Retaliation against whistleblowers is a well-recognized problem, yet there is little explanation for why uninvolved peers choose to retaliate through ostracism. We conduct two experiments in which participants take the role of a peer third-party observer of theft and subsequent whistleblowing. We manipulate injunctive norms and descriptive norms. Both experiments support the core of our theoretical model, based on social intuitionist theory, such that moral judgments of the acts of wrongdoing and whistleblowing influence the perceived likeability of each actor and (...) ultimately influence intention to ostracize each actor and indicate more willingness to ostracize the whistleblower than the wrongdoer. When we vary norms for the wrongdoing in Experiment 1, we find that descriptive and injunctive norms indirectly influence intentions to ostracize both the wrongdoer and whistleblower. These relationships are serially mediated by the observers’ moral judgments of the act and likeability of the actor. When we vary norms for whistleblowing in Experiment 2, the injunctive norm manipulation affected moral judgment of the action of whistleblowing, and we do not observe any other significant effects of the norm manipulations on moral judgments of the actions of wrongdoing or whistleblowing. (shrink)

Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings Most respondents (...) see a need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. (shrink)

Les technologies hypermédias ont le potentiel de multiplier les sources d'information et de favoriser une communication scientifique plus ouverte à la discussion et au débat. Cependant, la lecture des documents hypermédias entraîne des difficultés, telles que la désorientation, pour de nombreux lecteurs. Nous avons évalué un ensemble d'hypertextes publiés par des revues de vulgarisation scientifique à la lumière des recommandations ergonomiques issues d'études expérimentales. Il en ressort que la plupart des publications offre une lisibilité médiocre, ignorant souvent les recommandations publiées. (...) Ensuite, notre étude expérimentale réalisée avec 59 lecteurs d'un dossier de vulgarisation, en version papier et hypertexte, nous a permis de confirmer le premier constat et d'identifier des sources de difficulté. Les lecteurs de l'hypertexte avaient une moindre compréhension du dossier et une plus grande perception de charge cognitive, bien que leur satisfaction soit aussi forte que celle des lecteurs du papier. La présente expérience montre des résultats significatifs en faveur de la version papier, mais pas de rejet a priori de la technologie. Nous présentons quelques suggestions pour améliorer la lisibilité des revues en ligne.Hypermedia can potentially increase the number of information sources and improve scientific communication by facilitating public debate. However, reading hypermedia documents can lead to difficulties such as disorientation for a number of readers. We investigated a corpus of hypermedia reports from online science magazines in the light of ergonomic recommendations based on results from experimental studies. We found that most publications showed poor levels of readability and did not follow the published recommendations. An experiment involving 59 readers and one popular science report from our initial corpus published in print and hypertext versions confirmed our first observations and allowed us to identify sources of difficulty. Hypertext readers showed poorer comprehension performance and higher perception of cognitive load. However satisfaction levels were high for hypertext and paper readers. The present study shows significant results in favor of the print format, but bias against technology from readers. We conclude with some suggestions to improve the readability of online science magazines. (shrink)

In previous literature, ethicists mention several goals of Clinical Ethics Support (CES). It is unknown what key persons in healthcare institutions see as main–—and sub-goals of CES. This article presents the goals of CES as perceived by board members and members of ethics support staff. This is part of a Dutch national research using a mixed methods design with questionnaires, focus groups and interviews. Quantitative and qualitative data were analyzed and combined in an iterative process. Four main clusters of (...) goals were found: 1) encouraging an ethical climate, 2) fostering an accountable and transparent organization, 3) developing professionalism and a final goal, overarching the previous three, 4) good care. Most important sub-goals of CES were: attention for ethical issues, raising awareness of ethical issues, fostering ethical reflection and supporting employees. The article ends with a discussion on the desirability to further operationalize the general goal of good care, the context-boundedness of our findings and the need to relate goals of CES to the features of organizational cultures to further improve the integration of CES in healthcare institutions. (shrink)

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction (Abbott) and the assignment of responsibilities (Gusfield). This (...) theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as 'intentionally taking the life of another person by a physician, upon that person's request' can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction. (shrink)

This study considers freedom of speech and the rules of engagement in the public sphere; good government, civic responsibility, and public education; and the foundations of religion and society, as seen through the eyes of seventeenth-century Dutch philosopher, Spinoza.

