During his internship the medical student often feels a basic need for ethical discussion. The department of medical ethics at the University of Nijmegen offers a monthly discussion in single clinical departments. The ethicist is then assisted by staff responsible for guiding the interns. These discussions, based on daily experience, aim at critical evaluation of ways the profession is being exercised. As such they form an essential counterpart to the more theoretical learning in classrooms and seminars during previous years. The (...) method is rather flexible. Either an inventory of problems is made, followed by a selection and discussion of one problem. Or a discussion is initiated by an introduction by either staff or ethicist. The actual programme and its origin, the objectives and some of the problems of such a programme are presented in this article. (shrink)

It is generally accepted that bioethics is an interdisciplinary science. Why this is so and what it means is not always clear or agreed upon and, in this author's view, its implications are insufficiently researched. On the basis of involvement in projects which were labelled interdisciplinary, the author reflects upon the method of interdisciplinarity, especially its starting point. It is suggested that interdisciplinarity cannot thrive unless it curbs, from the very start, the inevitable reductions of all monodisciplinary approaches. This effort (...) is called methodical epochè, ideally the temporary suspension of all known methods. Its purpose is to achieve an interdisciplinary way of stating the question. Until then no breakdown of the global question by particular methods of single disciplines ought to be attempted. Realistic variations of this ideal are also discussed. CiteULike Connotea Del.icio.us What's this? (shrink)

Nearly fifteen years after the Council of Europe first called for a pan‐European convention on issues in bioethics to harmonize disparate national regulations, in November 1996 the council's Committee of Ministers approved the Convention on Human Rights and Biomedicine for formal adoption. The draft convention, released in July 1994, provoked strong public, professional, and governmental debate among European nations, particularly regarding provisions for biomedical research with subjects unable to give informed consent. If ratified, the “bioethics convention” will become the first (...) such document to have binding force internationally. (shrink)

The editors welcome letters from readers, although we cannot guarantee that all will be published. To ensure timeliness, correspondents must respond to an article within seven weeks and not exceed two double‐spaced pages. Letters become the property of the editors and may be edited and shortened at our discretion.

Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in (...) a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare. (shrink)

Ethics support services like Moral Case Deliberation intend to support healthcare professionals in ethically difficult situations. To assess outcomes of MCD, the Euro-MCD Instrument has been developed. Field studies to test this instrument are needed and have been conducted, examining important outcomes before MCD participation and experienced outcomes. The current study aimed to describe how participants’ perceive the importance of MCD outcomes after MCD; compare these perceptions with those before MCD participation; and test the factor structure of these outcomes. Swedish, (...) Norwegian and Dutch healthcare professionals rated the importance of outcomes in the Euro-MCD Instrument after four and eight MCDs. Ratings were compared with those before MCD participation using paired and independent samples t-tests. The factor structure was tested using exploratory factor analyses. After 4 and 8 MCDs, 443 respectively 247 respondents completed the instrument. More than 69% rated all MCD outcomes as ‘quite’ or ‘very’ important, especially outcomes from Enhanced Collaboration, Improved Moral Reflexivity and Improved Moral Attitude. Significant differences for 16 outcomes regarding ratings before and after MCD participation were not considered meaningful. Factor analyses suggested three categories, which seemingly resemble the domains Improved Moral Reflexivity, Enhanced Collaboration and a combination of Improved Moral Attitude and Enhanced Emotional Support. After participation in MCDs, respondents confirmed the importance of outcomes in the Euro-MCD Instrument. The question on perceived importance and the categorization of outcomes need reconsideration. The revised instrument will be presented elsewhere, based on all field studies and theoretical reflections. (shrink)

The blackbody radiation field is studied from different points of view. The existence of zero-point fluctuations is shown to be crucial in determining the form of the thermal part of the spectrum. The notion of a continuous field is seen to be compatible with a discrete structure for its interaction: The description normally used in the quantum context does not refer to the field but to its interaction with atomic systems, which involves statistically independent elementary acts of absorption and emission. (...) The same classical field has different effects on absorption and on emission, and these are conveniently, but not necessarily, described in terms of non-commuting operators. (shrink)

The transition towards sustainable and just food systems is ongoing, illustrated by an increasing number of initiatives that try to address unsustainable practices and social injustices. Insights are needed into what a just transition entails in order to critically engage with plural and potentially conflicting justice conceptualisations. Researchers play an active role in food system transitions, but it is unclear which conceptualisations and principles of justice they enact when writing about food system initiatives. To fill this gap this paper investigates: (...) Which conceptualisations of justice emerge from the literature related to food system initiatives and which principles of justice do authors use? We developed an initial framework for which we drew on political philosophy literature. We then undertook an extensive review of the food system transitions literature using this framework and were able to identify a range of recognition, distributive, and procedural justice conceptualisations and associated principles of justice. Recognised as subjects of justice were those with a particular role in the food system, people who are marginalised, Indigenous communities, those with experiences of negative consequences of the food system, future generations, and nonhumans. The identified conceptualisations and the developed framework can be used by those involved in food system initiatives to reflect on how they conceptualise justice. We challenge them to be more explicit about who they do and do not recognise as subjects of justice and which principles of justice they use. Such clarity is needed to reflexively enact a just transition towards sustainable and just food systems. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

Zusammenfassung Einrichtungen der Altenpflege weisen spezifische ethische Spannungsfelder und ethische Fragestellungen auf. Das Strukturinstrument EMMA (_E_thik _M_ultiprofessionell _M_ethodisch _A_nwenden) zur Moderation einer Ethik-Fallberatung wurde für den Einsatz in Einrichtungen der Altenpflege konzipiert. Inhaltlich werden die Besonderheiten dieses Settings unter Bezugnahme auf den Schlüsselbegriff Privatheit in den Mittelpunkt gestellt. EMMA eignet sich aufgrund seiner Kontextsensitivität darüber hinaus zum Einsatz in der Ethik-Fallberatung in unterschiedlichen außerklinischen Settings.

