Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could benefit from a care ethical (...) approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands. (shrink)

The current empirical research and normative arguments on physician-assisted dying in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and (...) a certain view on ethics. Furthermore, the paper elaborates on how other approaches to empirical research in bioethics, such as found in the broad field of narrative research, could supplement the empirical and ethical evaluation of PAD in the Netherlands. This paper also addresses the challenging question of how empirical data—in this case narratives—relate to normativity. The paper is written in the form of a personal narrative of the author, a young Dutch general practitioner and researcher in bioethics. This style is intentionally chosen, to illustrate how work context and professional background influence the observations one makes and the questions one may ask about the topic of PAD. In addition, by using this style, this paper not only gives a different perspective on a much-contested bioethical issue, but also on the challenges faced when a physician–bioethicist has to navigate different disciplinary fields and epistemological paradigms, especially since the ‘empirical turn’ in bioethics. (shrink)

The use of qualitative research in empirical bioethics is becoming increasingly popular, but its implementation comes with several challenges, such as difficulties in aligning moral epistemology and methods. In this paper, we describe some problems that empirical bioethics researchers may face; these problems are related to a tension between the different poles on the spectrum of scientific paradigms, namely a positivist and interpretive stance. We explore the ideas of narrative construction, ‘genres’ in medicine and dominant discourses in relation to empirical (...) research. We also reflect on the loss of depth and context that may occur with thematic or content analyses of interviews, and discuss the need for transparency about methodologies in empirical bioethics. Drawing on insights from narrative approaches in the social sciences and the clinical-educational discipline of Narrative Medicine, we further clarify these problems and suggest a narrative approach to qualitative interviewing in empirical bioethics that enables researchers to ‘listen (and read) in new ways’. We then show how this approach was applied in the first author’s research project about euthanasia decision-making. In addition, we stress the important ethical task of scrutinizing methodologies and meta-ethical standpoints, as they inevitably impact empirical outcomes and corresponding ethical judgments. Finally, we raise the question whether a ‘diagnostic’, rather than a ‘problem-solving’, mindset could and should be foregrounded in empirical ethics, albeit without losing a commitment to ethics’ normative task, and suggest further avenues for theorizing about listening and epistemic (in)justice in relation to empirical (bio)ethics. (shrink)

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

Approaches to business ethics can be roughly divided into two streams: ‹codes of behavior’ and ‹forms of subjectification’, with code-oriented approaches clearly dominating the field. Through an elaboration of poststructuralist approaches to moral philosophy, this paper questions the emphasis on codes of behaviour and, thus, the conceptions of the moral and responsible subject that are inherent in rule-based approaches. As a consequence of this critique, the concept of a practice-based ‹ethics of responsiveness’ in which ethics is never final but rather (...) always ‹to come’, is investigated. In such an approach the ethical self is understood as being continuously constituted within power/knowledge relations. Following this line, we ask how one can become a responsible subject while also acknowledging certain limits of full responsibility. We thereby explore responsibility as a considered but unconditional openness in response to the other. (shrink)

Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

L’itinéraire de Jeanne Kœhler-Lumière l’a conduite de la philanthropie à la collaboration avec les pouvoirs publics pour la réalisation d’une politique sociale à Lyon après la Première Guerre mondiale. Fille et sœur d’industriels, elle participe aux œuvres mises en place pour le personnel de l’usine familiale, puis élargit son action en faveur de l’enfance à l’échelle de la ville. Cependant, l’ancrage de la famille Lumière dans le camp de la République laïque isole Jeanne Kœhler-Lumière des milieux traditionnels de la philanthropie (...) conservatrice et catholique. La guerre constitue un tournant durant lequel elle s’engage dans les services de santé, travaillant avec des sommités du monde médical lyonnais. Son expérience et sa notabilité lui valent dans les années 1920 d’être sollicitée par la municipalité radicale en quête de compétences pour impulser une politique sociale. Dame d’œuvres puis ambassadrice du social, Jeanne Kœhler-Lumière illustre une forme originale de participation des femmes à la vie politique. (shrink)