Recent policy developments in the area of livestock husbandry have suggested that, from the perspective of optimizing animal welfare, new animal husbandry systems should be developed that provide opportunities for livestock animals to be raised in environments where they are permitted to engage in “natural behavior.” It is not known whether consumers regard animal husbandry issues as important, and whether they differentiate between animal husbandry and other animal welfare issues. The responsibility for the development of such systems is allocated jointly (...) between farmers, regulators, different actors in the food chain, and consumers. This research focuses on understanding consumer attitudes and preferences regarding the development and introduction of such systems, to ensure that they are acceptable to consumers as well as producers, regulators, and scientists. Consumer perceptions of animal welfare and animal husbandry practices were evaluated using quantitative consumer survey, which focused on two animal husbandry issues – farmed pigs and farmed fish. Following pilot work, 1000 representative Dutch consumers were sampled about their attitudes to either pig or fish husbandry. The results indicated that consumers think about animal welfare in terms of two broad categories related to their health and living environment, but do not think about welfare issues at a more detailed level. Greater concern was expressed about the welfare of pigs compared to fish. Consumer trust in labeling also emerged as an important issue, since consumers need to trust different food chain actors with responsibility for promoting animal welfare, and are reluctant to consider the details of animal husbandry systems. As a consequence, a transparent, enforceable, and traceable monitoring system for animal welfare friendly products is likely to be important for consumers. (shrink)

Recent policy developments in the area of livestock husbandry have suggested that, from the perspective of optimizing animal welfare, new animal husbandry systems should be developed that provide opportunities for livestock animals to be raised in environments where they are permitted to engage in “natural behavior.” It is not known whether consumers regard animal husbandry issues as important, and whether they differentiate between animal husbandry and other animal welfare issues. The responsibility for the development of such systems is allocated jointly (...) between farmers, regulators, different actors in the food chain, and consumers. This research focuses on understanding consumer attitudes and preferences regarding the development and introduction of such systems, to ensure that they are acceptable to consumers as well as producers, regulators, and scientists. Consumer perceptions of animal welfare and animal husbandry practices were evaluated using quantitative consumer survey, which focused on two animal husbandry issues – farmed pigs and farmed fish. Following pilot work, 1000 representative Dutch consumers were sampled about their attitudes to either pig or fish husbandry. The results indicated that consumers think about animal welfare in terms of two broad categories related to their health and living environment, but do not think about welfare issues at a more detailed level. Greater concern was expressed about the welfare of pigs compared to fish. Consumer trust in labeling also emerged as an important issue, since consumers need to trust different food chain actors with responsibility for promoting animal welfare, and are reluctant to consider the details of animal husbandry systems. As a consequence, a transparent, enforceable, and traceable monitoring system for animal welfare friendly products is likely to be important for consumers. (shrink)

Background and aim With the increasing interest in lifestyle, health and consequences of unhealthy lifestyles for the healthcare system, a new kind of solidarity is gaining importance: lifestyle solidarity. While it might not seem fair to let other people pay for the costs arising from an unhealthy lifestyle, it does not seem fair either to punish people for their lifestyle. However, it is not clear how solidarity is assessed by people, when considering disease risks or lifestyle risks. The aim of (...) this study was to investigate the degree of solidarity with lifestyle as well as with other factors that are related to health outcomes—for example, old age—and the relation between this degree of solidarity and various characteristics. Methods This cross-sectional study is part of the Dutch longitudinal SMILE study. Data on the degree of solidarity with different lifestyles and old age, and the relation between the degree of solidarity and various demographic and other variables were obtained in a questionnaire survey. Results Solidarity with smokers and overweight people was moderate, as was solidarity with older people. Respondents were ambivalent about athletes. Respondents who were younger, male and highly educated, and those with a healthy lifestyle, a small social network, high quality of life and an internal locus of control, showed low solidarity. Conclusions Solidarity with an unhealthy lifestyle and old age is moderate and the degree of solidarity varies among the different subgroups. (shrink)

