Background Increasing social pluralism adds to the already existing variety of heterogeneous moral perspectives on good care, health, and quality of life. Pluralism in social identities is also connected to health and care disparities for minoritized patient (i.e. care receiver) populations, and to specific diversity-related moral challenges of healthcare professionals and organizations that aim to deliver diversity-responsive care in an inclusive work environment. Clinical ethics support (CES) services and instruments may help with adequately responding to these diversity-related moral challenges. However, (...) although various CES instruments exist to support healthcare professionals with dealing well with morally challenging situations in healthcare, current tools do not address challenges specifically related to moral pluralism and intersectional aspects of diversity and social justice issues. This article describes the content and developmental process of a novel CES instrument called the Diversity Compass. This instrument was designed with and for healthcare professionals to dialogically address and reflect on moral challenges related to intersectional aspects of diversity and social justice issues that they experience in daily practice. Methods We used a participatory development design to develop the Diversity Compass at a large long-term care organization in a major city in the Netherlands. Over a period of thirteen months, we conducted seven focus groups with healthcare professionals and peer-experts, carried out five expert interviews, and facilitated four meetings with a community of practice consisting of various healthcare professionals who developed and tested preliminary versions of the instrument throughout three cycles of iterative co-creation. Results The Diversity Compass is a practical, dialogical CES instrument that is designed as a small booklet and includes an eight-step deliberation method, as well as a guideline with seven recommendations to support professionals with engaging in dialogue when they are confronted with diversity-related moral challenges. The seven recommendations are key components in working toward creating an inclusive and safe space for dialogue to occur. Conclusions The Diversity Compass seeks to support healthcare professionals and organizations in their efforts to facilitate awareness, moral learning and joint reflection on moral challenges related to diversity and social justice issues. It is the first dialogical CES instrument that specifically acknowledges the role of social location in shaping moral perspectives or experiences with systemic injustices. However, to make healthcare more just, an instrument like the Diversity Compass is not enough on its own. In addition to the Diversity Compass, a systemic and structural approach to social justice issues in healthcare organizations is needed in order to foster a more inclusive, safe and diversity-responsive care and work environment in health care organizations. (shrink)

Ethical guidelines protecting medical research participants have been criticized for stripping the sociocultural contexts of research. This critique is urgent considering ongoing calls to account for participant diversity in recruitment and inclusion procedures. Our intersectional analysis of illness narratives explores how sociostructural factors might play a role in participants’ exposure to research-related harm in clinical trials. Although widening participation does respond to generalizability concerns, we argue that gendered, classed, and ableist processes of self-silencing could simultaneously enhance risk of harm for (...) participants with multiple oppressed identities. To prevent this, researchers might actively involve participants when designing trials. (shrink)

An important and supposedly impactful form of clinical ethics support is moral case deliberation. Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings. A systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science. Both the data collection and the (...) qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti. Based on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level. This review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support. (shrink)

This article gives an overview of the moral problems experienced and described by nurses working in a dialysis unit in the Netherlands. The nurses raised a wide variety of issues that they considered were moral problems, which were grouped into seven topics. A selection of cases are described, one of which is analysed using the Nijmegen method of ethical case deliberation. This method facilitates practical approaches to the different types of moral problems encountered. The argument is made that, owing to (...) their specific moral position and responsibility, nurses' contribution to ethical reflection in ward discussions should be valued more. All caregivers involved are indispensable in developing a basis for well-reasoned decisions when deliberating about moral problems. (shrink)

Clarifying and analysing moral problems arising in the practice of palliative care was the objective of participatory observations in five palliative care settings. The results of these observations will be described in this contribution. The moral problems palliative caregivers have to deal with in their daily routines will be explained by comparison with the findings of a previously performed literature study. The specific differences in the manifestation of moral problems in the different palliative care settings will be highlighted as well.

