This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral dimension? and (2) how do self-esteem and personal identity relate to the professional identity of nurses? We demonstrate it is important that the moral and personal goals in nurses' life coincide. If nurses' personal view of (...) the good life is compatible with their experiences and feelings as professionals, this improves their performance as nurses. We also discuss how good nursing depends on the responses that nurses receive from patients, colleagues and family; they make nurses feel valued as persons and enable them to see the value of the work they do. (shrink)

Good nursing is more than exercising a specific set of skills. It involves the personal identity of the nurse. The aim of this article is to answer two questions: (1) what kind of person should the hospice nurse be? and (2) how should the hospice nurse engage in caring conversations? To answer these questions we analyse a nurse’s story that is intended to be a profile of an exemplary hospice nurse. This story was constructed from an analysis of five semistructured (...) interviews with hospice nurses, based on the ‘ethics of the caring conversation’, which is inspired by the ethical perspective of Paul Ricoeur. The research questions concentrate on the norms of respect, responsibility and reciprocity, which are integral parts of the ‘ethics of the caring conversation’. (shrink)

A closer look at the lived illness experiences of medical professionals themselves shows that shared decision making is in need of a logic of care. This paper underlines that medical decision making inevitably takes place in a messy and uncertain context in which sharing responsibilities may impose a considerable burden on patients. A better understanding of patients’ lived experiences enables healthcare professionals to attune to what individual patients deem important in their lives. This will contribute to making medical decisions in (...) a good and caring manner, taking into account the lived experience of being ill. (shrink)

The main measure of quality of life is well-being. The aim of this article is to compare insights about well-being from contemporary philosophy with the practice-related opinions of palliative care professionals. In the first part of the paper two philosophical theories on well-being are introduced: Sumner’s theory of authentic happiness and Griffin’s theory of prudential perfectionism. The second part presents opinions derived from interviews with 19 professional palliative caregivers. Both the well-being of patients and the well-being of the carers themselves (...) are considered in this empirical exploration. In the third part the attention shifts from the description of “well-being” to prescriptions for the promotion of well-being. Our interview data are analysed in light of the theories of Sumner and Griffin for clues to the promotion of “well-being.” The analysis (1) underscores the subject-relativity of well-being, (2) points out that values that are considered important in every life still seem to be relevant (at least in palliative care practice), and (3) shows the importance of living a certain sort of life when aiming to enhance dying patients’ well-being. (shrink)

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were formulated to (...) improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory. (shrink)

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were formulated to (...) improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory. (shrink)

Patient participation in healthcare is highly promoted for democratic reasons. Older patients make up a large part of the hospital population but their voices are less easily heard by most patient participation instruments. The client council can be seen as an important medium to represent the interests of this increasing group of patients. Every Dutch healthcare institution is obliged to have a client council and its rights are legally established. This paper reports on a case study of a client council (...) in a hospital and shows how equality as the core democratic value manifests itself in practice and marginalizes the voices of older patients. Based on the work of Joan Tronto we show that sameness is the driving force behind the functioning of the client council which leads the council to operate as part of the hospital system. Consequently, important aspects of the hospital practice remain out of sight. To be of greater value for all patients we argue that successful patient participation requires not only equal opportunities but also ‘the condition of equal voice’. (shrink)

Patient participation in healthcare is highly promoted for democratic reasons. Older patients make up a large part of the hospital population but their voices are less easily heard by most patient participation instruments. The client council can be seen as an important medium to represent the interests of this increasing group of patients. Every Dutch healthcare institution is obliged to have a client council and its rights are legally established. This paper reports on a case study of a client council (...) in a hospital and shows how equality as the core democratic value manifests itself in practice and marginalizes the voices of older patients. Based on the work of Joan Tronto we show that sameness is the driving force behind the functioning of the client council which leads the council to operate as part of the hospital system. Consequently, important aspects of the hospital practice remain out of sight. To be of greater value for all patients we argue that successful patient participation requires not only equal opportunities but also ‘the condition of equal voice’. (shrink)

Hospitalization significantly impacts the lives of older people, both physically and psychosocially. There is lack of observation studies that may provide an embodied understanding of older patients’ experiences in its context. The aim of this single case study was to reach a deeper understanding of one older patient’s lived experiences of hospitalization. The study followed a phenomenological embodied enquiry design and the qualitative observation method of shadowing was used. In April 2011, one older patient was shadowed for 7 days, 5–7 (...) h per day. To facilitate understanding in the reader the experiences are first presented in a story and subsequently analyzed by means of the lifeworld framework. The findings show that hospitalization is experienced as ambiguous safety, disconnected time, the feeling of being partially involved, and the struggle to re-attune to the body. (shrink)

