Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices, knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in Flanders, (...) Belgium. Nurses, care assistants and allied care staff completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels, as part of a cluster randomized controlled trial. Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated. After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations and documented advance care planning ; differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses ; 95% confidence interval 0.08–0.17; p < 0.001) and allied staff scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)

Creatively operationalizing Claude Lévi-Strauss’ predicament that food is good to think with, I initiate a methodological conceptualization of food by exploring the ways in which it is apt to study Sri Lankan domestic and collective village life. Food is approached as an assemblage that is an emergent resultant of heterogeneous aspects with which it is deeply entangled and by way of which it turns into a potent agent shaping life. More specifically, I explore the vibrancy of these different components that (...) co-create the overall soundscape of food that as such becomes the conductor of Sri Lankan life. Food shapes domestic life by way of its preparation and consumption, and through its cultivation also conducts the collective rhythms at the village level. The conceptualization of food as an assemblage seeks to develop it as a methodology that opens up for a holistic integration and interdisciplinary collaboration. (shrink)

This paper draws on an in-depth phenomenological analysis of some interviews taken from volunteers, inviting them to reflect on their lived experiences of meaningfulness in the context of volunteering and citizenship. It is found that while some testimonies reinforce the standard conceptions of meaningfulness, other testimonies vary from it. The main challenge of this contribution consists in phenomenologically describing this alternative picture of meaningfulness, depicted as the event of witnessing. In a final part, the authors consider how volunteering is at (...) times especially prone to further experiences of witnessing. (shrink)

Precision medicine research involving human biological material is becoming an increasingly central component of healthcare, and its potential is quickly growing due to rapid technological progress...

The American Journal of Bioethics, Volume 12, Issue 10, Page 10-12, October 2012.

The credit policy of the«Communal Bank» is based on objective criteria in order to respect local autonomy. The financial results of the consolidation are difficult to determine. Several factors could have influenced the present state of municipal finances : the consolidation being done in a period of economic difficulties, the crisis of the public finances, the reform of the Municipal Fund, and the transformation of the Centers for Public Assistance into Public Centers for Social Welf are. The consolidations did not (...) generale any savings, but it al,so did not cause an alarming increase of expenses. With respect to budget balancing, the amalgamated municipalities should do better than the non-amalgamated municipalities. To keep the increase of expenses low in comparison with the revenues, the municipalities had to make cuts in several sectors.As to the current fniancial situation in the three regions, the municipalities of the Brussels regon are in a very painful situation ; in Flanders, the number of municipalities with deficits is higher than in Wallonia, but the deficits in W allonia are bigger. To stop this negative evolution one must strive for balanced budgets and reshape them into reliable instruments. (shrink)

Raphaël Van Daele L’expression chinoise ziran 自然 s’entend aussi bien à propos de la « nature », cette région de l’être dont l’émergence et les processus ne relèvent pas de la volonté ou de l’action humaine, qu’à propos d’un certain type d’agir humain. Le geste expert de l’artiste est l’exemple privilégié d’un tel agir. Loin de nuire à la cohérence de cette notion, le fait que celle-ci soit mobilisée dans le discours théorique sur l’art autant que dans le discours sur (...) la nature témoigne d’un lien organique qui, dans la pensée chinoise, unit différents domaines de la réflexion. Le présent article propose d’esquisser une lecture philosophique de la notion de ziran. Pour ce faire, nous explorerons le rôle joué par ziran dans l’oeuvre esthétique de Cai Yong 蔡邕 (133-192) et dans la pensée de Guo Xiang 郭象 († 312). (shrink)

In this comment on Johan Von Essen’s contribution on the meaning of volunteering we make some remarks about Von Essen’s starting point, which reveals a particular perspective on meaningfulness, namely that people perceive reality as meaningful when their actions and the things they encounter are part of a meaningful whole. By introducing another perspective on meaningfulness, namely that the shattering of a meaningful whole is full of meaning, we question if practices of volunteering which occur in face-to-face situations—and thus outside (...) the public realm—can be fully captured by the five predicates that make up the phenomenological structure of volunteering. (shrink)