BackgroundLarge-scale, centralized data repositories are playing a critical and unprecedented role in fostering innovative health research, leading to new opportunities as well as dilemmas for the medical sciences. Uncovering the reasons as to why citizens do or do not contribute to such repositories, for example, to population-based biobanks, is therefore crucial. We investigated and compared the views of existing participants and non-participants on contributing to large-scale, centralized health research data repositories with those of ex-participants regarding the decision to end their (...) participation. This comparison could yield new insights into motives of participation and non-participation, in particular the behavioural change of withdrawal.MethodsWe conducted 36 in-depth interviews with ex-participants, participants, and non-participants of a three-generation, population-based biobank in the Netherlands. The interviews focused on the respondents’ decision-making processes relating to their participation in a large-scale, centralized repository for health research data.ResultsThe decision of participants and non-participants to contribute to the biobank was motivated by a desire to help others. Whereas participants perceived only benefits relating to their participation and were unconcerned about potential risks, non-participants and ex-participants raised concerns about the threat of large-scale, centralized public data repositories and public institutes, such as social exclusion or commercialization. Our analysis of ex-participants’ perceptions suggests that intrapersonal characteristics, such as levels of trust in society, participation conceived as a social norm, and basic societal values account for differences between participants and non-participants.ConclusionsOur findings indicate the fluidity of motives centring on helping others in decisions to participate in large-scale, centralized health research data repositories. Efforts to improve participation should focus on enhancing the trustworthiness of such data repositories and developing layered strategies for communication with participants and with the public. Accordingly, personalized approaches for recruiting participants and transmitting information along with appropriate regulatory frameworks are required, which have important implications for current data management and informed consent procedures. (shrink)

May discovered Diderot's copiously annotated copy of this anti-materialist tract by Hemsterhuis, known to many contemporaries as "the Dutch Plato"; this edition contains May's interesting introduction, a facsimile of the original text, and a transcription of all of Diderot's comments. The comments bear on infelicities of style as well as of thought, though the latter preponderate: the Lettre is not, alas, the product of a first-rate philosophical intellect. Diderot's strong objections to Hemsterhuis' crude theory of a moral organ can (...) be taken as complementing his Refutation of Helvetius, which dates from the same period.—W. L. M. (shrink)

The complex emotional work of nurses calls for more recognition of emotional labour and the incorporation of emotional labour in nursing education. Based on participant observation and semistructured interviews, we describe the experiences of student nurses in two nursing homes for elderly people with dementia in the Netherlands. We analyse their interactions using Goffman's dramaturgical view on the front and backstage behaviour and the distinction between surface acting and deep acting. The study reveals the complexity of emotional labour, as nurses (...) swiftly adapt their communication styles and behavioural strategies between settings, patients, and even between moments within one interaction sequence, which shows that the theoretical binaries fail to fully capture their skills. Although student nurses take pride in their emotionally taxing work, the societal undervaluation of the nursing profession negatively impacts their self‐image and ambitions. More explicit recognition of these complexities would enhance their self‐appreciation. This calls for a professional ‘backstage area’ that allows nurses to articulate and strengthen their emotional labour skills. Educational institutions should provide this backstage for nurses‐in‐training to strengthen these skills as part of the professional skill set. (shrink)

Although both EU policy makers and researchers acknowledge that public or stakeholder engagement is important for responsible innovation (RI), empirical evidence in this field is still scarce. In this article, we explore to what extent companies with a disposition to innovate in a more responsible way are moving towards the ideal of mutual responsiveness among stakeholders, as it is presented in the RI literature. Based on interviews with companies and non-economic stakeholders in the Dutch Food industry, it can be (...) concluded that innovative food companies are still far from implementing the ideal of mutual responsiveness in a significant way. The tension between the call for the active involvement of stakeholders in the literature and actual stakeholder engagement practices is explained by identifying a number of critical issues regarding stakeholder engagement, which are specific to actors involved in RI in the private sector. Finally, management practices designed to deal with these critical issues regarding stakeholder engagement are identified. (shrink)