Phenomenological healthcare research should include the lived experiences of a broad group of healthcare users. In this paper it is shown how shadowing can give a voice to people in vulnerable situations who are often excluded from interview studies. Shadowing is an observational method in which the researcher observes an individual during a relatively long time. Central aspects of the method are the focus on meaning expressed by the whole body, and an extended stay of the researcher in the phenomenal (...) event itself. Inherent in shadowing is a degree of ambivalence that both challenges the researcher and provides meaningful insights about the phenomenon. A case example of a phenomenological study on the experiences of elderly hospital patients is used to show what shadowing yields. (shrink)

Considered by many to be Abraham Robinson's magnum opus, this book offers an explanation of the development and applications of non-standard analysis by the mathematician who founded the subject. Non-standard analysis grew out of Robinson's attempt to resolve the contradictions posed by infinitesimals within calculus. He introduced this new subject in a seminar at Princeton in 1960, and it remains as controversial today as it was then. This paperback reprint of the 1974 revised edition is indispensable reading for anyone interested (...) in non-standard analysis. It treats in rich detail many areas of application, including topology, functions of a real variable, functions of a complex variable, and normed linear spaces, together with problems of boundary layer flow of viscous fluids and rederivations of Saint-Venant's hypothesis concerning the distribution of stresses in an elastic body. (shrink)

Recent discussions in the various circles of feminism, postmodernism, and environmentalism have begun to make clear that ontology and epistemology without ethics is deadly - oppressive to women, oppressive to men, oppressive to the earth. In response to this crisis of reason in modernity, this collection of essays suggests the importance of knowing other-wise, non-rational ways of knowing which are wise to the "other" - a spiritual knowing of the heart with the passionate eye of love. Knowing Otherwise calls into (...) question the Western philosophical tradition of giving pride of place to reason in the acquisition of knowledge. Reasoning is only one of many ways in which we engage, i.e. know, the world. We know more than we think. We know by touch, by feel, by taste, by sight, by sounds, by smell, by symbols, by sex, by trust - by means of every modality of human experience. Philosophy becomes, in the fashion of Levinas, "the wisdom of love at the service of love. Tracing connections between epistemology, ethics, and spirituality - between "knowing" and the "other," between an other and the Other - all the essays serve as points of convergence between postmodern discussions and the Calvinian spirituality which is the home for writers in this collection. In particular, this collection explores the contributions of feminist thought and thinkers such as Emmanuel Levinas, Richard Rorty, Jacqes Derrida, and John D. Caputo to a spiritually and ethically sensitive knowing. (shrink)

This article reports on moral problems that were raised by medical students as the basis for an ethical case-conference in an obstetrics and gynaecology clerkship. After introducing the issue of teaching clinical ethics, the method of our case-conference is explained. Next, the variety of topics and related moral problems are presented. The article continues with a discussion of three distinct and challenging aspects that characterise obstetrics and gynaecology as a domain for teaching clinical ethics. The conclusion puts forward three significant (...) points our review raises. (shrink)

Prologue: on the weakness of education -- Creativity -- Communication -- Teaching -- Learning -- Emancipation -- Democracy -- Virtuosity -- Epilogue: for a pedagogy of the event -- Appendix: coming into the world, uniqueness, and the beautiful risk of education: an interview with Gert Biesta by Philip Winter.

This book offers the fullest and most sophisticated account of Gert's influential moral theory, a model first articulated in the classic work The Moral Rules: A New Rational Foundation for Morality, published in 1970. In this final revision, Gert makes clear that the moral rules are only one part of an informal system that does not provide unique answers to every moral question but does always provide a range of morally acceptable options. A new chapter on reasons includes (...) an account of what makes one reason better than another and a second new chapter is devoted to the question of justifying violations of the rules. Moral impartiality, the moral ideals, and virtue and vice, are all treated in greater detail. Throughout, Gert attempts to answer all of the challenges that his work has provoked. (shrink)

An updated and expanded successor to Culver and Gert's Philosophy in Medicine, this book integrates moral philosophy with clinical medicine to present a comprehensive summary of the theory, concepts, and lines of reasoning underlying the ...