Dutch manner of motion verbs play a prominent role in the literature on unaccusativity. As these verbs can take both hebben ‘have’ and zijn ‘be’ as their perfective auxiliaries, they are considered to show both unergative and unaccusative behavior. The general consensus is that these verbs normally take hebben, yet occur with zijn if they are ‘telicized’ by an endpoint, and that the auxiliaries are diagnostics for the syntactic status of prepositional phrases (PPs). The paper presents attested data that reveal (...) that this generalization is untenable: there are examples that take the opposite auxiliary from what the generalization predicts. To account for the full set of data, the paper takes a cognitive-grammar perspective, arguing that auxiliary choice, telicity and syntactic status of PPs are independent issues requiring their own explanations. Auxiliary choice is analyzed in terms of alternate construals of a motion event: with hebben as a type of act and with zijn as a change of location. In this manner, the paper adds to a growing body of literature that questions the usefulness of the coarse unergative–unaccusative distinction, advocating a ‘local analysis’ instead. (shrink)

This piece lists, in an evocative way, how the author hopes that psychoanalysis may contribute to liberation.

In the emerging academic field of game studies, Roger Caillois’ Les Jeux et les hommes has already received the status of an obligatory reference. It is honoured as one of the few classic texts in game theory, but some also argue that it is not useful for analysing digital games. Caillois’ book is of particular interest for cultural theorists, though, because it presents a theory of games and play while also addressing the meaning of play. After analysing more closely why (...) Caillois’ theory falls short when it is applied to digital games, we suggest a slight modification of its categories. Starting from the four game dimensions outlined by Caillois - competition, chance, simulation and vertigo - and his two modes of playing, paidia and ludus, we build on his theory by distinguishing two additional game characteristics, called repens and repositio. Both deal with the internal, temporal organization of a game. Repens is a specific characteristic of games that appeals to the player’s desire to discover, explore and get to know the surprises a game has in store and to make progress by learning from these surprises. Repositio denotes complementary experiences: having to retry, return, replay and repeat a certain action while getting better at it with every try. The balance, or unbalance, between repens and repositio, as characteristic elements of many digital games, determines to a large extent their attraction. Finally, repens and repositio are not only indicators of fun in the playing of digital games; they also hint at basic elements in learning theories and social theory. The study of the interplay between repens and repositio can help in clarifying the possibilities and limitations of digital games for learning purposes. (shrink)

ABSTRACT The Dutch case of Brongersma presents novel challenges to the definition and evaluation of voluntary euthanasia since it involved a doctor assisting the suicide of an individual who was (merely?) ‘tired of life’. Legal officials had called on the courts to ‘set a principled boundary’, excluding such cases from the scope of permissible voluntary euthanasia, but they arguably failed. This failure is explicable, however, since the case seems justifiable by reference to the two major principles in favour of that (...) practice, respect for autonomy and beneficence. Ultimately, it will be argued that those proponents of voluntary euthanasia who are wary of its use in such circumstances may need to draw upon ‘practical’ objections, in order to erect an otherwise arbitrary perimeter. Furthermore, it will be suggested that the issues raised by the case are not peculiarly Dutch in nature and that, therefore, there are lessons here for other jurisdictions too. (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.

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.

This article proposes the use of agent-based simulation to analyze complex design trade-offs that involve value tensions. This is illustrated by a case study in the domain of train traffic control. In this case, agent-based simulation supported the involvement of stakeholders and increased understanding of a design trade-off.

Ibn al-Sāʿī, Consorts of the Caliphs: Women and the Court of Baghdad. Edited by Shawkat M. Toorawa, translated by Editors of LAL. Library of Arabic Literature. New York: New York University Press, 2015. Pp. xlv + 226. $30.

This text elaborates an understanding of abstraction as fundamental to how we think from a closer look at relationships between abstraction, movement, materiality and lived experience. Starting from Whitehead-inspired reflections on ab­straction by Alberto Toscano and Brian Massumi, the differences between their respective readings of his work are shown to be indicative for their different conceptions of the relationships between abstraction, the concrete, and lived experience. The text then continues to elaborate how Alva Noë’s enactive approach to perception illumi­nates the (...) central role of movement and sensorimotor skills in the emergence of abstractions from the continuity of process that is reality, and could contribute to further understanding of the relationship between movement and abstraction as what Massumi describes as the incorporeal dimension of the real. Finally, this text reflects on the potential of movement practices and technology to become part of how abstraction is achieved. (shrink)