BackgroundConsent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and (...) health-related data for observational research.MethodsWe conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues.ResultsSudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients’ data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives.ConclusionsSudden cardiac arrest patients’ donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants’ data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well. (shrink)

Social robots and their interactions with children are becoming increasingly sophisticated, with the emergence of child-robot relationships as a likely result. However, adequate measurement instruments that tap into concepts associated with child-robot relationship formation are scarce. We aimed to develop three measures that can be used to assess children’s closeness to, trust in, and perceived social support from, a social robot. We established the validity and reliability of these measures among 87 Dutch children aged 7 to 11 years old. (...) Because of their shortness, the measures can efficiently be applied by scholars aiming to gain insight into the general process of child-robot relationship formation and its specific sub-processes, that is, the emergence of closeness, trust, and perceived social support. (shrink)

This book also examines the thinking of scholars within the Dutch, British and North American 'schools' of religious phenomenology.

The culture-economy dialectic (CED) – the opposition of the concepts and phenomena of culture and economy – is one of the most important ideas in the modern history of ideas. Both disciplinary boundaries and much theoretical thought in social science are strongly influenced or even determined by the CED. For that reason, a thorough analysis and evaluation of the CED is needed to improve understanding of the history of ideas in social science and the currently fashionable research on the cultural (...) influences on economic differences between countries and regions. This thesis is an attempt to do just that. The concepts of “culture” and “economy” (and related concepts) and the (assumed) relations therebetween are compared and analyzed. Empirical results from earlier studies are summarized and some new test are presented. These new tests are partly based on a measurement of Dutch regional culture. However, most theories of the CED are (nearly) impossible to verify (empirically). There appears to be some influence of wealth on specific cultural phenomena (such as individualism and post-materialism), but the often assumed influence of culture on entrepreneurship and economic growth remains unconfirmed. Moreover, from an analysis of the theories themselves, it appears that most of these cannot be falsified and are, therefore, hardly 'scientific'. Many of the theories of the CED and, in fact, many theories of social science in general are of a conceptual rather than a causal nature. These theories cannot be falsified (or verified) by empirical means alone, but must be studied by means of conceptual analysis. In the final conclusions, this thesis, therefore, argues for conceptual analysis in – and a more anarchist approach to – social science. (shrink)

An English double-embedded relative clause from which the middle verb is omitted can often be processed more easily than its grammatical counterpart, a phenomenon known as the grammaticality illusion. This effect has been found to be reversed in German, suggesting that the illusion is language specific rather than a consequence of universal working memory constraints. We present results from three self-paced reading experiments which show that Dutch native speakers also do not show the grammaticality illusion in Dutch, whereas (...) both German and Dutch native speakers do show the illusion when reading English sentences. These findings provide evidence against working memory constraints as an explanation for the observed effect in English. We propose an alternative account based on the statistical patterns of the languages involved. In support of this alternative, a single recurrent neural network model that is trained on both Dutch and English sentences is shown to predict the cross-linguistic difference in the grammaticality effect. (shrink)