In many countries grappling with the politics of equal recognition, the experiences, beliefs and reasons for action of people who identify as non-binary are starting to be seen as valid and intelligible.1 And, despite some gender clinics still responding cautiously to requests for non-standard medical interventions, their treatment needs are now recognised in major clinical guidelines. This is the current social context in which Notini and colleagues outline the case of ‘Phoenix’, an 18-year-old birth-assigned woman, who has requested the indefinite (...) continuation of puberty suppression, a treatment that was initiated when the client was 11 years old to mitigate their intense distress at the onset of puberty. Drawing on a conception of health as overall well-being, the authors conclude that OPS is ‘consistent with the proper goals of medicine’, and that there are ‘equity-based reasons’ for offering OPS to adults as a group. They concede that the physical risks are greater for OPS than for hormonal interventions generally provided to people with a binary gender identity. They also acknowledge the need for ‘a fine-grained ethical evaluation of Phoenix’s particular situation’ to assess whether the potential benefits of OPS outweigh the potential harms for this individual. Here I respectfully raise three points to amplify the authors’ discussion. First, there seem to be significant ethical issues of a general, not a particular, kind arising from the type of individual evaluation they call for. Following initial screening for significant mental distress and other major vulnerabilities, the key undertaking …. (shrink)

The aim of this study was to explore how Belgian nurses view issues related to the development, dissemination and implementation of a code of ethics for nurses. Fifty nurses took part in eight focus groups. The participants stated that, on the whole, a code of ethics for nurses would be useful. They stressed that a code should be a practical and useful instrument developed by nurses for nurses, and that it should be formulated and presented in a practical way, just (...) as educational courses dealing specifically with codes of ethics require a practical approach to be effective. They emphasized that the development of a code should be an ongoing process, enabling nurses to provide input as they reflect on the ethical issues dealt with in the code and apply the code in their practice. Finally, they stressed the need for support at institutional level for the effective implementation of a code. (shrink)