This text elaborates an understanding of abstraction as fundamental to how we think from a closer look at relationships between abstraction, movement, materiality and lived experience. Starting from Whitehead-inspired reflections on ab­straction by Alberto Toscano and Brian Massumi, the differences between their respective readings of his work are shown to be indicative for their different conceptions of the relationships between abstraction, the concrete, and lived experience. The text then continues to elaborate how Alva Noë’s enactive approach to perception illumi­nates the (...) central role of movement and sensorimotor skills in the emergence of abstractions from the continuity of process that is reality, and could contribute to further understanding of the relationship between movement and abstraction as what Massumi describes as the incorporeal dimension of the real. Finally, this text reflects on the potential of movement practices and technology to become part of how abstraction is achieved. (shrink)

This chapter explores the relationship between theatre and thinking through a confrontation of Gilles Deleuze and Félix Guattari's philosophical staging of thinking with Ivana Müller's theatrical staging of thinking in How Heavy Are My Thoughts? It explains that Müller's lecture performance reports her attempts to find an answer to the question concerning the mind/body dualism. It argues that Deleuze and Guattari did not mention theatre in their work, their account of thinking suggests the possibility of conceiving of theatre in terms (...) of thinking. (shrink)

In this article, we report on eight grand challenges for value sensitive design, which were developed at a one-week workshop, Value Sensitive Design: Charting the Next Decade, Lorentz Center, Leiden, The Netherlands, November 14–18, 2016. A grand challenge is a substantial problem, opportunity, or question that motives sustained research and design activity. The eight grand challenges are: Accounting for Power, Evaluating Value Sensitive Design, Framing and Prioritizing Values, Professional and Industry Appropriation, Tech policy, Values and Human Emotions, Value Sensitive Design (...) and Intelligent Algorithms, and Value Tensions. Each grand challenge consists of a discussion of its importance and a set of tractable key questions. (shrink)

God in the Courtroom: The Transformation of Courtroom Oath and Perjury between Islamic and Franco-Egyptian Law. By Guy Bechor. Studies in Islamic Law and Society, vol. 34. Leiden: Brill, 2012. Pp. xv + 412. $196.

ABSTRACT The Dutch case of Brongersma presents novel challenges to the definition and evaluation of voluntary euthanasia since it involved a doctor assisting the suicide of an individual who was (merely?) ‘tired of life’. Legal officials had called on the courts to ‘set a principled boundary’, excluding such cases from the scope of permissible voluntary euthanasia, but they arguably failed. This failure is explicable, however, since the case seems justifiable by reference to the two major principles in favour of that (...) practice, respect for autonomy and beneficence. Ultimately, it will be argued that those proponents of voluntary euthanasia who are wary of its use in such circumstances may need to draw upon ‘practical’ objections, in order to erect an otherwise arbitrary perimeter. Furthermore, it will be suggested that the issues raised by the case are not peculiarly Dutch in nature and that, therefore, there are lessons here for other jurisdictions too. (shrink)

ABSTRACTPreviously depressed individuals experience disturbances in affect. Affective disturbances may be related to visual mental imagery, given that imagery-based processing of emotional stimuli causes stronger affective responses than verbal processing in experimental laboratory studies. However, the role of imagery-based processing in everyday life is unknown. This study assessed mental imagery in the daily life of previously and never depressed individuals. Higher levels of visual mental imagery was hypothesised to be associated with more affective reactivity to both negatively and positively valenced (...) mental representations.This study was the first to explore mental imagery in daily life using experience sampling methodology. Previously depressed and matched never depressed individuals participated in this study. Momentary affect and imagery-based processing were assessed using the “Imagine your mood” smartphone application. Participants recorded on average 136 momentary reports ove... (shrink)

In this article, we introduce the Special Issue, Value Sensitive Design: Charting the Next Decade, which arose from a week-long workshop hosted by Lorentz Center, Leiden, The Netherlands, November 14–18, 2016. Forty-one researchers and designers, ranging in seniority from doctoral students to full professors, from Australia, Europe, and North America, and representing a wide range of academic fields participated in the workshop. The first article in the special issue puts forward eight grand challenges for value sensitive design to help guide (...) and shape the field. It is followed by 16 articles consisting of value sensitive design nuggets—short pieces of writing on a new idea, method, challenge, application, or other concept that engages some aspect of value sensitive design. The nuggets are grouped into three clusters: theory, method, and applications. Taken together the grand challenges and nuggets point the way forward for value sensitive design into the next decade and beyond. (shrink)