The second volume in Joel Feinberg's series The Moral Limits of the Criminal Law, Offense to Others focuses on the "offense principle," which maintains that preventing shock, disgust, or revulsion is always a morally relevant reason for legal prohibitions. Feinberg clarifies the concept of an "offended mental state" and further contrasts the concept of offense with harm. He also considers the law of nuisance as a model for statutes creating "morals offenses," showing its inadequacy as a model for understanding "profound (...) offenses," and discusses such issues as obscene words and social policy, pornography and the Constitution, and the differences between minor and profound offenses. (shrink)

Moral problems do not always come in the form of great social controversies. More often, the moral decisions we make are made quietly, constantly, and within the context of everyday activities and quotidian dilemmas. Indeed, these smaller decisions are based on a moral foundation that few of us ever stop to think about but which guides our every action. Here distinguished philosopher Bernard Gert presents a clear and concise introduction to what he calls "common morality" -- the moral system (...) that most thoughtful people implicitly use when making everyday, common sense moral decisions and judgments. Common Morality is useful in that -- while not resolving every disagreement on controversial issues -- it is able to distinguish between acceptable and unacceptable answers to moral problems. In the first part of the book Gert lays out the fundamental features of common morality: moral rules, moral ideals, and a two-step procedure for determining when a violation of a moral rule is justified. Written in a non-technical style, the ten general moral rules include rules on which everyone can agree, such as "do not kill," "do not deceive," and "keep your promises." The moral ideals include similarly uncontroversial precepts such as "Relieve pain" and "Aid the needy." In the second part of the book Gert examines the underlying concepts that justify common morality, such as the notions of rationality and impartiality. The distillation of over 40 years of scholarship, this book is the most accessible version of Gert's influential theory of morality as well as an eye-opening look at the moral foundations of our everyday actions. Throughout the discussion is clear enough for a reader with little or no philosophy background. (shrink)

The use of philosophy in educational programmes and practices under such names as philosophy for children, philosophy with children, or the community of philosophical enquiry, has become well established in many countries around the world. The main attraction of the educational use of philosophy seems to lie in the claim that it can help children and young people to develop skills for thinking critically, reflectively and reasonably. By locating the acquisition of such skills within communities of enquiry, the further claim (...) is that engagement with philosophy can foster the development of moral reflection and sensitivity and of social and democratic skills more generally. Claims like these provide a set of arguments for the inclusion of philosophy in the school curriculum that goes well beyond philosophy as just another curricular subject or body of knowledge. The aim of this article is to raise some questions about the conception of education that appears to inform the discussion about the educational use of philosophy. My ambition is to suggest an additional rather than an alternative view about the educational use of philosophy in the hope that this may act as a reminder of a different way in which one can engage with philosophy in educational settings which, in turn, might also act as a reminder of how philosophy might engage with us. The philosophical distinction in which my argument is phrased is that between humanism and post-humanism and the guiding educational concept is that of exposure. (shrink)

_Obstinate Education: Reconnecting School and Society_ argues that education is not just there to give individuals, groups and societies what they want from it, but that education has a duty to resist.

In lieu of an abstract, here is a brief excerpt of the content:“Above and Beneath Classification”: Bartleby, Life and Times of Michael K, and Syntagmatic ParticipationGert Buelens (bio) and Dominiek Hoens (bio)The history of the relation between the law, norm, or rule on the one hand and what forms an exception to that rule on the other is complex and multifaceted.1 In the most general terms, one could posit that the exception is that which escapes from the rule. Thus, confronted (...) with the strangeness of Michael K, his noncommunicativeness, his odd combination of meekness and intransigence, the medical officer in J. M. Coetzee’s Life and Times of Michael K assigns K a place “above and beneath classification” [Coetzee 151]. Michael K is at once too large and too small to fit into the administrative and humanitarian categories that pertain at the prisoner camp. He appears to the medical officer—whose good intentions and patient, selfless interest in K cannot be doubted—as a recalcitrant, nonidentifiable object that flirts with dehumanization. To put it in Bataille’s terms, Michael K is formless (informe), and his existence can, by mere virtue of that fact, be called scandalous.2Let us take a closer look at the expression “above and beneath classification.” We can note that (1) it names something that situates itself on the outside of any classification; (2) this something must have a paradoxical status, since it is at once above and beneath classification; (3) the nonclassifiable is regarded as such from a classifying perspective. Although the latter point may sound tautological, it nonetheless touches upon one of the most difficult dimensions of the exception: if the exception is always an exception to the rule, how can it exist otherwise than by virtue of that rule? how can it be more than just the rule’s negative? But if the exception radically breaks away from the rule, then how is it possible for that rule to identify the exception and recognize it as such? This crucial problem has formed the basis for reflection on the relation between rule and exception. Freud, for instance, saw the exception (crime) as constitutive of social ties and the social order. Lacan needed a special topology to show the extimate character of what is at once inside and outside the symbolic order [Lacan, Miller]. Religious ways of thinking could be said to have located the exception as transcendent to any human order. For Badiou, the secularization of the infinite cannot be thought apart from an immanent, rather than transcendent, event that is disruptive of all order. In Derrida’s subtle analyses, the originary supplement appears as both constitutive and deconstructive. Agamben regards the exception as having become the political rule. These interpretative frameworks, in spite of some deep distinctions, all show not only that the rule cannot do without the exception, but that the exception is just as dependent on the rule. Even when the exception is regarded as a kind of pure, ruleless being-as-such, the rule is at the very least conceptually [End Page 157] indispensable for this pure, mere being to be thinkable in the first place. In brief, however much one may want, for political or other reasons, to assign the exception a central place at the expense of the rule, that rule remains inescapable.Nonetheless, the inevitability of the rule should not lead us to conclude that it is also immutable, nor that we should adopt a conservatism that accepts the rule as a repressive normativity or as an inclusive and exclusive apparatus of judgment. That this is as impossible as it is undesirable is suggested by what we indicated under the second item: the exception is both above and beneath. The exception is the paradoxical given of that which at once escapes from existing categories and lacks all identity in that escape. The problem that Michael K and Bartleby, the second figure of exception we consider in this essay, present for the rule resides not just in the recalcitrance that allows them to show up the limits of the rule, but also in the doubling with which this goes hand in hand. Michael K and Bartleby are as pliant as they are obdurate, show great loyalty even... (shrink)

