This bibliography records the initial publication of each original work by C.G. Jung, each translation, and significant revisions and expansions of both, up to 1975. In nearly every case, the compilers have examined the publications in German, French and English. Translations are recorded in Danish, Dutch, English, Finnish, French, Greek Hebrew, Hungarian, Italian, Japanese, Norwegian, Portuguese, Russian, Serbo-Croatian, Slovenian, Spanish, Swedish and Turkish. It is arranged according to language, with German and English first, publications being listed chronologically in each (...) language. The _General Bibliography_ lists the contents of the respective volumes of the_ Collected Works_ and the _Gesammelte Werke_, published in Switzerland, and shows the interrelation of the two editions. It also lists Jung's seminars and provides, where possible, information about the origin of works that were first conceived as lectures. An index is provided of all the titles in English and German, and all original works in the other languages. Three specialist indexes, of personal names, organizations and societies and periodicals, complete the work. The publication of the _General Bibliography_, together with the _General Index_, complete the publication of the _Collected Works of C.G. Jung _in English. (shrink)

To an increasing extent ethical controversies affect and sometimes obstruct public health work and epidemiological research. In order to improve communication between the concerned parties a model for identification and analysis of ethical conflicts in individual-based research has been worked out in co-operation between epidemiologists and moral philosophers. The model has two dimensions. One dimension specifies relevant ethical principles (as beneficence, non-maleficence, autonomy and justice). The other dimension specifies the groups of persons involved in the conflict under consideration (for example: (...) the study-population, individuals who may benefit from the results, the researchers and their personnel, the community at large). The model has been applied to the problem of legitimacy of case-register research and to problems in psychiatric health services research as well as epidemiological research. (shrink)

It is shown, assuming the linear case of Schinzel's Hypothesis, that the first-order theory of the structure $\langle \omega; +, P\rangle$ , where P is the set of primes, is undecidable and, in fact, that multiplication of natural numbers is first-order definable in this structure. In the other direction, it is shown, from the same hypothesis, that the monadic second-order theory of $\langle\omega; S, P\rangle$ is decidable, where S is the successor function. The latter result is proved using a (...) general result of A. L. Semenov on decidability of monadic theories, and a proof of Semenov's result is presented. (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)

Taking Parenting Public makes a compelling case that parenting has become dangerously undervalued in America today. It calls for a new investment—both personal and public—into the work of raising children and argues that we are all "stockholders" in the next generation. With a foreword by Sylvia Ann Hewlett and Cornel West, Taking Parenting Public crosses boundaries to bring together thinkers from diverse fields spanning the political spectrum. It features contributions from distinguished experts in economics, political science, public policy, child (...) development, public health, history, and the media. While recent books have focused on working mothers or absent fathers, Taking Parenting Public is the first volume to take a comprehensive look at the common struggles of parents. These essays go beyond the usual chest-beating about busy parents torn between work and family demands to suggest bold solutions. Instead of the typical call for "parent replacement"—more child care, more after school programs and more mentors—the contributors offer fresh strategies for "parent replenishment," ways to put mothers and fathers back into the lives of their children not only as economic providers, but also as emotional and moral providers. (shrink)

Obstetricians face difficult decisions when the interests of fetus and mother conflict. An example is the problem of choosing the delivery method when labour begins prematurely and the fetus is breech. Vaginal delivery involves risks for the breech fetus of brain damage or death caused by umbilical cord compression and head entrapment. Caesarean section might avoid these dangers but involves risks for the mother, including infection, haemorrhage and even death in a small percentage of cases. If a caesarean section is (...) performed the infant might die anyway, due to complications of prematurity. Thus, decisions about delivery method involve balancing the risks to mother and fetus. Uncertainty about the frequency of fetal injuries in vaginal breech deliveries adds to the difficulty of these decisions. (shrink)

Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...) physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed. Results Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched. Conclusions The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society. (shrink)

Cushman, Young, & Greene (2010) urge the consolidation of moral psychology around a dual-system consensus. On this view, a slow, often-overstretched rational system tends to produce consequentialist intuitions and action-tendencies, while a fast, affective system produces virtuous (or vicious) intuitions and action-tendencies that perform well in their habituated ecological niche but sometimes disastrously outside of it. This perspective suggests a habit-corrected-by-reason picture of moral behavior. Recent research, however, has raised questions about the adequacy of dual-process theories of cognition and behavior, (...) which tend to distinguish categorically between fast, affect-laden, automatic, sometimes-unconscious, nearly-incorrigible mental processes and slow, rational, effortful, conscious, corrigible mental processes. Processes of one alleged type often have properties associated with the contrary type. For instance, rational processes can be emotional, and fast thinking can perform logical operations. In addition, the fast-slow binary transforms a continuous temporal scale into a dichotomous one, losing potentially important information along the way. While these problems are beginning to be addressed in some subfields of psychology, moral psychology has yet to grapple with them. In this theoretical paper, we argue that moral psychology needs a framework that accounts for our knowledge of both temporal and spatial (anatomical) dimensions of the brain basis of moral cognition and virtuous decision-making. We argue that methodologies with very fine-grained temporal granularity, such as electroencephalography (EEG), should be used to complement more frequently used methodologies such as functional magnetic resonance imaging (fMRI). We outline how this might be accomplished using generosity, gratitude, and integrity as a case study. (shrink)