Food and life are intimately entangled. To grasp the underlying complexity of this seemingly simple statement, this article first introduces the approach to food/eating as an assemblage enacted by various heterogeneous components, and further develops it by engaging with actor network theory and material semiotics. Thereafter the focus turns to ‘entanglement’, as inspired by quantum physics, to elicit the basic dynamics of the entanglement of food and more-than-human beings, conceived of as involving mutual and differential becomings within and among assemblages. (...) The article illustrates these entangled becomings by drawing upon examples from Sri Lanka, which in an intercultural philosophical fashion serve to establish an articulation (in the sense of a connection) between the proposed abstract approach to food and some basic premises of Buddhism and Ayurveda, a South Asian health system. Overall, the article crafts a conceptual toolbox and performs ontological groundwork wherein food and human beings as entangled assemblages provide a productive, refined, and sensitive research apparatus for the intimate study of more-than-human life and organization while also spurring novel theorizations through food/eating. (shrink)

The essay describes with great clarity the situation of publishing in the XVI-XVII Centuries, focussing on several important examples of Flemish books.

Moral sensitivity and moral reasoning are essential competencies biomedical researchers have to develop to make ethical decisions in their daily practices. Previous research has shown that these competencies can be developed through ethics education. However, it is unclear which underlying mechanisms best support the development of these competencies. In this article we argue that the development of moral sensitivity and moral reasoning can be fostered through teaching strategies that tap into students’ moral imagination. We describe how moral imagination can stimulate (...) the development of these competencies through three different merits of moral imagination. Moral imagination can help students to 1) transfer and apply abstract moral concepts to concrete situations and contexts, 2) explore the perspective of others, 3) explore and foresee the moral consequences of different decisions and actions. We explain these three merits of moral imagination in the context of biomedical research and present a theoretical model for how these merits can be used to stimulate the development of moral sensitivity and moral reasoning. Furthermore, we describe multiple teaching strategies for biomedical curricula that tap into the three merits of moral imagination. These teaching strategies can inspire teachers to design ethics education that activates students’ moral imagination for the development of moral sensitivity and moral reasoning. (shrink)

Le présent livre est audacieux et marque, à n’en pas douter, une avancée pour les recherches sur la pensée de Damascius. Tiré de la thèse de doctorat de l’auteur, le livre interroge le concept de causalité comme procession dans le Traité des premiers principes (De principiis) de Damascius. Pelin entend se distancier de ce qu’il estime être une tendance dominante des études damascéennes (p. 32-33) : plutôt que de lire le De principiis dans une perspective épistémologique et d’y voir une (...) enquêt... (shrink)

International documents on ethical conduct in clinical research have in common the principle that potential harms to research participants must be proportional to anticipated benefits. The anticipated benefits that can justify human research consist of direct benefits to the research participant, and societal benefits, also called social value. In first-in-human research, no direct benefits are expected and the benefit component of the risks-benefit assessment thus merely exists in social value. The concept social value is ambiguous by nature and is used (...) in numerous ways in the research ethics literature. Because social value justifies involving human participants, especially in early human trials, this is problematic. (shrink)

Regenerative Medicine promises to develop treatments to regrow healthy tissues and cure the physical body. One of the emerging developments within this field is regenerative implants, such as jawbone or heart valve implants, that can be broken down by the body and are gradually replaced with living tissue. Yet challenges for embodiment are to be expected, given that the implants are designed to integrate deeply into the tissue of the living body, so that implant and body become one. In this (...) paper, we explore how regenerative implants may affect the embodied experience of implant recipients. To this end, we take a phenomenological approach. First, we explore what insights the existing phenomenological and empirical literature on embodiment offers regarding the experience of illness and of living with regular (non-regenerative) implants and organ transplants. Second, we apply these insights to better understand how future implant recipients might experience living with regenerative implants. Third, we conclude that concepts and considerations from the existing phenomenological literature do not sufficiently address what it might be like to live with an implantable technology that, over time, becomes one with the living body. We argue that the interwovenness and intimate relationship of people living with regenerative implants should be understood in terms of ‘entanglement’. Entanglement allows us to explore the complexities of human-technology relations, acknowledging the inseparability of humans and implantable technologies. Our theoretical foundations regarding the role of embodiment may be tested empirically once more people will be living with regenerative implants. (shrink)