Religion wurde seit jeher als eine zentrale Begründung moralischer Prinzipien gehandelt. Im Rahmen der fortschreitenden Modernisierung scheint diese Verbindung brüchig zu werden. Empirisch sind nicht nur immer wieder eine (Re-) Modernisierung der Religion, sondern auch erneute religiöse Fundierungen von Moral zu beobachten. Wie ist nun die Beziehung zwischen Religion und Moral konstituiert? Sind religiös-moralische Bedingungszusammenhänge überhaupt in der Realität institutionalisiert und empirisch feststellbar? Verfällt die Moral in und durch ein Auseinanderdriften zu religiösen Überzeugungen? Entsprechend der Themenstellung, wird ein interdisziplinärer Zugang (...) gewählt, der ausgehend von religionssoziologischen Gedanken, Auseinandersetzungen mit dem Thema in der Philosophie, Pädagogik und Theologie berücksichtigt. Neben der theoretischen Diskussion der Beziehungen von Religion und Moral, werden (auch methodisch) verschiedene Analysen zu der Aufdeckung und näheren Betrachtung dieser Wechselbeziehungen in verschiedenen europäischen Gesellschaften vorgelegt. (shrink)

In this essay, Gert Biesta provides a critical analysis of the idea of evidence‐based practice and the ways in which it has been promoted and implemented in the field of education, focusing on the tension between scientific and democratic control over educational practice and research. Biesta examines three key assumptions of evidence‐based education: first, the extent to which educational practice can be compared to the practice of medicine, the field in which evidence‐based practice was first developed; second, the role (...) of knowledge in professional actions, with special attention to what kind of epistemology is appropriate for professional practices that wish to be informed by the outcomes of research; and third, the expectations about the practical role of research implicit in the idea of evidence‐based education. Biesta concludes that evidence‐based practice provides a framework for understanding the role of research in educational practice that not only restricts the scope of decision making to questions about effectivity and effectiveness, but that also restricts the opportunities for participation in educational decision making. He argues that we must expand our views about the interrelations among research, policy, and practice to keep in view education as a thoroughly moral and political practice that requires continuous democratic contestation and deliberation. (shrink)

Studies of the association between wealth and fertility in industrial populations have a rich history in the evolutionary literature, and they have been used to argue both for and against a behavioral ecological approach to explaining human variability. We consider that there are strong arguments in favor of measuring fertility (and proxies thereof) in industrial populations, not least because of the wide availability of large-scale secondary databases. Such data sources bring challenges as well as advantages, however. The purpose of this (...) article is to illustrate these by examining the association between wealth and reproductive success in the United States, using the National Longitudinal Study of Youth 1979. We conduct a broad-based exploratory analysis of the relationship between wealth and fertility, employing both cross-sectional and longitudinal approaches, and multiple measures of both wealth (income and net worth) and fertility (lifetime reproductive success and transitions to first, second and third births). We highlight the kinds of decisions that have to be made regarding sample selection, along with the selection and construction of explanatory variables and control measures. Based on our analyses, we find a positive effect of both income and net worth on fertility for men, which is more pronounced for white men and for transitions to first and second births. Income tends to have a negative effect on fertility for women, while net worth is more likely to positively predict fertility. Different reproductive strategies among different groups within the same population highlight the complexity of the reproductive ecology of industrial societies. These results differ in a number of respects from other analyses using the same database. We suggest this reflects the impossibility of producing a definitive analysis, rather than a failure to identify the “correct” analytical strategy. Finally, we discuss how these findings inform us about (mal)adaptive decision-making. (shrink)