Objectives Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. Methods A vignette study was undertaken in participants in a colorectal cancer screening pilot programme in the Netherlands. Screenees with a negative test result received a questionnaire in which nine hypothetical situations were described: three different healthcare settings (screening, lung cancer, chronic (...) obstructive pulmonary disease) combined with three forms of differentiation each: a difference in premium, waiting list ordering or copayment according to lifestyle. We evaluated the responses using a general hierarchical linear model. Results The percentage of participants in agreement with differentiation varied from 20% to 58% (overall mean of 40%). Significantly more participants were in favour of giving a premium discount to those who do not engage in unhealthy behaviour compared with supporters for higher payments for those who do. More differentiation was supported for non-smoking versus smoking cessation than for participation versus non-participation in screening. We observed in-group favouritism in smokers, but no significant effects of age or disease. There was no support for waiting list ordering based on lifestyle. Conclusions Results of this study show that Dutch citizens eligible for colorectal cancer screening are in favour of some form of financial differentiation in the distribution of healthcare, but that significant differences exist between type of setting and the type of behaviour. Our study can be used in the ongoing discussion about solidarity and behaviour in healthcare. (shrink)

Verslag van een eeuwenlange strijd tussen geloof en rede in Nederland via portretten van denkers en beschrijvingen van geestelijke stromingen die hebben bijgedragen tot de ontwikkeling van een humanistische levensbeschouwing.

BackgroundThe Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain.MethodsWe did an electronic search of seven Dutch national newspapers between January 2009 and May 2010 and conducted a content analysis.ResultsOf the 284 articles containing the term ‘euthanasia’, 24% referred to practices outside the scope of the law, mostly (...) relating to the forgoing of life-prolonging treatments and assistance in suicide by others than physicians. Of the articles with euthanasia as the main topic, 36% described euthanasia in the context of a terminally ill patient, 24% for older persons, 16% for persons with dementia, and 9% for persons with a psychiatric disorder. The most frequent arguments for euthanasia included the importance of self-determination and the fact that euthanasia contributes to a good death. The most frequent arguments opposing euthanasia were that suffering should instead be alleviated by better care, that providing euthanasia can be disturbing, and that society should protect the vulnerable.ConclusionsOf the newspaper articles, 24% uses the term ‘euthanasia’ for practices that are outside the scope of the euthanasia law. Typically, the more unusual cases are discussed. This might lead to misunderstandings between citizens and physicians. Despite the Dutch legalisation of euthanasia, the debate about its acceptability and boundaries is ongoing and both sides of the debate are clearly represented. (shrink)

Social robots and their interactions with children are becoming increasingly sophisticated, with the emergence of child-robot relationships as a likely result. However, adequate measurement instruments that tap into concepts associated with child-robot relationship formation are scarce. We aimed to develop three measures that can be used to assess children’s closeness to, trust in, and perceived social support from, a social robot. We established the validity and reliability of these measures among 87 Dutch children aged 7 to 11 years old. (...) Because of their shortness, the measures can efficiently be applied by scholars aiming to gain insight into the general process of child-robot relationship formation and its specific sub-processes, that is, the emergence of closeness, trust, and perceived social support. (shrink)

At the end of Matters of Exchange , Harold Cook's major revisionist account of the early modern scientific revolution, he locates the political and economic writings of Bernard Mandeville within the practices and values of contemporaneous Dutch observational medicine. Like Mandeville, Cook describes the potency of early modern capitalism and its attendant value system in generating industry and knowledge; like Mandeville, Cook finds coercive systems of moral regulation to be mistaken in their estimation of human capacities; and like Mandeville, (...) Cook does not shy away from the violence that often made the worldwide commerce in matters of fact possible. “Every Part was full of Vice,” famously rhymed Mandeville, “Yet the whole Mass a Paradise.” The practices and values of science, this book suggests, stemmed from the vices of the merchant and the consumer, not the sprezzatura of the baroque courtier, the asceticism of the Christian gentleman, the speculation of the university philosopher, or the dour appraisal of the theologian. Interest, not claims to disinterest, made modern science and its attendant values possible. Scrupulous attention to goods from around the world and right at home created the conditions for natural knowledge. (shrink)