„On 23rd February 2022, when the editors had worked out topical issues of dispute relating to politics, ethics, technology and religion for a Hans Jonas Centre conference on responsibility for the future and discourse ethics, it was suddenly foreseeable that Russia would invade the core area of Ukraine the next night. We immediately informed our Ukrainian colleagues that we would allow them asylum, if desired, and invite them to the conference in Bad Kissingen as keynote speakers. In no time at (...) all, the new programme for the confer-ence was ready: After commemorating Hans Jonas' honorary doctorate in Berlin under the motto ‘Fatalism would be a mortal sin’ exactly 30 years ago, we now focus on ‘Discourse despite war’. After that, we discuss digitalisation as well as theology, philosophy and commitment". With contributions by Prof. Dr. Claus Altmayer; Harald Asel, M.A.; Dorothee Bär, MdB; Dr. Thomas Bausch; Prof. Dr. Dietrich Böhler; Prof. Dr. Michael Bongardt; Wolfgang Freese; Bernadette Herrmann, M.A.; Sebastian Höpfl; Bischof em. Prof. Dr. Dr. h.c. mult. Wolfgang Huber; Dr. Grigori Katsakoulis; Pfarrer Wolfgang Klein; Wolfgang Korb; Dr. Lena Kornyeyeva; Prof. Dr. Dr. h.c. Klaus Leisinger; Prof. Dr. Dr. h.c. Hans Lenk; Prof. Dr. Ulf Liedke; Prof. Dr. Alfons Matheis; Dr. Olaf Meyer; Dr. Jürgen Naeher-Zeiffer; Stephanie von Dallwitz; Dr. Marianne Rabe; Dr. Manuela Rottmann, MdB; PD Dr. Dr. Thomas Rusche; Prof. Dr. Johann Michael Schmidt; Dr. Eva-Maria Schwickert; Maritta Strasser, M.A.; OB Dr. Dirk Vogel and Prof. Dr. Anatoliy Yermolenko. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:diacritics 30.2 (2000) 25-42 [Access article in PDF] What is Political Feeling? Bernadette Meyler Anthony Cascardi. Consequences of Enlightenment. Cambridge: Cambridge UP,1999. As disaffection with poststructuralism increases, but new paradigms have not yet emerged, theorists have begun to reconsider the ties that current thought maintains with the tradition it critiques, in particular, its affiliations with the Enlightenment. Focus has inevitably fallen on the writings of Immanuel Kant, which (...) in the act of codifying Enlightenment rationality simultaneously initiated its dissolution. Disputes tend to arise, however, over the precise nature and cause of the hairline fracture that prevents Kant's Critiques from attaining the unity to which they aspire. Even greater controversy centers on the advisability of possible responses: should we set the bones, break open the gap, or provide an entirely new limb? In Consequences of Enlightenment, Anthony Cascardi undertakes a detailed discussion of how various theoretical schools interpret the fissure, and the problems posed by their accounts. Not simply remaining content with this critique of critiques, Cascardi presents his own stance, advising that we embrace Kant's recourse to "feeling" in the Critique of Judgment as an inevitable entailment of the Kantian system. Whereas Horkheimer and Adorno's Dialectic of Enlightenment argues that the opposition between Kantian reason and Nietzschean irrationalism represents the undoing of the Enlightenment, Cascardi responds that Kant's own writings encompass the duality. As an essential moment of what he terms the Enlightenment's "aesthetic critique," the resistance that feeling poses to "the unity of experience"--or to the unity of the Critique of Pure Reason and the Critique of Practical Reason--should be embraced. Cascardi further maintains that this "should" entails political consequences, although his text does not itself fully elaborate a vision of what these might be.The fact that such a rich suggestion remains relatively undeveloped is perhaps inevitable in a book of such comprehensive scope. Consequences of Enlightenment is a text that seems to call the reader to the task of continuing the multiple projects that Cascardi has initiated. I will attempt to articulate what those endeavors might be, and to propose points in his work upon which future inquiry could be focused. Because Cascardi's goals are two-pronged--to examine twentieth-century thinkers' Kantian inheritance and to engage directly with the "aesthetic critique" of Kant--it is sometimes difficult to ascertain whether Consequences of Enlightenment attributes certain positions to Kant or to his interpreters. Although this difference might not seem significant given Cascardi's claims about the persistence of Kantian aporias in the work of his inheritors, returning to Kant may allow us to ask how we should proceed in developing the political potentials of aesthetic critique. Two principal questions arise in this regard. The first inquires whether and how one can think aesthetics with politics; in other words, [End Page 25] what is political feeling? The second question provides a more limited point of entry into the same problem by focusing on the Critique of Judgment itself; what politics are entailed respectively by the beautiful and the sublime?Cascardi discusses the Kantian sublime only twice in detail during the course of Consequences of Enlightenment, once in chapter 4, "Communication and Transformation: Aesthetics and Politics in Habermas and Arendt," and for the second time, and most provocatively, in chapter 7, "Feeling and/as Force." In treating Hannah Arendt, who, in her 1970 Lectures on Kant's Political Philosophy, attempted to derive a Kantian account of the political from the Critique of Judgment, Cascardi explains that she tried to complete the Enlightenment by erroneously "turning from the indeterminacy of the aesthetic in Kant to a politics that designates democratic community as its field or object-domain"; he then asserts that, "Specifically, the politics that Arendt would claim to derive from Kant's aesthetics is a democratic politics of the beautiful..." [156]. Subsequently elaborating on the reasons that Arendt overemphasized the beautiful, seemingly at the expense of the sublime, Cascardi writes, "Arendt's tendency to privilege the beautiful over the sublime must be seen as part of her larger effort to construct a rational politics. For this effort, she takes... (shrink)

Stakeholder theory provides a framework for investigating the relationship between corporate social performance (CSP) and corporate financial performance. This relationship is investigated by examining how change in CSP is related to change in financial accounting measures. The findings provide some support for a tenet in stakeholder theory which asserts that the dominant stakeholder group, shareholders, financially benefit when management meets the demands of multiple stakeholders. Specifically, change in CSP was positively associated with growth in sales for the current and subsequent (...) year. This indicates that there are short-term benefits from improving CSP. Return on sales was significantly positively related to change in CSP for the third financial period, indicating that long-term financial benefits may exist when CSP is improved. (shrink)