This is the result of a two year theological reflection on the religious and social activities of Catholic women’s organisations. The organisations are found to be active in the area of human rights and particularly women’s rights, as expressed in a critique of society and the Church, and in campaigning or working in the field of social concern. The background to their work is a view of the image of God in all people, which I have compared with the feminist (...) principle of Imago Dei. I find in the activities of these women’s organisations, which are inclined to be marginalized as they deal with day to day issues, Norvene West’s principle of ‘tender competence’ which describes their importance for a theological agenda and helps make them visible to theological reflection. (shrink)

Disregarding trends of secularization, the Virgin Mary still plays an important role in religious devotions all over the world, even in the West. This does not diminish the controversies, debates and theo-political struggles that surround Mary and a Marian theology, as will be shown in this article. Western feminist theologies mostly choose, in general accordance with the Second Vatican Council, for a liberating, biblical, human Mary contra a more cosmological Mary, object of devotional piety. This contribution gives a critical sketch (...) of the background of these developments in Mariology and argues for a closer look at Marian devotional practices in order to find some inspiring elements for rethinking divine presence, Mary and perhaps a new Mariology. Can feminists find inspiration in this approach without forfeiting critical power and without denying the paradoxical and dangerous dimensions of Mary? (shrink)

The Iliad opens with the image of abandoned corpses, left as prey to the wild beasts. It closes with the hard-won and respectful funeral of Hector, during which his maimed body is finally laid to rest. In-between these passages, death and the fate of dead bodies are often part of the epic's subject matter. The audience is treated to a wide selection of images concerning the fallen and their remains, ranging from those taken gently away from the battlefield to be (...) buried to those who are posthumously mutilated where they lie. Instances of corpse mutilation are rare elsewhere in Greek historical and literary writing, but occur in the Iliad at a regular rate. The gruesomeness of these acts makes for shocking and violent scenes, and represents a radical departure from the normal funeral ritual with lasting repercussions for the relatives of the deceased and the fate of the dead person in the afterlife. (shrink)

The introduction of results of AI and Law research in actual legal practice advances disturbingly slow. One of the problems is that most research can be classified as either theoretical or pragmatic, while combinations of these two are scarce. This interferes with the need for feedback as well as with the need of getting support, both financially and from actual legal practice. The conclusion of this paper is that an emphasis on research that generates operational and sophisticated systems is necessary (...) in order to provide a future for AI and Law. (shrink)

Automated decision systems are often used to enforce legislation.As such, they have considerable regulating effects. These systemsregulate the behaviour of users and addressees mainly throughstandardization. This research classifies these systems intocategories according to which the regulating effects can bedescribed more clearly. Furthermore, this categorization resultsin a better understanding how problems encountered with atpresent can be avoided in the future. Many problems result fromthe way the development process has been organized. It turns outthe development process can be divided according to the (...) time thesystems are developed with regard to the legislation they aim toenforce. Present procedures lack good monitoring of thedevelopment process. To this end, legal procedures are needed toensure that a legally correct product will be made, partiesinvolved should change their tune, system developers should bemore concerned with the legal status of the system and thelegislator should be actively involved in the development of thesystem. Moreover, an ex ante-evaluation should notice thepossible regulating effects caused by the system to ensure acorrect balance of the pros and cons. It should be ensured thatthese systems are effectively put to control. Transparency isindispensable. (shrink)

The aim of this article is to demonstrate the usefulness of qualitative research for studying the ethics of care, bringing to light the lived experience of health care recipients, together with the importance of methods that allow reconstruction of the processes underlying this lived experience. Lived experiences of families being approached for organ donation, parents facing the imminent death of their child and patients being treated using stem cell transplantation are used to illustrate how ethical principles are differentiated, modified or (...) contradicted by the narrative context of persons concerned. The integration of empirical data into ethics will help caregivers in their ethical decision making and may enrich care ethics as a narrative and interpretative field. (shrink)