There is a growing consensus that the offer of a reasonable compensation for oocyte donation for reproductive treatment is acceptable if it does not compromise voluntary and altruistically motivated donation. However, how to translate this ‘reasonable compensation’ in practice remains unclear as compensation rates offered to oocyte donors between different European Union countries vary significantly. Clinics involved in oocyte donation, as well as those in other medical contexts, might be encouraged in calculating a more consistent and transparent compensation for donors (...) if the elements that constitute a reasonable compensation are explicated. In doing so, lessons can be learnt from living organ donation and medical research participation. Practices in which the elements of a reasonable compensation for the individuals involved have already been more defined in the literature. By means of analogical reasoning, we will outline the different components of a reasonable compensation and subsequently apply these to the context of oocyte donation. We will argue that oocyte donors should first of all be reasonably reimbursed direct expenses related to the donation, without standard remuneration of lost wages. Second, donating oocytes requests a serious time investment, therefore donors are entitled to suitable compensation for their time spent and efforts made. Finally, we will explain that a reasonable compensation consisting of these two components allows for altruism to remain the key value of oocyte donation for reproductive treatment. However, if we acknowledge that donors’ motives are more complex and often include reasons from self-interest, the reasonable compensation may be complemented with modest (non)monetary benefits. (shrink)

Recent developments in biotechnology allow for the generation of increasingly complex products out of human tissues, for example, human stem cell lines, synthetic embryo-like structures and organoids. These developments are coupled with growing commercial interests. Although commercialisation can spark the scientific and clinical promises, profit-making out of human tissues is ethically contentious and known to raise public concern. The traditional bioethical frames of gift versus market are inapt to capture the resulting practical and ethical complexities. Therefore, we propose an alternative (...) approach to identify, evaluate and deal with the ethical challenges that are raised by the increasing commercialisation of the exchange of sophisticated human tissue products. We use organoid technology, a cutting-edge stem cell technology that enables the cultivation of ‘mini-organs’ in a dish, as an example. First, we examine the moral value of organoids and recognise them as hybrids that relate to persons and their bodies as well as to technologies and markets in ambiguous ways. Second, we show that commercialisation of organoids is legitimised by a detachment of the instrumental and commercial value of organoids from their associations with persons and their bodies. This detachment is enacted in steps of disentanglement, among which consent and commodification. Third, we contend that far-reaching disentanglement is ethically challenging: (1) Societal interests could be put under pressure, because the rationale for commercialising organoid technology, that is, to stimulate biomedical innovation for the good of society, may not be fulfilled; (2) The interests of donors are made subordinate to those of third parties and the relational moral value of organoids may be insufficiently recognised. Fourth, we propose a ‘consent for governance’ model that contributes to responsible innovation and clinical translation in this exciting field. (shrink)

Sankary et al. (2022) report the results of an empirical study on research participant experiences of exiting research at the end of clinical trials of deep-brain-stimulation (DBS) and responsive n...

This article discusses whether ecology represents an alternative type of natural science, that is normatively committed. Central questions are: -- how man and human action are integrated into the subject matter of ecology; -- whether evaluative concepts like 'health' are incorporated into the conceptual structure of ecology; and -- whether ecology transcends the image of natural knowledge as control of nature. It is concluded that all hypotheses of ecology being inherently judgmental in character must be rejected.