Despite advances in theory, often driven by feminist ethicists, research ethics struggles in practice to adequately account for and respond to the agency and autonomy of people considered vulnerable in the research context. We argue that shifts within feminist research ethics scholarship to better characterise and respond to autonomy and agency can be bolstered by further grounding in discourses from the social sciences, in work that confirms the complex nature of human agency in contexts of structural and other sources of (...) vulnerability. We discuss some of the core concepts and critiques emerging from the literature on women and children's agency in under‐resourced settings, highlighting calls to move from individualistic to relational models of agency, and to recognise the ambiguous, value‐laden, and heterogeneous nature of the concept. We then draw out what these conceptual shifts might mean for research ethics obligations and guidance, illustrating our analysis using a case vignette based on research ethics work conducted in South Africa. We conclude that if research practices are to be supportive of agency, it will be crucial to scrutinise the moral judgements which underpin accounts of agency, derive more situated definitions of and responses to agency, and enable people and participants to influence these based on their own experiences and self‐perceptions. (shrink)

According to evolutionary theory, emotions are psychological mechanisms that have evolved to enhance fitness in specific situations by motivating appropriate (adaptive) behavior. Taking this perspective, a previous study examined the relationship between mood and preference for natural environments. It reported that participants’ anxiety level was associated with a preference for landscapes offering what Appleton called "refuge," while participants’ anger and cheerfulness were both associated with a preference for landscapes offering what Appleton called "prospect." We attempted to replicate these results and (...) to improve on the study by experimentally manipulating mood. Using a between-subjects design, 80 participants were instructed to self-induce one of four moods: anger, sadness, anxiety, or joy. After the mood induction, they viewed fourteen landscape photographs and recorded the seven most preferred. It was hypothesized that subjects experiencing anger or joy would prefer landscapes rich in "prospect" features, whereas participants experiencing sadness or anxiety would prefer landscapes rich in "refuge" features. In contrast to the previous study, the predictions were not supported: artificially induced moods may not provide ecological validity as a test of the "mood as motivator" model; alternatively, the first study may have reported an alpha error. To see whether the model has practical value, we recommend a study of landscape preference using participants with clinically significant levels of mood dysphoria. (shrink)

Furthering an integrative ethics-as-practice framework, this paper explores the professional practices, self-understanding and ethics of lawyers working in the Germanic legal context. Existing studies of the legal profession often argue that changing conditions in law have led to a ‘constrained morality’ and an ‘erosion of ethos’ among lawyers. While the current study acknowledges shifts in lawyers’ ethos, it challenges the claim of an erosion or ‘lack’ of morality. The narratives of the interviewed practitioners rather suggest that socio-discursively constituted professional practices, (...) identity and ethics are complex and contingent. Focusing on the ‘moral rules in use’ and how lawyers negotiate ethical matters ‘from within’ evokes ongoing ambiguities and struggles inscribed in ethical (self-)positions, pointing, as such, to the limits of assessing lawyers’ conduct as ‘ethical’ or ‘unethical’. The study thereby extends both normative and practice-based business and professional ethics studies. (shrink)

This paper, conceptually mainly informed by Michel Foucault’s notion of morality, ethics, and ethical practice, illustrates the power program and the moral codes which currently govern the professional field of the arts. Building on empirical material from the field of theatre, the paper discusses how the moral codes and subject ideals that are promoted through the ‘culturepreneurial’ program affect and shape the subjectivity of artists and their specific modes of organizing ethical relations to self and others (Foucault 1984, 1986). The (...) insights of the study emphasize that subjectification presents a dynamic and precarious process. Discursively promoted moral codes are used by the artists in a variety of ways; they are accepted, undermined, and re-created. While doing so, artistic professionals contribute to both their own subjection and in-subordination. (shrink)

An innovative approach to rethinking sciences of mind at the turn of the twenty-first century via the texts of philosopher and psychologist William James.

