Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three (...) characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)

From an interdisciplinary perspective the authors of this book, scholars in theology and religious studies, give an account of the problematic and promising aspects of biblically based monotheism, considered as a formative religious idea, belief, and practice in Western history and culture.

In diesem Fazit & Ausblick werden nun die in der Einleitung formulierten Themenfelder, in denen wir auch die Anschlüsse an Arbeiten und Forschungsgebiete der Historischen Anthropologie gegeben sahen, wieder aufgegriffen. Dies geschieht entlang von Aspekten, die durch die responses aufgeworfen wurden, und die wir hinsichtlich unserer Forschung zu Arenen transkultureller Bildung weiterdenken. Ein wichtiger Schwerpunkt liegt dabei auf den Transmissionseffekten, die sich im Forschungsprozess, auch unter Einbezug der responses, zwischen den Forschungsfeldern – den Arenen Theater und Schule – ergeben haben. (...) Daran anschließend formulieren wir die Implikationen, die sich daraus für die Weiterentwicklung unserer Methoden ergeben haben, sowie einen Ausblick, der sich den Möglichkeiten der Erweiterung der Forschung zu kultureller Bildung unter Einbezug postkolonialer und transkultueller Analyseperspektiven widmet. Wir haben in den drei Method Labs„Method Mixing: Methoden der Praxis in postmigrantischen Kontaktzonen“ (November 2017); „Towards new methodologies in transcultural education: Performativity of the digital, Material Feminism and transcultural analysis” (Juni 2018) und “Arenas of transcultural Education: artistic research, art based methods, New Materialism and Sensory Ethnography“ (Januar 2019). Praktiker*innen und Wissenschaftler*innen, die aus unterschiedlichen Disziplinen und Forschungsschwerpunkten kommen und in verschiedenen europäischen Universitäten und Institutionen forschen und arbeitenSound Studies, Historische und pädagogische Anthropologie; Allgemeine Erziehungswissenschaft, Anglistik und Postcolonial Studies, Global Childhood & Youth Studies, International Childhood Studies, Grundschulpädagogik, Theaterpädagogik und Dramaturgie sowie Lehrerbildung, künstlerische Forschung und kulturelle Bildung., eine Auswahl des über drei Jahre im Feld erhobenen Materials, das Method Mixing der beiden Arenen Schule und Theater, sowie unsere diffraktionellen Analysen, die entstandenen Interferenzen, und das sich daraus entwickelnde Method Mixing des Projekts vorgestellt. Nach intensiven, über zwei Tage andauernden Diskussionen über das unseren Gästen der Method Labs vorgestellte Material haben wir diese um eine Verschriftlichung ihrer responses gebeten. Die Wahl des Themas sowie des Umfangs und der Form wurden dabei freigestellt. Herausgekommen sind sehr unterschiedliche, und, wie wir finden, im Kern ebenfalls diffraktionell operierende Antworten, die in den vorangegangen Kapiteln vorgestellt wurden. (shrink)

Is het nog de moeite waard om het op te nemen voor de transcendentale kritiek van Dooyeweerd? Deze vraag suggereert dat de transcendentale kritiek wanneer zij aan zichzelf overgelaten zou worden, niet meer te redden is. Dat is misschien wat overdreven, maar één ding is duidelijk: de transcendentale kritiek is niet onomstreden, zelfs niet onder de meest trouwe volgelingen van Dooyeweerd. En daarin zit iets paradoxaals: het was hem er immers om te doen met zijn transcendentale kritiek ‘de denkgemeenschap in (...) het avondland’ te herstellen, maar het lukt hem niet eens om de denkgemeenschap onder gelijkgezinden op dit punt te bewaren. Intentie en werkelijkheid lopen hier dus ver uiteen. Daar zijn verschillende redenen voor. In de eerste plaats lijkt de transcendentale kritiek geplaagd te worden door een tweetal tegenstrijdige uitgangspunten. Kort gezegd komen deze uitgangspunten hierop neer: 1) de transcendentale kritiek poogt aan te tonen dat ieder theoretisch denken uitgaat van religieuze uitgangspunten; het theoretische denken is dus niet neutraal, zelfgenoegzaam of autonoom; 2) het onder punt 1 genoemde kan worden aangetoond door een stringente analyse van de aard van het theoretische denken zelf, zoals het door ieder die zich bezighoudt met wetenschap en wijsbegeerte beoefend wordt. De vraag is nu of het eerste punt niet impliceert, dat het tweede onmogelijk is. (shrink)

