To support healthcare professionals in dealing with ethically difficult situations, Clinical Ethics Support (CES) services like Moral Case Deliberation (MCD) are increasingly implemented. To assess the impact of CES, it is important to evaluate outcomes. Despite general claims about outcomes from MCD experts and some qualitative research, there exists no conceptual analysis of outcomes yet. Therefore, the aim of this study was to systematically define and categorize MCD outcomes. An additional aim was to compare these outcomes with the outcomes in (...) the Euro-MCD Instrument from 2014, to further validate this Instrument. The concept mapping method was used and involves qualitative and quantitative steps including brainstorming, individual structuring, computation of concept maps (by principal component analysis and cluster analysis), group interpretation and utilization. In total, 12 experienced MCD participants from a variety of professional backgrounds participated in two sessions. The focus group brainstorm resulted in a list of 85 possible MCD outcomes, of which a point map and concept maps were constructed. After a thorough discussion of each cluster, final consensus was reached on the names and position of 8 clusters of MCD outcomes: 1) Organisation and Policy; 2) Team development; 3) Personal development focused on the Other Person; 4) Personal development as Professional, focused on Skills; 5) Personal development as Professional, focused on Knowledge; 6) Personal development as an Individual; 7) Perception and Connection; and 8) Concrete action. This study explored and categorized MCD outcomes in a concept mapping focus group. When comparing the results with the Euro-MCD Instrument, our study confirms that outcomes of MCD can be categorized in clusters referring to the organisational level, team development, personal development (both as an individual and a professional) and the concrete case-level. In developing CES evaluation tools, it is important to be explicit if an outcome refers to the individual or the team, to knowledge or skills, to the organisation or the specific case. The findings will be used in the further validation of the Euro-MCD Instrument. The current study further contributes to the field of evaluating CES in general and defining outcomes of MCD in particular. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation. Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European field survey (...) among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such as moral reflexivity and moral attitude outcomes, should still be included. In the future, a combination of empirical findings and normative reflection will contribute to the revision of the instrument. (shrink)

It has been claimed that a broad attentional breadth buffers the impact of negative stimuli on human perception and cognition. Here we identify issues with the research on which this claim is based, and then rigorously test the claim. To induce narrow versus broad attentional breadth participants attended to the local versus global elements of Navon stimuli, and to investigate the impact of emotionally salient stimuli on performance we measured the effect of task-irrelevant stimuli of varying emotional salience (negative, neutral, (...) or positive) on task performance. Across a series of experiments, we found that the Navon stimuli were effective in inducing different attentional breadths, and that both negative and positive task-irrelevant stimuli slowed responses relative to neutral stimuli, but that the magnitude of this emotion-induced slowing was invariant to whether attentional breadth was broad or narrow. This indicates that a broad attentional breadth did not buffer against the effect of either negative or positive emotionally salient stimuli. These results challenge the claim the broadening attentional breadth protects against the impact of emotionally salient stimuli. (shrink)

Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

The problem of the one and the many is central to ancient Greek philosophy, but surprisingly little attention has been paid to Aristotle's treatment of it in the Metaphysics. The Central Books of the Metaphysics are widely recognised as the most difficult portion of a most difficult work. This title aims to examine the Central Books.

This paper introduces a new typology and associated measure of social and environmental mission integration by conceptually framing a feature of hybrid organizations—the degree of integration of their revenue model and social–environmental mission. The SEMI measure is illustrated using a hand-collected sample of 256 North American Certified B Corporations. We explore the heterogeneity of SEMI scores by identifying external-facing correlates and demonstrate non-congruence with Certified B Corporation’s audit results. Overall, our findings advance existing knowledge of these hybrid organizations and how (...) they balance their social–environmental missions with their economic objectives. (shrink)

Post-foundational politics and democracy -- Agonism and democracy -- A typology of agonistic democracy -- Agonistic democracy and the question of institutions -- Agonistic democracy and the limits of popular participation -- Populism, representation, and the popular will -- Political liberalism, contingency and agonistic pluralism -- Liberalism, agonism, and democracy.

Today most of us are awash with choices. The cornucopia of material goods available to those of us in the developed world can turn each of us into a kid in a candy store; but our delight at picking the prize is undercut by our regret at lost opportunities. And what's the criterion for choosing anything -- material, spiritual, the path taken or not taken -- when we have lost our faith in everything? In The Era of Choice Edward Rosenthal (...) argues that choice, and having to make choices, has become the most important influence in both our personal lives and our cultural expression. Choice, he claims, has transformed how we live, how we think, and who we are.This transformation began in the nineteenth century, catalyzed by the growing prosperity of the Industrial Age and a diminishing faith in moral and scientific absolutes. The multiplicity of choices forces us to form oppositions; this, says Rosenthal, has spawned a keen interest in dualism, dilemmas, contradictions, and paradoxes. In response, we have developed mechanisms to hedge, compromise, and to synthesize. Rosenthal looks at the scientific and philosophical theories and cultural movements that choice has influenced -- from physics to postmodernism, from Disney trailers to multiculturalism. He also reveals the effect of choice on the personal level, where we grapple with decisions that range from which wine to have with dinner to whether to marry or divorce, as we hurtle through lives of instant gratification, accelerated consumption, trend, change, and speed. But we have discovered, writes Rosenthal, that sometimes, we can have our cake and eat it, too. (shrink)

This textbook in Medical Ethics covers most of the standard issues. Each chapter begins with detailed comments by the editors, followed by the best available articles on each topic covered.

After showing how Aristotle justifies his doctrines by demonstrating how they resolve one/many problems, the author uses this justification to clarify the doctrines and what is puzzling in them.