This study explores the impact of participation in a series of moral case deliberations (MCD) on the moral craftsmanship (MCS) of Dutch prison staff. Between 2017–2020, ten MCDs per team were implemented in three prisons (i.e., intervention group). In three other prisons (i.e., control group) no MCDs were implemented. We compared the intervention and control group using a self-developed questionnaire, administered before (pre-measurement) and after the series of MCDs (post-measurement). Results After the MCDs, participants scored significantly higher on 7 of (...) the 70 items related to MCS. On some items there were significant impact differences between the various professional disciplines. Discussion Possible explanations for a relatively low impact are discussed. A shorter and validated questionnaire is needed in order to further study the MCS of professionals and the impact of Ethics Support Services (ESS). Conclusions There was a positive development on some elements of MCS after participation in a series of MCDs. (shrink)

ABSTRACTAt present, the consequences and functions of experiences of shame are not yet well understood. Whereas psychology literature typically portrays shame as being bad for social relations, motivating social avoidance and withdrawal, there are recent indications that shame can be reinterpreted as having clear social tendencies in the form of motivating approach and social affiliation. Yet, until now, no research has ever put these alternative interpretations of shame-motivated behaviours directly to the test. The present paper presents such a test by (...) studying the extent to which shame motivates a preference for social withdrawal versus a preference for social approach. Two studies using different shame inductions both showed people experiencing shame to prefer to be together with others over being alone. In addition, the preference for a social situation was found to be unique for shame; it was not found for the closely related emotion of gui... (shrink)

The present paper reveals (non-relativistic) quantum mechanics as an emergent property of otherwise classical ergodic systems embedded in a stochastic vacuum or zero-point radiation field (zpf). This result provides a theoretical basis for understanding recent numerical experiments in which a statistical analysis of an atomic electron interacting with the zpf furnishes the quantum distribution for the ground state of the H atom. The action of the zpf on matter is essential within the present approach, but it is the ergodic demand (...) what ultimately leads to the matrix formulation of quantum mechanics. The paper thus represents a step forward in the quest for an elucidation of the fundamentals of quantum mechanics. (shrink)

We formulate from first principles a theory of stochastic processes in configuration space. The fundamental equations of the theory are an equation of motion which generalizes Newton's second law and an equation which expresses the condition of conservation of matter. Two types of stochastic motion are possible, both described by the same general equations, but leading in one case to classical Brownian motion behavior and in the other to quantum mechanical behavior. The Schrödinger equation, which is derived here with no (...) further assumption, is thus shown to describe a specific stochastic process. It is explicitly shown that only in the quantum mechanical process does the superposition of probability amplitudes give rise to interference phenomena; moreover, the presence of dissipative forces in the Brownian motion equations invalidates the superposition principle. At no point are any special assumptions made concerning the physical nature of the underlying stochastic medium, although some suggestions are discussed in the last section. (shrink)

We assessed how synchronous speech listening and lipreading affects speech recognition in acoustic noise. In simple audiovisual perceptual tasks, inverse effectiveness is often observed, which holds that the weaker the unimodal stimuli, or the poorer their signal-to-noise ratio, the stronger the audiovisual benefit. So far, however, inverse effectiveness has not been demonstrated for complex audiovisual speech stimuli. Here we assess whether this multisensory integration effect can also be observed for the recognizability of spoken words. To that end, we presented audiovisual (...) sentences to 18 native-Dutch normal-hearing participants, who had to identify the spoken words from a finite list. Speech-recognition performance was determined for auditory-only, visual-only (lipreading) and auditory-visual conditions. To modulate acoustic task difficulty, we systematically varied the auditory signal-to-noise ratio. In line with a commonly-observed multisensory enhancement on speech recognition, audiovisual words were more easily recognized than auditory-only words (recognition thresholds of -15 dB and -12 dB, respectively). We here show that the difficulty of recognizing a particular word, either acoustically or visually, determines the occurrence of inverse effectiveness in audiovisual word integration. Thus, words that are better heard or recognized through lipreading, benefit less from bimodal presentation. Audiovisual performance at the lowest acoustic signal-to-noise ratios (45%) fell below the visual recognition rates (60%), reflecting an actual deterioration of lipreading in the presence of excessive acoustic noise. This suggests that the brain may adopt a strategy in which attention has to be divided between listening and lipreading. (shrink)

An analysis is briefly presented of the possible causes of the failure of stochastic electrodynamics (SED) when applied to systems with nonlinear forces, on the basis that the main principles of the theory are correct. In light of this analysis, an alternative approach to the theory is discussed, whose postulates allow to establish contact with quantum mechanics in a natural way. The ensuing theory, linear SED, confirms the essential role of the vacuum–particle interaction as the source of quantum phenomena.

The «law of weak parliaments» states that parliaments with small competences only attract weak candidates, which in turn weakens the parliament even more.Research concerning the Belgian delegates to the European Parliament from 1952 to 1979, confirmed this law, but also qualified it by showing that the downward trend can be crosscut when the parliament gains importance as an institutional platform for a social movement, in this case for the European integration.