In 2001 hield Johan J. Graafland zijn oratie Maatschappelijk ondernemen: analyse, verantwoording en fundering. Hiermee aanvaardde hij het ambt van bijzonder hoogleraar Economie, Onderneming en Ethiek aan de Universiteit van Tilburg. Graag wil ik Johan Graafland van harte feliciteren met zijn benoeming. Ik ervaar het toch steeds weer als een bijzondere zegen als christenen zo’n positie mogen bezetten. Ik wens hem veel vruchten toe op zijn arbeid. Op de nieuwjaarsconferentie 2002 van de Vereniging voor Reformatorische Wijsbegeerte heeft Graafland een lezing (...) gegeven waarin hij enkele momenten uit zijn oratie toelichtte. Op die conferentie mocht ik als co-referent optreden. De week voorafgaande aan de conferentie was ik voor een zakenreis in Taiwan. Ik kwam vrijdagsavonds weer in Nederland terug. Door een ongelukkige samenloop van omstandigheden kreeg ik ook toen pas de tekst van de oratie van Graafland in handen. De tijd was voor mij te kort — en de onvermijdelijke jet-lag werkt dan ook niet mee — om de oratie goed te bestuderen en op vruchtbare wijze te kunnen reageren. Ik had geen andere mogelijkheid dan een ‘eigen’ verhaal te houden . Graag wil ik nu van de gelegenheid gebruik maken om inhoudelijk op de oratie van Graafland in te gaan. (shrink)

From an interdisciplinary perspective the authors of this book, scholars in theology and religious studies, give an account of the problematic and promising aspects of biblically based monotheism, considered as a formative religious idea, belief, and practice in Western history and culture.

Deze korte studie biedt niet de zoveelste inleiding in het denken van Spinoza, maar doet verslag van de persoonlijke, vijfentwintig jaar durende zoektocht om de vaak moeilijke thema's van Spinoza onder de knie te krijgen. Om via Spinoza's filosofie meer te begrijpen van de wereld en van het eigen leven. Om de vreugde te ervaren die dit verbeterde inzicht, in oorzaken en gevolgen, en ook in de eigen beperktheid, ons biedt. Elk hoofdstuk gaat over een onderwerp dat de auteur bijzonder (...) aanspreekt. Bestaat er een levenswil, Spinoza's conatus, die mensen voort doet leven ook onder de meest bittere omstandigheden? Is kennis en inzicht gradueel van aard? Wat is het verschil tussen adequate en inadequate kennis van de oorzaken van ons handelen? Hoe ontwikkelt een machtsstaat zich tot een rechtsstaat? (shrink)

De drie korte verhandelingen over de positie van hooggeplaatsten moeten gezien worden als een schakel in de lange keten van de literair-filosofische traditie van de Vorstenspiegels, die met name in de Italiaanse Renaissance zeer geliefd waren. Pascal volt echter deze voorbeelden maar gedeeltelijk, omdat hij een nieuwe macht introduceert, waaraan ook de groten der aarde onderworpen zijn, nl. de macht van het geloof. Zijn bespiegelingen over macht, morele plicht en verantwoordelijkheid zijn nog steeds actueel.

Asylbarns status og rettigheter i Norge er i kritisk søkelys. En særlig utsatt gruppe er barn av papirløse foreldre som fødes på norske sykehus. Med bakgrunn i Kirkens Bymisjons arbeid med denne gruppen, argumenterer jeg i denne artikkelen for at slike eksempler viser at norsk offentlig politikk overfor disse barna tenderer mot å gradere og dermed underminere deres grunnleggende menneskeverd, slik dette blant annet kommer til uttrykk i barnekonvensjonens krav om hensynet til barnets beste. Ved hjelp av Judith Butlers tenkning (...) om sårbarhet og «framing» samt Giorgio Agambens tenkning om «nakent liv» og unntakstilstanden, analyserer jeg hvordan denne graderingen av asylbarnas menneskeverd skjer. Til slutt viser jeg kort hvordan Helsesenteret uttrykker motstand mot disse mekanismene som bidrar til å underminere asylbarnas og de papirløses menneskeverd.Nøkkelord: menneskeverd, asylbarn, papirløse i Norge, Kirkens Bymisjon, helsesenter, etikk, flyktninger, Judith Butler, Giorgio Agamben, diakonalt arbeidEnglish summary: Children of asylum seekers and human dignity: Ethical reflections based on the experiences of the Health Care Centre for Undocumented MigrantsThe human rights and dignity of children of asylum seekers and undocumented migrants is much debated in Norway. A group that is particularly at risk is children born in Norwegian hospitals whose parents do not possess a legal residence permit. On the basis of the diaconal work of the Church City Mission in Oslo that aims at providing care and defending the rights of these groups through the Health Care Centre for Undocumented Migrants, the purpose of this article is to argue that the inherent human dignity of these children is being undermined in contemporary Norwegian politics. By relating to Judith Butler's thoughts on vulnerability and «framing» and Giorgio Agamben's theory of the «bare life» and the state of exception, the article aims at showing mechanisms that contribute to the undermining of the human dignity and rights of this group. The last part shows how the work of the health care center with its ethical and theological basis can be seen as offering resistance to these mechanisms and tendencies. (shrink)

Diverse omstandigheden hebben het schrijven en verschijnen van het in jaargang 62, nr. 2 aangekondigde slotartikel vertraagd. Ook toen al uitte ik het voornemen de vier denkers die in het tweede artikel besproken waren nog even te groeperen. Zo’n korte groepering lijkt nu, na meer dan twee jaar, des te meer wenselijk. De vier besproken filosofen waren allen, zij het op uiteenlopende wijze, op zoek naar een nieuwe bepaling van de verhoudingen, — niet alleen tussen “Leidenschaft” en “Vernunft”, maar ook (...) tussen “Leidenschaft” als in-zet — meer actief — en als “passio”, in de zin van “lijden”. (shrink)

After having defined the KARO logic for specifying intelligent agents in earlier work we now turn to the question how to realise agents specified in the KARO framework. To this end we look at agent programming languages that we have defined, and investigate how programs in these languages can be linked to the KARO logic.