SummaryIntense, sustained nursing lengthens inter-birth intervals and is causally linked with low natural fertility. However, in traditional settings, the effects of such nursing on fertility are difficult to disentangle from those of nutrition. Results from an prospective, direct observational study of reproductive function in well-nourished Amele women who nurse intensively and persistently but who also have high fertility are here presented. Endocrine measures show that ovarian activity resumes by median 11·0 months postpartum. Median duration of postpartum amenorrhoea is 11·3 months, (...) time to next conception is 19·0 months, and the inter-birth interval is 28·0 months. Average life time fertility is 6·8. High fertility in Amele women is due both to refractoriness of reproductive function to suckling stimuli, and to maintenance of equivalent age-specific fertility rates across the reproductive life span. (shrink)

Background In the EU, clinical assessors, rapporteurs and the Committee for Medicinal Products for Human Use are obliged to assess the ethical aspects of a clinical development program and include major ethical flaws in the marketing authorization deliberation processes. To this date, we know very little about the manner that these regulators put this obligation into action. In this paper, we intend to look into the manner and the extent that ethical issues discovered during inspection have reached the deliberation processes. (...) Methods To gather data, we used the Dutch Medicines Evaluation Board database and first searched for the inspections, and their accompanying site inspection reports and integrated inspection reports, related to central marketing authorization applications of drugs submitted to the European Medicines Agency from 2011 to 2015. We then extracted inspection findings that were purely of ethical nature, i.e., those that did not affect the benefit/risk balance of the study. Only findings graded at least major by the inspectorate were included. Lastly, to identify how many of the ethically relevant findings reach the application deliberation processes, we extracted the relevant joint response assessment reports and reviewed the sections that discussed inspection findings. Results From 2011 to 2015, there were 390 processed applications, of which 65 had inspection reports and integrated inspection reports accessible via the database of the Dutch Medicines Evaluation Board. Of the 65, we found ERFs in 37. The majority of the ERFs were graded as major and half of the time it was informed-consent related. A third of these findings were related to research ethics committee processes and requirements. Of the 37 inspections with ERFs, 30 were endorsed in the integrated inspection reports as generally GCP compliant. Day 150 joint response assessment reports and Day 180 list of outstanding issues were reviewed for all 37 inspections, and none of the ERFs were carried over in any of the assessment reports or list of outstanding issues. Conclusion None of the ethically relevant findings, all of which were graded as major or critical in integrated inspection reports, were explicitly carried over to the joint assessment reports. This calls for more transparency in EMA application deliberations on how ERFs are considered, if at all, in the decision-making processes. (shrink)

Using telephone interviews among a random sample of 537 Dutch children aged 7–12 years old, we investigated the prevalence of fear reactions to television news among younger and older children and among boys and girls, what types of news items children in different age and gender groups refer to as frightening, and whether children's fear reactions to regular adult television news differed from their fear reactions to a special children's news program. Overall, 48.2 % of the children who reported (...) watching the adult or children's news programs, reported fear reactions to adult news, while 32.6 % reported fear of children's news content. For both types of news programs, younger children and girls more often reported fear than older children and boys did. The most prevalent fear-inducing news content categories were interpersonal violence, fires, accidents, and disasters, and visual depictions of the consequences of violence. (shrink)

Even the critics of Dutch Reformed theologian, politician, and publicist Abraham Kuyper acknowledge his great power of oratory. This essay examines the nature of Kuyper's rhetoric in a mythopoetic perspective that sees its inspiration in a romantic understanding of artistic inspiration and vivid representations of reality. Long-term editor of De Standaard, Kuyper's stalwart defence of Calvinism against Modernism drew from the struggles of Dutch history and from his personal history to espouse strong views that are couched in military (...) as well as organic metaphors. His mastery of the psychology of mass communication enabled Kuyper to accomplish many, though not all, of his political goals. (shrink)

The essay presents a set of interlinked claims about posture in modern culture. Over the past two centuries it has come to define a wide range of assumptions in the West from what makes human beings human (from Lamarck to Darwin and beyond) to the efficacy of the body in warfare (from Dutch drill manuals in the 17th century to German military medical studies of soldiers in the 19th century). Dance and sport both are forms of posture training in (...) terms of their own claims. Posture separates ‘primitive’ from ‘advanced’ peoples and the ‘ill’ from the ‘healthy.’ Indeed an entire medical sub-specialty developed in which gymnastics defined and recuperated the body. But all of these claims were also part of a Western attempt to use posture (and the means of altering it) as the litmus test for the healthy modern body of the perfect citizen. Focusing on the centrality of posture in two oddly linked moments of modern thought—modern Zionist thought and Nationalism in early 20th century China—in terms of bodily reform, we show how “posture” brings all of the earlier debates together to reform the body. (shrink)

