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

This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic (...) and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this.;This book is a good example of the contribution a clear conceptual analysis can make to highlighting and clarifying problematic thinking about real issues in education. In the literature there are different claims of varying strength and plausibility which require very careful sorting. David Carr demonstrates such careful sorting in the difficult field of ethics and maps some paths for fruitful thinking about professionalism in teaching. &lsquoThe distinctions of Peters and others between education and teaching, theory and practice, and intrinsic and instrumental value, stand in need of more careful mapping and refinement&rsquo which could enable us to steer clear of &lsquoeducationally pernicious conclusions&rsquo . Carr succeeds in doing just this. (shrink)

This paper analyses the use of strategies and instruments for organising ethics by small and large business in the Netherlands. We find that large firms mostly prefer an integrity strategy to foster ethical behaviour in the organisation, whereas small enterprises prefer a dialogue strategy. Both large and small firms make least use of a compliance strategy that focuses on controlling and sanctioning the ethical behaviour of workers. The size of the business is found to have a positive impact on the (...) use of several instruments, like code of conduct, ISO certification, social reporting, social handbook and confidential person. Also being a subsidiary of a larger firm has a significant positive influence on the use of instruments. The most popular instrument used by small firms is to let one member of the board be answerable for ethical questions, which fits the informal culture of most small firms. With respect to sectorial differences, we find that firms in the metal manufacturing and construction sectors are more actively using formal instruments than firms in the financial service sector and retail sector. The distinction between family and non-family firms hardly affects the use of instruments. (shrink)

This paper analyses the use of strategies and instruments for organising ethics by small and large business in the Netherlands. We find that large firms mostly prefer an integrity strategy to foster ethical behaviour in the organisation, whereas small enterprises prefer a dialogue strategy. Both large and small firms make least use of a compliance strategy that focuses on controlling and sanctioning the ethical behaviour of workers. The size of the business is found to have a positive impact on the (...) use of several instruments, like code of conduct, ISO certification, social reporting, social handbook and confidential person. Also being a subsidiary of a larger firm has a significant positive influence on the use of instruments. The most popular instrument used by small firms is to let one member of the board be answerable for ethical questions, which fits the informal culture of most small firms. With respect to sectorial differences, we find that firms in the metal manufacturing and construction sectors are more actively using formal instruments than firms in the financial service sector and retail sector. The distinction between family and non-family firms hardly affects the use of instruments. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.