The past 50 years have seen an accumulation of evidence suggesting that associative learning depends on high-level cognitive processes that give rise to propositional knowledge. Yet, many learning theorists maintain a belief in a learning mechanism in which links between mental representations are formed automatically. We characterize and highlight the differences between the propositional and link approaches, and review the relevant empirical evidence. We conclude that learning is the consequence of propositional reasoning processes that cooperate with the unconscious processes involved (...) in memory retrieval and perception. We argue that this new conceptual framework allows many of the important recent advances in associative learning research to be retained, but recast in a model that provides a firmer foundation for both immediate application and future research. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

We develop a framework for assessing security market quality, relating five elements of market design to three metrics of market integrity and two metrics of market efficiency. We empirically implement this integrity–efficiency MQ framework by testing a hypothesis that trade-based ramping manipulation at the close raises execution costs on 24 security markets worldwide. Estimating a simultaneous equations model of ramping incidence, spreads, and the probability of deploying real-time surveillance, we show that quoted bid-ask spreads are positively related to the incidence (...) of MTC across seven liquidity deciles. The magnitude is economically significant; improving market integrity by cutting MTC in half reduces spreads 6–11 %. Allowing direct market access in conjunction with RTS, conducting auctions at the close, and developing regulations that require surveillance, all reduce MTC and thereby lower spreads, assuring better market integrity and enhancing market efficiency. Introducing circuit breakers or prohibiting shorts poses integrity–efficiency tradeoffs. (shrink)

Advanced practice nursing is an expanding field within many healthcare environments around the world. The scope and particular focus of an advanced practice nurse’s role is highly variable and thus the ethical challenges they face are equally diverse. Yet, the dominant existing ethics pedagogies used in the nursing context have been described as not fit-for-purpose. Existing pedagogies do not adequately prepare APN candidates to meet the ethical challenges they will encounter in practice. Applying an arts-based pedagogy in ethics education for (...) advanced practice nurses has the capacity to provide effective ethics learning. This article reports on the value of a multidisciplinary pedagogy used in a graduate course in nursing leadership, law and ethics for advanced practice at an Australian university. Written in a multidisciplinary mode that allies with the pedagogy it presents, it addresses the key pedagogical challenges and opportunities of teaching ethics through an innovative arts-based pedagogy centred upon the changing depictions of the human person in works of art housed in a major state-funded art gallery. (shrink)

Advanced practice nursing is an expanding field within many healthcare environments around the world. The scope and particular focus of an advanced practice nurse’s role is highly variable and thus the ethical challenges they face are equally diverse. Yet, the dominant existing ethics pedagogies used in the nursing context have been described as not fit-for-purpose. Existing pedagogies do not adequately prepare APN candidates to meet the ethical challenges they will encounter in practice. Applying an arts-based pedagogy in ethics education for (...) advanced practice nurses has the capacity to provide effective ethics learning. This article reports on the value of a multidisciplinary pedagogy used in a graduate course in nursing leadership, law and ethics for advanced practice at an Australian university. Written in a multidisciplinary mode that allies with the pedagogy it presents, it addresses the key pedagogical challenges and opportunities of teaching ethics through an innovative arts-based pedagogy centred upon the changing depictions of the human person in works of art housed in a major state-funded art gallery. (shrink)

Advanced practice nursing is an expanding field within many healthcare environments around the world. The scope and particular focus of an advanced practice nurse’s role is highly variable and thus the ethical challenges they face are equally diverse. Yet, the dominant existing ethics pedagogies used in the nursing context have been described as not fit-for-purpose. Existing pedagogies do not adequately prepare APN candidates to meet the ethical challenges they will encounter in practice. Applying an arts-based pedagogy in ethics education for (...) advanced practice nurses has the capacity to provide effective ethics learning. This article reports on the value of a multidisciplinary pedagogy used in a graduate course in nursing leadership, law and ethics for advanced practice at an Australian university. Written in a multidisciplinary mode that allies with the pedagogy it presents, it addresses the key pedagogical challenges and opportunities of teaching ethics through an innovative arts-based pedagogy centred upon the changing depictions of the human person in works of art housed in a major state-funded art gallery. (shrink)

The aim of this article is to take relational ethics concepts and apply them to the context of application to research ethics committees for approval to carry out research. The process of a multinational qualitative research application is described. The article suggests that a relational ethics approach can address two issues: how qualitative proposals are interpreted by research ethics committees and how this safeguards potentially vulnerable respondents. In relational terms, the governance of a research project may be enhanced by shared (...) ownership and willingness to engage in mutual dialogue. This challenges both researchers and research ethics committees to reframe their understanding of roles and functions in the assessment of research protocols, particularly those of a qualitative nature and those that address end-of-life issues. (shrink)