain the acquisition of linguistic forms and their meanings in various ways. The novel predictions generated by the computational simulations point out several directions for future research. (shrink)

In 'Descartes' droom' worden strip en filosofie met elkaar verbonden. Een idee van Hubert Dethier, die in zijn colleges aan de VUB het medium strip tot onderwerp van filosofische bezinning maakte. Filosofe en vroegere stripuitgeefster Margreet van Muijlwijk nam de fakkel van hem over en verbond ter gelegenheid van Hubert Dethiers tachtigste verjaardag diens gedachtegoed met de vele aspecten van wat intussen een volwassen kunst (de negende kunst) is geworden. Strip en filosofie passen goed bij elkaar. Terwijl filosofie een (...) eeuwenoude praktijk is, is het stripverhaal het oudste medium onder de nieuwe media. In tegenstelling tot die laatste is de tijdlijn van een stripverhaal op elk moment tot stilstand te brengen of om te keren. Dat is een eerste voorwaarde voor reflectie: bij de dingen kunnen stilstaan en afwegingen maken. De strip kan op die manier onvermoede inzichten bieden in talloze stromingen van de westerse filosofie en in onze maatschappij in het algemeen. (shrink)

Drawing on detailed German panel data, we find that gifts and inheritances substantially increase households’ private pension savings in accounts which are costly or impossible to withdraw prematurely. Back-of-the-envelope calculations suggest that the average difference in bequest-induced private pension savings between heirs and non-heirs accrues to more than 40,000 euros at retirement, and that it would take an average non-heir household roughly 14 years to match this gap. The sizable difference in private pension savings between heirs and non-heirs persists when (...) we take into account other investments of heirs and non-heirs potentially intended to provide for old age. Our evidence supports the impact of gifts and inheritances on inequality in retirement wealth highlighted in recent research on intergenerational justice. We discuss several policy implications of our results. Online appendix. (shrink)

In many countries and resource sectors, the state is devolving responsibility for natural resource management responsibility to ``communities'' or local user groups. However, both policymakers and researchers in this area have tended to ignore the implications of gender and other forms of intra-community power differences for the effectiveness and equity of natural resource management. In the irrigation sector, despite the rhetoric on women's participation, a review of evidence from South Asia shows that organizations often exclude women through formal or informal (...) membership rules and practices. Women may have other ways to obtain irrigation services, but even if they are effective, these other informal ways of obtaining irrigation services are typically less secure. As resource management – and rights to resources – are transferred from the state to local organizations, ensuring women's participation is essential for gender equity in control over resources. Greater involvement of women can also strengthen the effectiveness of local organizations by improving women's compliance with rules and maintenance contributions. Further detailed and comparative research is required to identify the major factors that affect women's participation and control over resources, if devolution policies are to be both equitable and sustainable. (shrink)

An inscription composed in the Old Persian language and carved in the Old Persian cuneiform script on the tomb of Phirozshaw D. Saklatvala and his family in the Woodlawn Cemetery in New York City adds to the corpus of known ancient and modern inauthentic Old Persian texts. This article describes and illustrates the tomb, discusses the family for which it was built, presents a full illustrated edition of the text and philological commentary on it, and speculates on the identity of (...) its composer. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals (...) bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

This article presents the results of a study in The Netherlands among two groups of religious people: i.e., 165 Christian outpatients and 171 parishioners. In this study, we focused on the following main questions. To what degree did these two groups of Christians practice positive religious coping, negative religious coping and receptive coping? What are the relationships between these three coping strategies? To what degree were positive religious, negative religious and receptive coping activities related to the well-being of the respondents? (...) What are the best predictors of well-being: positive religious, negative religious or receptive coping? The results showed that positive religious, negative religious and receptive coping were three independent predictors of well-being, with negative religious coping being the best predictor. (shrink)

Over the past years the relevance of compassion for society and specific practices such as in healthcare is becoming a focus of attention. Philosophers and scientists discuss theoretical descriptions and defining characteristics of the phenomenon and its benefits and pitfalls. However, there are hardly any empirical studies which substantiate these writings in specific societal areas. Besides, compassion may be in the eye of attention today but has always been of interest for many contemporary philosophers as well as philosophers in the (...) past, David Hume amongst them. Three themes related to Hume’s hypotheses on compassion are discussed and compared to outcomes of an empirical study amongst nurses and patients with a chronic disease. This comparison gives insights into the perception of those for whom compassion is of specific importance in their daily lives and into the usefulness of Hume’s notions on compassion. (shrink)

The widespread trend to transferirrigation management responsibility from the stateto “communities” or local user groups has byand large ignored the implications ofintra-community power differences for theeffectiveness and equity of water management. Genderis a recurrent source of such differences. Despitethe rhetoric on women‘s participation, a review ofevidence from South Asia shows that femaleparticipation is minimal in water users‘organizations. One reason for this is that theformal and informal membership criteria excludewomen. Moreover, the balance between costs andbenefits of participation is often negative forwomen (...) because complying with the rules and practicesof the organization involves considerable time costsand social risks, whereas other ways to obtainirrigation services may be more effective for femalewater users. Although effective, these other andoften informal ways of obtaining irrigation servicesare also typically less secure. More formalparticipation of women can strengthen women‘sbargaining position as resource users withinhouseholds and communities. Greater involvement ofwomen can also strengthen the effectiveness of theorganization by improving women‘s compliance withrules and maintenance contributions. Furtherdetailed and comparative research is required toidentify the major factors that affect women‘sparticipation and control over resources, ifdevolution policies are to address the tensionbetween objectives of transferring control overresources to community institutions, and ensuringthe participation of all members of the community,especially women. (shrink)

A fun introduction in comics to deep thinking and the history of philosophy -- Back cover.

