BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

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Mutual perceptions of ethical behaviour among managers in nine EU-countries were quantatively measured and related to perceptions concerning "ease of cooperation". A strong positive correlation obtains: the more ethical a country is perceived to be, the higher it is valued as an international business partner. Germany, however, is a typical exception to this rule: German managers are perceived as the most ethical, but are considered relatively difficult to cooperate with.

Purpose This study aims to explore how the public perceives the effectiveness of surveillance technology, and how people’s views on privacy and their views on effectiveness are related. Likewise, it looks at the relation between perceptions of effectiveness and opinions on the acceptable cost of surveillance technology. Design/methodology/approach For this study, surveys of Dutch students and their parents were conducted over three consecutive years. Findings A key finding of this paper is that the public does not engage in a trade-off (...) neither with regard to privacy-effectiveness nor with effectiveness-cost, but rather expects all three elements to be achieved simultaneously. This paper also found that the correlation between perceived effectiveness and perceived privacy was stronger for parents than for students. Research limitations/implications Participants for this study were exclusively in The Netherlands. Survey questions on the effectiveness of surveillance technology focused on one type of technology, and on private mobile device use in two scenarios. Social implications The public’s perceptions of the effectiveness of surveillance technology potentially influence its acceptance of the technology, which, in turn, can affect the legitimacy and use of the technology. Originality/value Within the much-discussed privacy-security debate lies a less-heard debate – that of the effectiveness of the surveillance technology in question. The public is one actor in this debate. This study examines the public’s perceptions of this less-heard debate. (shrink)

Thanks to the exchange of arguments, groups outperform individuals on some tasks, such as solving logical problems. However, these results stem from experiments conducted among Westerners and they could be due to cultural particularities such as tolerance of contradiction and approval of public debate. Other cultures, collectivistic cultures in particular, are said to frown on argumentation. Moreover, some influential intellectual movements, such as Confucianism, disapprove of argumentation. In two experiments, the hypothesis that Easterners might not share the benefits of argumentation (...) was tested. In Experiment 1, Japanese participants had to solve a standard logical problem individually and then in groups. They performed significantly better in groups. In Experiment 2, Japanese participants had to estimate the weight of various animals. They did so individually, then after learning of another participant's estimates, then after discussing these estimates with the other participant, and then indi.. (shrink)

"This book contains ideas to develop interdisciplinary and transdisciplinary views on economy and society. It aims to disseminate heterodox ideas on various subjects related to economics and global society. The book is organised in six parts. Part 1 contains the key lectures of Backhaus on the concept of state sciences and of Klamer on the importance of culture for economics. Parts 2- 6 contain successively contributions in the areas of economic paradigms and theories, population and society, corporate issues, environment, and (...) international relations. Examples of the content are: - the changes of family life cycles due to the rise of non-traditional households; - subjective and objective inflation rates after the introduction of the Euro; - the economics of genetic engineering; - the contribution of foreign direct investment to the economic development of host countries; - the inaccuracy of economic models applied in places characterized by extreme income disparities; - the improvement of political and corporate governance; - evolutionary thinking and emission trading; - freedom and order in the European Union; - the reform of social policy in Europe. The book provides interesting creative multi-disciplinary ideas with respect to various topical issues concerning the contemporary global society. It is highly recommended for economists and social scientists in search of broad views on social science and society.". (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

BackgroundThe rise of Big Data-driven health research challenges the assumed contribution of medical research to the public good, raising questions about whether the status of such research as a common good should be taken for granted, and how public trust can be preserved. Scandals arising out of sharing data during medical research have pointed out that going beyond the requirements of law may be necessary for sustaining trust in data-intensive health research. We propose building upon the use of a social (...) licence for achieving such ethical governance.Main textWe performed a narrative review of the social licence as presented in the biomedical literature. We used a systematic search and selection process, followed by a critical conceptual analysis. The systematic search resulted in nine publications. Our conceptual analysis aims to clarify how societal permission can be granted to health research projects which rely upon the reuse and/or linkage of health data. These activities may be morally demanding. For these types of activities, a moral legitimation, beyond the limits of law, may need to be sought in order to preserve trust. Our analysis indicates that a social licence encourages us to recognise a broad range of stakeholder interests and perspectives in data-intensive health research. This is especially true for patients contributing data. Incorporating such a practice paves the way towards an ethical governance, based upon trust. Public engagement that involves patients from the start is called for to strengthen this social licence.ConclusionsThere are several merits to using the concept of social licence as a guideline for ethical governance. Firstly, it fits the novel scale of data-related risks; secondly, it focuses attention on trustworthiness; and finally, it offers co-creation as a way forward. Greater trust can be achieved in the governance of data-intensive health research by highlighting strategic dialogue with both patients contributing the data, and the public in general. This should ultimately contribute to a more ethical practice of governance. (shrink)

What is the value of an early diagnosis of dementia in the absence of effective treatment? There has been a lively scholarly debate over this question, but until now patients have not played a large role in it. Our study supplements biomedical research into innovative diagnostics with an exlporation of its meanings and values according to patients. Based on seven focusgroups with patients and their care-givers, we conclude that stakeholders evaluate early diagnostics with respect to whether and how they expect (...) it to empower their capacity to care. They value it, for instance, with respect to whether it explains experienced complaints, allows to start a process of psychological acceptance and social adaptation to the expected degeneration, contributes to dealing with anxieties, informs adequately about when to start preparing for the end of life, informs the planning of a request for euthanasia, or allows society to deal with a growing amount of dementia patients. Our study suggests that information about disease is considered ‘harmful’ or ‘premature’ when recipients feel unable to act on that information in their care. The results of this research offers input to further ethical research. It invites to adopt a care perspective in evaluation and to seek ways to prevent the ‘harm’ that such diagnostic methods can bring about. (shrink)