Many defenders of the possibility of time travel into the past also hold that such time travel places no restrictions on what said time travelers can do. Some hold that it places at least a few restrictions on what time travelers can do. In attempting to resolve this dispute, I reached a contrary conclusion. Time travelers to the past cannot do other than what they in fact do. Using a very weak notion of can, I shall argue that the correspondingly (...) strong cannot do otherwise applies in the case of backwards time travel. I defend this result from objections. (shrink)

There has been much discussion about what, if any, legal and moral duties professionals have to disclose relevant genetic information to the family members of someone with an identified disease predisposing mutation. Here, we present a case report where dissemination of such a genetic test result did not take place within a family. In contrast to previous literature, there appeared to be no deliberate withholding of information, instead distant relatives were unable to communicate relevant information appropriately. When communication was (...) facilitated through the follow-up of a chance remark, the patient was able to avoid planned major surgery, with its attendant morbidity, and her high anxiety levels were much reduced. We believe this case highlights the need for an ongoing debate on how genetic services can best support patients and their families with disclosing relevant genetic information to other family members. (shrink)

The general concept of a causal system has been basic in scientific thought. It may be formulated as follows. The system in question possesses certain measurable attributes such as those of dimensions, temperature, and so forth. In the case of a causal system, it is affirmed that the subsequent development of the system from a known initial condition—that is, a condition in which the measurable variables have known values—is uniquely determined by these values. More definitely, the value of these (...) same variables after any interval of time depends only on the initial values of the variables and the time interval which has elapsed. (shrink)

Business Ethics, the Environment &Responsibility, Volume 32, Issue 4, Page 1452-1469, October 2023.

Is it possible for an argument to have either zero premises or an infinite number of premises? I shall argue that regardless of how you conceive of arguments you should accept that an argument could have an infinite number of premises. The zero case is more complicated since the matter seems to depend not only on the metaphysics of arguments, but also the nature and function of arguing. I shall argue that at least a plausible case can be (...) made for the possibility of zero premise arguments. (shrink)

The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This (...) is largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

In 1926, Mally presented the first formal system of deontic logic. His system had several consequences which Mally regarded as surprising but defensible. It also, however, has the consequence that A is obligatory if and only if A is the case, which is unacceptable from the point of view of any reasonable deontic logic. We describe Mally's system and discuss how it might reasonably be repaired.

Moral case deliberation (MCD) is a form of clinical ethics support in which the ethicist as facilitator aims at supporting professionals with a structured moral inquiry into their moral issues from practice. Cases often affect clients, however, their inclusion in MCD is not common. Client participation often raises questions concerning conditions for equal collaboration and good dialogue. Despite these questions, there is little empirical research regarding client participation in clinical ethics support in general and in MCD in particular. This (...) article aims at describing the experiences and processes of two MCD groups with client participation in a mental healthcare institution. A responsive evaluation was conducted examining stakeholders’ issues concerning client participation. Findings demonstrate that participation initially creates uneasiness. As routine builds up and client participants meet certain criteria, both clients and professionals start thinking beyond ‘us-them’ distinctions, and become more equal partners in dialogue. Still, sentiments of distrust and feelings of not being safe may reoccur. Client participation in MCD thus requires continuous reflection and alertness on relational dynamics and the quality of and conditions for dialogue. Participation puts the essentials of MCD (i.e., dialogue) to the test. Yet, the methodology and features of MCD offer an appropriate platform to introduce client participation in healthcare institutions. (shrink)