Is fertility relevant to evolutionary analyses conducted in modern industrial societies? This question has been the subject of a highly contentious debate, beginning in the late 1980s and continuing to this day. Researchers in both evolutionary and social sciences have argued that the measurement of fitness-related traits (e.g., fertility) offers little insight into evolutionary processes, on the grounds that modern industrial environments differ so greatly from those of our ancestral past that our behavior can no longer be expected to be (...) adaptive. In contrast, we argue that fertility measurements in industrial society are essential for a complete evolutionary analysis: in particular, such data can provide evidence for any putative adaptive mismatch between ancestral environments and those of the present day, and they can provide insight into the selection pressures currently operating on contemporary populations. Having made this positive case, we then go on to discuss some challenges of fertility-related analyses among industrialized populations, particularly those that involve large-scale databases. These include “researcher degrees of freedom” (i.e., the choices made about which variables to analyze and how) and the different biases that may exist in such data. Despite these concerns, large datasets from multiple populations represent an excellent opportunity to test evolutionary hypotheses in great detail, enriching the evolutionary understanding of human behavior. (shrink)

Among educational theorists and philosophers there is growing interest in the work of Jacques Derrida and his philosophy of deconstruction. This important new book demonstrates how his work provides a highly relevant perspective on the aims, content and nature of education in contemporary, multicultural societies.

The idea that ethics is a matter of personal feeling is a dogma widespread among medical students. Because emotivism is firmly rooted in contemporary culture, the authors think that focusing on personal feeling can be an important point of departure for moral education. In this contribution, they clarify how personal feelings can be a solid basis for moral education by focusing on the analysis of compassion by the French phenomenologist Emmanuel Housset. This leads to three important issues regarding ethics education: (...) the necessity of a continuous attention for and interpretation of the meaning of language, the importance of examining what aspect of “the other” touches one and what it is that evokes the urge to act morally and the need to relate oneself to the community, both to the medical community and to collectively formulated rules and laws. These issues can have a place in medical education by means of an ethical portfolio that supports students in their moral development. First, keeping a portfolio will improve their expression of the moral dimension of medical practice. Second, the effects of self-knowledge and language mastery will limit the pitfalls of emotivism and ethical subjectivism and will stimulate the inclination to really encounter the other. Third, it will show medical students from the start that their moral responsibility is more than following rules and that they are involved personally. (shrink)

Proper procedures for informed consent are widely recognized as an ethical requirement for biomedical research involving human beings, in particular as a means to respect the autonomy and personal integrity of potential and actual research participants.

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

Gert Scobel zeigt in seinem kenntnisreichen Buch, dass uns heute kaum etwas so sehr fehlt wie Weisheit: Im Umgang mit der Welt, mit anderen und uns selbst. Denn in unserer immer komplexer werdenden Umwelt, die uns mit Widersprüchen ebenso konfrontiert wie mit immer mehr Faktenwissen, brauchen wir Orientierung. Doch die fehlt. Und Weisheit stellt sich auch im Alter nicht von selbst ein. Gert Scobel belegt fundiert, dass man sie erlernen kann - und sollte. Dabei speist sich die Gelassenheit, (...) von der der Autor spricht, nicht aus esoterischen Höhenflügen, die oft mit einer unsanften Bauchlandung enden. Vielmehr ist sie inspiriert von den Lehren des Buddhismus, die Scobel überraschend mit der westlichen Geistesgeschichte versöhnt. Er verfolgt die Weisheit bis zu ihren Ursprüngen, ins Mittelalter und in den fernen Osten. Das Buch bringt uns aber auch die neusten Erkenntnisse zur Weisheit aus Psychologie, Neurowissenschaften, Biologie, Glücks- und Komplexitätsforschung nahe. Entstanden ist die faszinierende und anschaulich erzählte Geschichte einer Geisteshaltung, die sich nicht nur unterhaltsam und spannend liest, sondern auch mit großem persönlichem Gewinn. Denn Weisheit ist die Grundvoraussetzung für ein sinnvolles und geglücktes Leben. (shrink)