Support from grandparents plays a role in mothers’ perinatal mental health. However, previous research on maternal mental health has mainly focused on influences of partner support or general social support and neglected the roles of grandparents. In this narrative review and meta-analysis, the scientific evidence on the association between grandparental support and maternal perinatal mental health is reviewed. Searches in PubMed, EMBASE, MEDLINE, Scopus, and PsycINFO yielded 11 empirical studies on N = 3381 participants, reporting on 35 effect sizes. A (...) multilevel approach to meta-analysis was applied to test the association between grandparental support and maternal mental health. The results showed a small, statistically significant association (r =.16; 95% CI: 0.09–0.25). A moderator test indicated that the association was stronger for studies reporting on support from the maternal grandmother in particular (r =.23; 95% CI: 0.06–0.29). Our findings suggest that involved grandparents, in particular mother’s own mother, constitute a protective factor for the development of maternal postpartum mental health problems. These findings have clear implications for interventions. Future studies should examine whether stimulating high-quality support from grandparents is a fruitful avenue for enhancing maternal postpartum mental health. (shrink)

We invite systematic consideration of the metaphors of cycles and circulation as a long-term theme in the history of the life and environmental sciences and medicine. Ubiquitous in ancient religious and philosophical traditions, especially in representing the seasons and the motions of celestial bodies, circles once symbolized perfection. Over the centuries cyclic images in western medicine, natural philosophy, natural history and eventually biology gained independence from cosmology and theology and came to depend less on strictly circular forms. As potent ‘canonical (...) icons’, cycles also interacted with representations of linear and irreversible change, including arrows, arcs, scales, series and trees, as in theories of the Earth and of evolution. In modern times life cycles and reproductive cycles have often been held to characterize life, in some cases especially female life, while human efforts selectively to foster and disrupt these cycles have harnessed their productivity in medicine and agriculture. But strong cyclic metaphors have continued to link physiology and climatology, medicine and economics, and biology and manufacturing, notably through the relations between land, food and population. From the grand nineteenth-century transformations of matter to systems ecology, the circulation of molecules through organic and inorganic compartments has posed the problem of maintaining identity in the face of flux and highlights the seductive ability of cyclic schemes to imply closure where no original state was in fact restored. More concerted attention to cycles and circulation will enrich analyses of the power of metaphors to naturalize understandings of life and their shaping by practical interests and political imaginations. (shrink)

This article argues that Rousseau's endorsement of male domination and his illiberal views of rape, punishment and the education of women have been seriously underestimated by twentieth century commentators who tend to produce expoisitions of his work that evade, ignore or marginalise this 'darker side' of his educational philosophy.

Developmental dyslexia is considered to be most effectively addressed with preventive phonics-based interventions, including grapheme-phoneme coupling and blending exercises. These intervention types require intact speech perception abilities, given their large focus on exercises with auditorily presented phonemes. Yet some children with dyslexia experience problems in this domain due to a poorer sensitivity to rise times, i.e., rhythmic acoustic cues present in the speech envelope. As a result, the often subtle speech perception problems could potentially constrain an optimal response to phonics-based (...) interventions in at-risk children. The current study therefore aimed to extend existing research by examining the presence of potential speech perception deficits in pre-readers at cognitive risk for dyslexia when compared to typically developing peers and to explore the added value of a preventive auditory intervention for at-risk pre-readers, targeting rise time sensitivity, on speech perception and other reading-related skills. To obtain the first research objective, we longitudinally compared speech-in-noise perception between 28 5-year-old pre-readers with and 30 peers without a cognitive risk for dyslexia during the second half of the third year of kindergarten. The second research objective was addressed by exploring growth in speech perception and other reading-related skills in an independent sample of 62 at-risk 5-year-old pre-readers who all combined a 12-week preventive phonics-based intervention with an auditory story listening intervention. In half of the sample, story recordings contained artificially enhanced rise times, while in the other half, stories remained unprocessed. Results revealed a slower speech-in-noise perception growth in the at-risk compared to the non-at-risk group, due to an emerged deficit at the end of kindergarten. Concerning the auditory intervention effects, both intervention groups showed equal growth in speech-in-noise perception and other reading-related skills, suggesting no boost of envelope-enhanced story listening on top of the effect of combining GraphoGame-Flemish with listening to unprocessed stories. These findings thus provide evidence for a link between speech perception problems and dyslexia, yet do not support the potential of the auditory intervention in its current form. (shrink)