This paper examines an issue that is becoming increasingly relevant as the pressures of a warming planet, changing climate and changing ecosystems ramp up. The broad context for the paper is the intragenerational, intergenerational, and interspecies equity implications of changing the climate and the value orientations of adapting to such change. In addition, the need to stabilize the planetary climate by urgent mitigation of change factors is a foundational ethical assumption. In order to avoid further animal and plant extinctions, or (...) at the very least, their increased vulnerability to becoming rare and endangered; the systematic assisted colonization of “at risk” species is being seriously considered by scientists and managers of biodiversity. The more practical aspects of assisted colonization have been covered in the conservation biology literature; however, the ethical implications of such actions have not been extensively examined. Our discussion of the value issues, using a novel case study approach, will rectify the limited ethical analysis of the issue of assisted colonization of species in the face of climate change pressures. Beyond sustainability ethics, both animal and environmental ethical approaches will be used and intrinsic versus instrumental value orientations in the literature shall form the basis of our discussion. After the application of all the ethical approaches to the case studies, we conclude that without mitigation and the prospect of a future stable climate, assisted colonization will be involved in an inherently unethical process and a “move and lose it” outcome. With mitigation, there is wide-ranging ethical support for assisted colonization. (shrink)

Decompressive craniectomy is a technically straightforward procedure whereby a large section of the cranium is temporarily removed in cases where the intracranial pressure is dangerously high. While its use has been described for a number of conditions, it is increasingly used in the context of severe head injury. As the use of the procedure increases, a significant number of patients may survive a severe head injury who otherwise would have died. Unfortunately some of these patients will be left severely disabled; (...) a condition likened to the RUB, an acronym for the Risk of Unacceptable Badness. Until recently it has been difficult to predict this outcome, however an accurate prediction model has been developed and this has been applied to a large cohort of patients in Western Australia. It is possible to compare the predicted outcome with the observed outcome at 18 months within this cohort. By using predicted and observed outcome data this paper considers the ethical implications in three cases of differing severity of head injury in view of the fact that it is possible to calculate the RUB for each case. (shrink)

Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. (...) Swedish, Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as ‘quite’ or ‘very’ important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections. (shrink)

In moral case deliberation (MCD), healthcare professionals meet to reflect upon their moral questions supported by a structured conversation method and non-directive conversation facilitator. An increasing number of Dutch healthcare institutions work with MCD to (1) deal with moral questions, (2) improve reflection skills, interdisciplinary cooperation and decision-making, and (3) develop policy. Despite positive evaluations of MCD, organization and implementation of MCD appears difficult, depending on individuals or external experts. Studies on MCD implementation processes have not yet been published. (...) The aim of this study is to describe MCD implementation processes from the perspective of nurses who co-organize MCD meetings, so called ‘ local coordinators ’. Various qualitative methods were used within the framework of a responsive evaluation research design. The results demonstrate that local coordinators work hard on the pragmatic implementation of MCD. They do not emphasize the ethical and normative underpinnings of MCD, but create organizational conditions to foster a learning process, engagement and continuity. Local coordinators indicate MCD needs firm back-up from management regulations. These pragmatic action-oriented implementation strategies are as important as ideological reasons for MCD implementation. Advocates of clinical ethics support should pro-actively facilitate these strategies for both practical and ethical reasons. (shrink)

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases (...) in which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

Dr. Leaf's article in the Journal of Hellenic Studies has recalled our attention to the venerable problem of the Rhesus. I hasten to give my adhesion to his main contention that the play is a pièce d'occasion justifying or sanctifying the foundation of the city of Amphipolis. But, as he remarks, seeing that the oracle ordering the removal of the bones of Theseus from Skyros to Athens preceded the actual removal by some years, so this play may be intended to (...) prepare for the actual removal of the bones of Rhesus from Troy by Hagnon, and may be prior to it by several years. For this official theft—doubtless arranged beforehand—we have only the authority of Polyainos' Strategemata, but it is a story which seems likely in itself, and goes far to explain the previously obscure lament of the Muse at the end of the play. My object is to examine the play afresh and see whether anything prevents our believing that it was written and exhibited somewhere near 440 B.C., in which case of course it is almost certainly the work of Euripides and not far from his Cyclops in date. (shrink)

The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries (...) without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria. (shrink)

Time was when the proofs of the existence of God formed an essential part of any self-respecting system of Philosophy. But for many years now this has ceased to be the case. It may be due to the gradual increase of the influence of Kant that the idea seems to have become accepted, tacitly, in the main, but none the less very widely, that proof or disproof of a belief such as this was hardly a fit subject for philosophical (...) discussion at all. At any rate, it is noteworthy how rarely the question is faced directly in the philosophical discussions of the last forty years or so. What we have had, much more frequently, is discussion about how the God of religion might be thought of and what sort of place He might have in reality as conceived in this or that philosophical system. And certainly discussions on these lines have done much to clarify our conception of the Divine, even if they have sometimes seemed to explain it only by explaining it away altogether, or at any rate to present us with the idea of something which, whatever it is, is certainly not the God of any religion. But of recent years I seem to detect a growing readiness to face the question as squarely as the old theologians, who propounded the first proofs of God's existence, did. (shrink)