This study explores the impact of participation in a series of moral case deliberations (MCD) on the moral craftsmanship (MCS) of Dutch prison staff. Between 2017–2020, ten MCDs per team were implemented in three prisons (i.e., intervention group). In three other prisons (i.e., control group) no MCDs were implemented. We compared the intervention and control group using a self-developed questionnaire, administered before (pre-measurement) and after the series of MCDs (post-measurement). Results After the MCDs, participants scored significantly higher on 7 of (...) the 70 items related to MCS. On some items there were significant impact differences between the various professional disciplines. Discussion Possible explanations for a relatively low impact are discussed. A shorter and validated questionnaire is needed in order to further study the MCS of professionals and the impact of Ethics Support Services (ESS). Conclusions There was a positive development on some elements of MCS after participation in a series of MCDs. (shrink)

Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for an (...) ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills). (shrink)

Rule of law and constitutionalist ideals are understood by many, if not most, as necessary to create a just political order. Defying the traditional division between normative and positive theoretical approaches, this book explores how political reality on the one hand, and constitutional ideals on the other, mutually inform and influence each other. Seventeen chapters from leading international scholars cover a diverse range of topics and case studies to test the hypothesis that the best normative theories, including those regarding the (...) role of constitutions, constitutionalism and the rule of law, conceive of the ideal and the real as mutually regulating. (shrink)

Depletion of mitochondrial endo/exonuclease G‐like (EXOG) in cultured neonatal cardiomyocytes stimulates mitochondrial oxygen consumption rate (OCR) and induces hypertrophy via reactive oxygen species (ROS). Here, we show that neurohormonal stress triggers cell death in endo/exonuclease G‐like‐depleted cells, and this is marked by a decrease in mitochondrial reserve capacity. Neurohormonal stimulation with phenylephrine (PE) did not have an additive effect on the hypertrophic response induced by endo/exonuclease G‐like depletion. Interestingly, PE‐induced atrial natriuretic peptide (ANP) gene expression was completely abolished in endo/exonuclease (...) G‐like‐depleted cells, suggesting a reverse signaling function of endo/exonuclease G‐like. Endo/exonuclease G‐like depletion initially resulted in increased mitochondrial OCR, but this declined upon PE stimulation. In particular, the reserve capacity of the mitochondrial respiratory chain and maximal respiration were the first indicators of perturbations in mitochondrial respiration, and these marked the subsequent decline in mitochondrial function. Although pathological stimulation accelerated these processes, prolonged EXOG depletion also resulted in a decline in mitochondrial function. At early stages of endo/exonuclease G‐like depletion, mitochondrial ROS production was increased, but this did not affect mitochondrial DNA (mtDNA) integrity. After prolonged depletion, ROS levels returned to control values, despite hyperpolarization of the mitochondrial membrane. The mitochondrial dysfunction finally resulted in cell death, which appears to be mainly a form of necrosis. In conclusion, endo/exonuclease G‐like plays an essential role in cardiomyocyte physiology. Loss of endo/exonuclease G‐like results in diminished adaptation to pathological stress. The decline in maximal respiration and reserve capacity is the first sign of mitochondrial dysfunction that determines subsequent cell death. (shrink)

No names are more closely associated with modern trade theory than Eli Heckscher and Bertil Ohlin. The basic Heckscher-Ohlin proposition, according to which a country exports factors in abundant supply and imports factors in scarce supply, is a key component of modern trade theory. In this book, Robert Baldwin traces the development of the HO model, describing the historical twists and turns that have led to the basic modern theoretical model in use today. Baldwin not only presents a clear and (...) cohesive view of the model's evolution but also reviews the results of empirical tests its various versions. Baldwin, who published his first theoretical article on the HO model in 1948, first surveys the development of the HO model and then assesses empirical tests of its predictions. Most discussions of empirical work on HO models confine themselves to the basic theorem, but Baldwin devotes a chapter to empirical tests of three related propositions: the Stolper-Samuelson theorem; the Rybczynski theorem; and the factor price equalization theorem. He concludes that the formulation and testing of these later models have improved economists' understanding of the forces shaping international trade, but that many empirical trade economists were so enamored of the elegant but highly unrealistic factor price equalization models developed from the insights of Heckscher and Ohlin that they have neglected investigation of other models without this relationship. (shrink)