Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (...) (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses’ empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members. (shrink)

The design and implementation of clinical ethics support is attracting increasing attention. Often, the characteristics and aims of clinical ethics support are translated into practice in a top-down, programmatic manner. These characteristics and aims then remain a constant feature of the clinical ethics support functions within the organisation. We argue that the characteristics of clinical ethics support should be reflected in the implementation strategy. Inspired by dialogical, pragmatic and hermeneutic perspectives on clinical ethics support in general and moral case deliberation (...) in particular, we argue for a dialogical approach to implementing clinical ethics support, based on open, ongoing discussion with healthcare professionals about how they conceive clinical ethics support. Based on research and experience with various moral case deliberation implementation projects in mental healthcare, we present a theoretical framework for dialogical implementation and heuristic guidelines for implementing moral case deliberation in mental healthcare, which take into account the dialogical characteristics of moral case deliberation and some specific features of mental healthcare. (shrink)

Internationally, the prevalence of clinical ethics support (CES) in health care has increased over the years. Previous research on CES focused primarily on ethics committees and ethics consultation, mostly within the context of hospital care. The purpose of this article is to investigate the prevalence of different kinds of CES in various Dutch health care domains, including hospital care, mental health care, elderly care and care for people with an intellectual disability. A mixed methods design was used including two survey (...) questionnaires, sent to all health care institutions, two focus groups and 17 interviews with managing directors or ethics support staff. The findings demonstrate that the presence of ethics committees is relatively high, especially in hospitals. Moral case deliberation (MCD) is available in about half of all Dutch health care institutions, and in two-thirds of the mental health care institutions. Ethics consultants are not very prominent. A distinction is made between explicit CES forms, in which the ethical dimension of care is structurally and professionally addressed and implicit CES forms, in which ethical issues are handled indirectly and in an organic way. Explicit CES forms often go together with implicit forms of CES. MCD might function as a bridge between the two. We conclude that explicit and implicit CES are both relevant for clinical ethics in health care. We recommend research regarding how to combine them in an appropriate way. (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)

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)

The prevalence of Clinical ethics support services is increasing. Yet, questions about what quality of CES entails and how to foster the quality of CES remain. This paper describes the development of a national network, which aimed to conceptualize and foster the quality of CES in the Netherlands simultaneously. Our methodology was inspired by a responsive evaluation approach which shares some of our key theoretical presuppositions of CES. A responsive evaluation methodology engages stakeholders in developing quality standards of a certain (...) practice, instead of evaluating a practice by predefined standards. In this paper, we describe the relationship between our theoretical viewpoint on CES and a responsive evaluation methodology. Then we describe the development of the network and focus on three activities that exemplify our approach. In the discussion, we reflect on the similarities and differences between our approach and other international initiatives focusing on the quality of CES. (shrink)

Although Broad published many books in his lifetime, this volume is unique in presenting some of his most interesting unpublished writings. Divided into five clear sections, the following figures and topics are covered: Autobiography, Hegel and the nature of philosophy, Francis Bacon, Hume's philosophy of the self and belief, F. H. Bradley, The historical development of scientific thought from Pythagoras to Newton, Causation, Change and continuity, Quantitative methods, Poltergeists, Paranormal phenomena. -/- Each section is introduced and placed in context by (...) the editor, Joel Walmsley. The volume also includes an engaging and informative foreword by Simon Blackburn. It will be of great value to those studying and researching the history of twentieth-century philosophy, metaphysics, and the recent history and philosophy of science, as well as anyone interested in Broad's philosophical thought and his place in the history of philosophy. (shrink)

In this book, Professor Simu? demonstrates how Baur came to understand Christian theology as a Gnostic philosophy of religion under the influence of Böhme's unorthodox esoteric theosophy and Hegel's modern religious philosophy.

This one-volume edition allows the general reader to appreciate Jung's ideas and personality, as they reveal themselves in his comments to his colleagues and to those who approached him with genuine problems of their own, as well as in his communication with personal friends. The correspondence supplies a variety of insights into the genesis of Jung's theories and a running commentary on their development. Originally published in 1984. The Princeton Legacy Library uses the latest print-on-demand technology to again make available (...) previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Abusive practices in elite women’s artistic gymnastics have been the focus of discussions about how to eliminate or reduce them. Both coaches and parents have been named as key actors in bringing about change. Our focus is on parents and their ability to safeguard their daughters in WAG. Parents are not independent actors, however, but are part of a larger web consisting of an entanglement of emotions and technologies and rationalities used by staff, other parents, and athletes, bounded by skill (...) development plans and by coaching expertise and authority. This entanglement may limit the ability of parents to bring about change. We draw on a Deleuzian notion of assemblage, Foucauldian concepts of discourse and governmentality and Ahmed’s assertion about the entanglement of discourses and emotions to explore how parents are disciplined into accepting dominant discursive practices of sport clubs for elite athletes. The data were drawn from a project called the Parental Awareness Program that was designed to make parents aware of practices in competitive WAG that may not be in their child’s best interest. Participants were parents of young gymnasts who had been identified as “talented” and who were members of an elite gymnastics club. The data analysis was based on focus group discussions with a total of 22 parents and semi-structured interviews with 8 parents. The results suggested that although parents problematized many practices during PAP, processes of governmentality involving an assemblage of discourses about coaching expertise, families, talent, enjoyment, long term skill development plans and its associated time demands, together ensured parental consent for dominant practices. The data suggested that a reduction of abusive practices lies in part in critical examinations of skill development plans that are presented as regimes of truth and are kept in place by emotions and the authority accorded to coaching expertise. These processes curtail parents in their ability to safeguard what is in the best pedagogical interest of their daughter. (shrink)

This book is parapsychological study of the meaningful coincidence of events, extrasensory perception, and similar phenomena.

CHARLES LESLIE STEVENSON, Associate Professor of Philosophy in the University of Michigan, though an American, has an important place in the evolution of British ethics in this century. It was in Mind that his first papers on ethics were published in 1937-8. They had considerable influence in Britain in promoting the emotive-persuasive theory of moral language. The author of the theory that much of philosophy and ethics is persuasive rhetoric, was himself a plausible illustration of his own theory. His breeziness (...) of style seemed to sweep difficulties out of the way. His papers had an unconventionality which appealed all the more to the younger generation of philosophers because it shocked the older. He seemed to discredit critics by not appearing able to understand the archaic language they were talking. The ideas of these early papers were taken up into a book, Ethics and Language published in 1944. The book is more ponderous and indeed somewhat pedantic. In it, Stevenson’s ideas lose in freshness what they gain in professorial gravity. But the impressive size of the book, the number and variety of the examples of moral argument which it discussed, the apparently wide range of the treatment, made the book for some time a sort of bible of emotivism. The book was also important as the first major study of ethics based on the neo-Wittgensteinian slogan that moral philosophy is the analysis of moral language. (shrink)