Time was when the proofs of the existence of God formed an essential part of any self-respecting system of Philosophy. But for many years now this has ceased to be the case. It may be due to the gradual increase of the influence of Kant that the idea seems to have become accepted, tacitly, in the main, but none the less very widely, that proof or disproof of a belief such as this was hardly a fit subject for philosophical (...) discussion at all. At any rate, it is noteworthy how rarely the question is faced directly in the philosophical discussions of the last forty years or so. What we have had, much more frequently, is discussion about how the God of religion might be thought of and what sort of place He might have in reality as conceived in this or that philosophical system. And certainly discussions on these lines have done much to clarify our conception of the Divine, even if they have sometimes seemed to explain it only by explaining it away altogether, or at any rate to present us with the idea of something which, whatever it is, is certainly not the God of any religion. But of recent years I seem to detect a growing readiness to face the question as squarely as the old theologians, whopropounded the first proofs of God's existence, did. (shrink)

_Winner of the Fabian Dorsch ESA Essay Prize._ Julian Dodd defends the view that, in musical work-performance practice, interpretive authenticity is a more fundamental value than score compliance authenticity. According to him, compliance with a work’s score can be sacrificed in cases where it conflicts with interpretative authenticity. Stephen Davies and Andrew Kania reject this view, arguing that, if a performer intentionally departs from a work’s score, she is not properly instantiating that work and hence not producing an authentic performance (...) of it. I argue that this objection fails. A detailed analysis of work-performance practice reveals, first, that the normative scope of interpretive authenticity encompasses the practice of composing musical versions and that, second, when performers sacrifice score compliance to maximize interpretive authenticity, they are performing the target work by means of performing a version of it. By means of the nested types theory, I then show how performances produced in this way can be properly formed instances, and hence authentic performances, of their target work. (shrink)

BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in (...) field studies and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.MethodsThe revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.ResultsThe Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.ConclusionsThe Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD. (shrink)

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

Medea killed her children to take away the smile from her husband's face, according to Euripides, an offence against nature and morality. What if Medea had still been carrying her two children, perhaps due to give birth within a week or so, and had done the same? If this would also have been morally reprehensible, would that be a judgment based on her motives or on her action? We argue that the act has multiple and holistic moral features and that, (...) in fact, there is no absolute principle, such as the right of the fetus to life, which governs our moral judgments about fetal-maternal conflicts. We suggest that they illustrate a pervasive feature of human moral discourse and can only be addressed by attending to a range of negotiable moral considerations which depend on particular features of each situation. (shrink)

This methodological discussion invites critical reflection about the procedures used to analyze the contribution of qualitative and mixed methods research to nursing trials by mounting an argument that these should rest on multiple publications produced about a project, rather than a single article. We illustrate the value‐added of this approach with findings from a qualitative, cross‐case analysis of three critical case exemplars from nursing researchers that each used a qualitative approach with a mixed method phase. The holistic lens (...) afforded by a case‐based approach informs nursing inquiry by documenting that the critical case exemplars presented evidence of (a) a sustained commitment of resources and expertise for the qualitative methods that extended across more than one phase of the trial, (b) the impact of the qualitative methods on the trial or its aftermath, (c) deploying a theoretical or conceptual framework for a variety of purposes, and (d) integrating qualitative and quantitative data for purposes of extending explanatory power. Findings challenge the practice of linking purposes served by qualitative and mixed methods to a single trial phase. (shrink)

This volume of the Great American Thinkers series purports to let Thoreau speak for himself, primarily through passages quoted from his journals. Originally published in fourteen volumes, the journals represent over twenty years of Thoreau's life, and are the background and, in some cases, the original form of works more polished and more widely known. Murray has aptly considered Thoreau's wide range of thought and comment under several main headings, such as "Primacy or Purpose," "Society as Burden," and "Freedom and (...) Simplicity." In this arrangement, many of Thoreau's specific and often curt observations can be seen in a more general context, with Thoreau himself providing some of the keys to the transition.--G. B. S. C. (shrink)

BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is (...) the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

Background Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. Methods To identify key (...) ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher’s Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. Results After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. Conclusions The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies. (shrink)

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These (...) limitations warrant research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a (...) tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

The current study explores how the cultural distance of ethnic outgroups relative to the ethnic ingroup is related to stereotypical news representations. It does so by drawing on a sample of more than three million Dutch newspaper articles and uses advanced methods of automated content analysis, namely word embeddings. The results show that distant ethnic outgroup members (i. e., Moroccans) are associated with negative characteristics and issues, while this is not the case for close ethnic outgroup members (i. e., (...) Belgians). The current study demonstrates the usefulness of word embeddings as a tool to study subtle aspects of ethnic bias in mass-mediated content. (shrink)