As ethics committees become involved in discussing the propriety of euthanasia and assisted suicide, and as healthcare providers begin to seriously consider whether they might ever have a role in hastening the dying process, many have looked to The Netherlands as the only real example of a nation that permits euthanasia in limited circumstances. Unfortunately, partisans in the Dutch debate have often written about the Dutch experience as advocates rather than as neutral observers. Some have argued that euthanasia, (...) which, they claim, is rarely actually practiced, is universally accepted within The Netherlands; others have reported that the Dutch social fabric has been rended irreparably by what they claim, is a practice far more widespread than is generally understood. The debate in the United States has also been colored by a misunderstanding of the legal regulation of euthanasia in The Netherlands. (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 (...) class='Hi'>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)

The use of do not resuscitate (DNR) orders in Dutch hospitals was studied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, and 61 per cent of all in-hospital deaths were preceded by a DNR decision. We found that in only 14 per cent of the cases had the patients been involved in the DNR decision (32 per cent of competent patients). The concept (...) of futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a medical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patient involvement gave many reasons for their decision that went beyond determining effectiveness, we conclude that more patient involvement would have been desirable. (shrink)

Validated self-report measures of post-stroke fatigue are lacking. The Dutch Multifactor Fatigue Scale (DMFS) was translated into Danish, and response process evidence of validity was evaluated. DMFS consists of 38 Likert-rated items distributed on five subscales: Impact of fatigue (11 items), Signs and direct consequences of fatigue (9), Mental fatigue (7), Physical fatigue (6), and Coping with fatigue (5). Response processes to DMFS were investigated using a Three-Step Test-Interview (TSTI) protocol, and data were analyzed using Framework Analysis. Response processes (...) were indexed on the following categories: (i) “congruent,” response processes were related to the subscale construct; (ii) “incongruent,” response processes were not related to the subscale construct; (iii) “ambiguous,” response processes were both congruent and incongruent or insufficient to evaluate congruency; and (iv) “confused,” participants did not understand the item. Nine adults were recruited consecutively 10–34 months post-stroke (median = 26.5) at an outpatient brain injury rehabilitation center in 2019 [five females, mean age = 55 years (SD= 6.3)]. Problematic items were defined as <50% of response processes being congruent with the intended construct. Of the 38 items, five problematic items were identified, including four items of Physical fatigue and one of Mental fatigue. In addition, seven items posed various response difficulties to some participants due to syntactic complexity, vague terms, a presupposition, and a double-barrelled statement. In conclusion, findings elucidate the interpretative processes involved in responding to DMFS post-stroke, strengthen the evidence base of validity, and guide revisions to mitigate potential problems in item performance. (shrink)

Representatives from eight European countries compared the legal, ethical and professional settings within which decision making for neonates takes place. When it comes to limiting treatment there is general agreement across all countries that overly aggressive treatment is to be discouraged. Nevertheless, strong emphasis has been placed on the need for compassionate care even where cure is not possible. Where a child will die irrespective of medical intervention, there is widespread acceptance of the practice of limiting aggressive treatment or alleviating (...) suffering even if death may be hastened as a result. Where the infant could be saved but the future outlook is bleak there is more debate, but only two countries have tested the courts with such cases. When it comes to the active intentional ending of life, the legal position is standard across Europe; it is prohibited. However, recognising those intractable situations where death may be lingering and unpleasant, Dutch paediatricians have reported that they do sometimes assist babies to die with parental consent. Two cases have been tried through the courts and recent official recommendations have set out standards by which such actions may be assessed. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)