Christian theology conceives of ‘sacrificium intellectus’ to account for the message of Saint Paul that he will “take every thought captive to obey Christ”. Human insight gives way to the revealed truths of religion. In modern western cultures to explain the natural world has become the domain of science, and the imposition of collective rules of how we should live was shifted to democratically elected parliaments. In Germany legislation of bioethical issues is often justified with reasons that violate standards of (...) cognitive rationality. Is this another case of sacrificium intellectus? The Federal Constitutional Court refrains from the control of legislative arguments by conceding a broad margin of appreciation for the legislator. People have, however, a right to justification; they must not be subjected to arbitrary legal power. While the practice of democratic rule may seldom comply with the expectations of ‘government by discussion’, it is neither likely to gain acceptance as ‘government without discussion’. To impose legal force on the basis of false arguments and unsound reasoning is not a legitimate sacrificium intellectus, it is an intellectual scandal. (shrink)

Background Massively parallel sequencing techniques, such as whole exome sequencing (WES) and whole genome sequencing (WGS), may reveal unsolicited findings (UFs) unrelated to the diagnostic aim. Such techniques are frequently used for diagnostic purposes in pediatric cases of developmental delay (DD). Yet policy guidelines for informed consent and return of UFs are not well equipped to address specific moral challenges that may arise in these children’s situations. Discussion In previous empirical studies conducted by our research group, we found that it (...) is sometimes uncertain how children with a DD will develop and whether they could come to possess capacities for autonomous decision-making in the future. Parents sometimes felt this brought them into a Catch-22 like situation when confronted with choices about UFs before undergoing WES in trio-analysis (both the parents’ and child’s DNA are sequenced). An important reason for choosing to consent to WES was to gain more insight into how their child might develop. However, to make responsible choices about receiving or declining knowledge of UFs, some idea of their child’s future development of autonomous capacities is needed. This undesirable Catch-22 situation was created by the specific policy configuration in which parents were required to make choices about UFs before being sequencing (trio-analysis). We argue that this finding is relevant for reconfiguring current policies for return of UFs for WES/WGS and propose guidelines that encompass two features. First, the informed consent process ought to be staged. Second, differing guidelines are required for withholding/disclosing a UF in cases of DD appropriate to the level of confidence there is about the child’s future developmental of autonomous capacities. Conclusion When combined with a dynamic consent procedure, these two features of our guidelines could help overcome significant moral challenges that present themselves in the situations of children undergoing genomic sequencing for clarifying a DD. (shrink)

Pediatric biobanking is considered important for generating biomedical knowledge and improving health care. However, the inclusion of children’s samples in biobanks involves specific ethical issues. One of the main concerns is how to appropriately engage children in the consent procedure. We suggest that children should be involved through a personalized assent procedure, which means that both the content and the process of assent are adjusted to the individual child. In this paper we provide guidance on how to put personalized assent (...) into pediatric biobanking practice and consider both the content and process of personalized assent. In the discussion we argue that the assent procedure itself is formative. Investing in the procedure should be a requirement for pediatric biobank research. Although personalized assent will require certain efforts, the pediatric community must be aware of its importance. The investment and trust earned can result in ongoing engagement, important longitudinal information, and stability in/for the research infrastructure, as well as increased knowledge among its participants about research activity. Implementing personalized assent will both respect the child and support biobank research. (shrink)

Despite widespread and worldwide efforts to eradicate vector-borne diseases such as malaria, these diseases continue to have an enormous negative impact on public health. For this reason, scientists are working on novel control strategies, such as gene drive technologies (GDTs). As GDT research advances, researchers are contemplating the potential next step of conducting field trials. An important point of discussion regarding these field trials relates to who should be informed, consulted, and involved in decision-making about their design and launch. It (...) is generally argued that community members have a particularly strong claim to be engaged, and yet, disagreement and lack of clarity exist about how this “community” should be defined and delineated. In this paper, we shed light on this “boundary problem”: the problem of determining how boundaries of inclusion and exclusion in (GDT) community engagement should be drawn. As our analysis demonstrates, the process of defining and delineating a community is itself normative. First, we explicate why it is important to define and delineate the community. Second, we demonstrate that different definitions of community are used and intermingled in the debate on GDTs, and argue in favor of distinguishing geographical, affected, cultural, and political communities. Finally, we propose initial guidance for deciding who should (not) be engaged in decision-making about GDT field trials, by arguing that the definition and delineation of the community should depend on the rationale for engagement and that the characteristics of the community itself can guide the effective design of community engagement strategies. (shrink)