The 21st century is steeped in claims to interconnection, technological innovation, and new affective intensities amid challenges to the primacy and centrality of 'the human'. Flashpoint epistemology attends to the lived difficulties that arise in teaching, policymaking, curriculum and research among continuous practices of differentiation, and for which there is no pre-existing template for judgment, resolution or action. Flashpoint Epistemology Volume 1 examines contemporary collisions and reworkings of cultural-political issues in education through arts and humanities-based approaches. How and whether lines (...) are (re)drawn in educational practice - and via who-what - between justice, morality, religion, ethics, subjectivities, intersectionality, the sublime and the senses are a particular focus. The volume offers innovative relational approaches and new narrativization strategies, examining the aporia experienced when operating in educational domains of inevitable, recurring, difficult, fortuitous and/or unforeseen flashpoints. The chapters will engage researchers seeking new approaches to education's complexities, nested discourses, and ever-moving horizons of enactment. It will also benefit post/graduate students and teachers whose work intersects with sociological, philosophical and cultural studies and who are curious about claims to interconnection, the ethical quandaries embedded in practice, and the affordances and limits of technological innovation. (shrink)

La notion de médiation culturelle s'est institutionnalisée dans le monde culturel et dans le monde universitaire. Son analyse concerne la situation de médiation et le système de médiations comme répertoire d'actions, ce qui engage deux dimensions: la dimension historique et la dimension politique. Il est donc nécessaire, tant dans la recherche que dans les formations, de maintenir une distance critique envers certaines conceptions mythiques de la notion.The concept of cultural mediation has become an institutionalized part of the worlds of both (...) culture and the university. Analysis of the concept covers the context of mediation and the general system of mediations, understood as a repertoire of actions. This brings into play two dimensions, historical and political. It is therefore necessary to maintain a critical distance from certain mythologizing versions of this notion, as much in research as in education and training. (shrink)

Les événements culturels internationaux constituent-ils un système symbolique indépendant des médias? Le propos de cet article s'inscrit dans une théorie générale de la trivialité, c'est-à-dire de la circulation des concepts entre la sphère de la production culturelle et celle des médias. Sans remettre en cause l'apport fondamental de Davidson à la théorie de l'événement - à savoir qu'un événement existe indépendamment de toute reconstruction ultérieure notamment par les médias - et, au contraire, en soulignant les apports d'une sémantique de l'histoire (...) pour comprendre une production culturelle, il cherche à mettre en évidence les interactions entre ces deux sphères, notamment les rôles du dispositif et du répertoire d'actions dans la pré-construction de l'information et l'incorporation de certains éléments du débat mené dans les médias par la sphère culturelle. S'il ne peut pas proposer une définition arrêtée de l'événement culturel international, en revanche, le chercheur peut observer le travail permanent de reconfiguration que couvre la catégorisation de ces événements.The international cultural events they are a symbolic system independent media? The purpose of this article is part of a general theory of triviality, that is to say, the circulation of concepts between the sphere of cultural production and the media. Without jeopardizing the fundamental contribution of Davidson's theory of the event - ie an event exists independently of any subsequent reconstruction by the media - and, instead, highlighting the contributions of the semantics history to understand cultural production, it seeks to highlight the interactions between these two spheres, including the roles of the device and directory actions in the pre-construction information and the incorporation of some elements of the debate conducted in the media by the cultural sphere. If they can not provide a conclusive definition of the international cultural event, however, the researcher can observe the work of permanent reconfiguration covers the categorization of these events. (shrink)

Knowledge of the structure of ancestral genomes provides the basis of a new framework to better represent and interpret results from genomic and evolutionary studies. Because these ancestors lived tens of hundreds of million years ago, this knowledge will inevitably take the form of abstract representations, reconstructed on the basis both of experimental evidence collected on extant genomes and of our understanding of evolutionary processes. This is the field of Paleogenomics, a young discipline that is providing an increasingly precise picture (...) of our ancestral vertebrate genomes based on cytogenetic data, genome sequences and new algorithmic developments. Many recent studies have focused on the ancestral placental mammal and teleost fish genomes, although the outlines of even more distant pre‐vertebrate ancestors are being reported. BioEssays 30:122–134, 2008. © 2008 Wiley Periodicals, Inc. (shrink)