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)

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.

In diesem Fazit & Ausblick werden nun die in der Einleitung formulierten Themenfelder, in denen wir auch die Anschlüsse an Arbeiten und Forschungsgebiete der Historischen Anthropologie gegeben sahen, wieder aufgegriffen. Dies geschieht entlang von Aspekten, die durch die responses aufgeworfen wurden, und die wir hinsichtlich unserer Forschung zu Arenen transkultureller Bildung weiterdenken. Ein wichtiger Schwerpunkt liegt dabei auf den Transmissionseffekten, die sich im Forschungsprozess, auch unter Einbezug der responses, zwischen den Forschungsfeldern – den Arenen Theater und Schule – ergeben haben. (...) Daran anschließend formulieren wir die Implikationen, die sich daraus für die Weiterentwicklung unserer Methoden ergeben haben, sowie einen Ausblick, der sich den Möglichkeiten der Erweiterung der Forschung zu kultureller Bildung unter Einbezug postkolonialer und transkultueller Analyseperspektiven widmet. Wir haben in den drei Method Labs„Method Mixing: Methoden der Praxis in postmigrantischen Kontaktzonen“ (November 2017); „Towards new methodologies in transcultural education: Performativity of the digital, Material Feminism and transcultural analysis” (Juni 2018) und “Arenas of transcultural Education: artistic research, art based methods, New Materialism and Sensory Ethnography“ (Januar 2019). Praktiker*innen und Wissenschaftler*innen, die aus unterschiedlichen Disziplinen und Forschungsschwerpunkten kommen und in verschiedenen europäischen Universitäten und Institutionen forschen und arbeitenSound Studies, Historische und pädagogische Anthropologie; Allgemeine Erziehungswissenschaft, Anglistik und Postcolonial Studies, Global Childhood & Youth Studies, International Childhood Studies, Grundschulpädagogik, Theaterpädagogik und Dramaturgie sowie Lehrerbildung, künstlerische Forschung und kulturelle Bildung., eine Auswahl des über drei Jahre im Feld erhobenen Materials, das Method Mixing der beiden Arenen Schule und Theater, sowie unsere diffraktionellen Analysen, die entstandenen Interferenzen, und das sich daraus entwickelnde Method Mixing des Projekts vorgestellt. Nach intensiven, über zwei Tage andauernden Diskussionen über das unseren Gästen der Method Labs vorgestellte Material haben wir diese um eine Verschriftlichung ihrer responses gebeten. Die Wahl des Themas sowie des Umfangs und der Form wurden dabei freigestellt. Herausgekommen sind sehr unterschiedliche, und, wie wir finden, im Kern ebenfalls diffraktionell operierende Antworten, die in den vorangegangen Kapiteln vorgestellt wurden. (shrink)

In 2001 hield Johan J. Graafland zijn oratie Maatschappelijk ondernemen: analyse, verantwoording en fundering. Hiermee aanvaardde hij het ambt van bijzonder hoogleraar Economie, Onderneming en Ethiek aan de Universiteit van Tilburg. Graag wil ik Johan Graafland van harte feliciteren met zijn benoeming. Ik ervaar het toch steeds weer als een bijzondere zegen als christenen zo’n positie mogen bezetten. Ik wens hem veel vruchten toe op zijn arbeid. Op de nieuwjaarsconferentie 2002 van de Vereniging voor Reformatorische Wijsbegeerte heeft Graafland een lezing (...) gegeven waarin hij enkele momenten uit zijn oratie toelichtte. Op die conferentie mocht ik als co-referent optreden. De week voorafgaande aan de conferentie was ik voor een zakenreis in Taiwan. Ik kwam vrijdagsavonds weer in Nederland terug. Door een ongelukkige samenloop van omstandigheden kreeg ik ook toen pas de tekst van de oratie van Graafland in handen. De tijd was voor mij te kort — en de onvermijdelijke jet-lag werkt dan ook niet mee — om de oratie goed te bestuderen en op vruchtbare wijze te kunnen reageren. Ik had geen andere mogelijkheid dan een ‘eigen’ verhaal te houden . Graag wil ik nu van de gelegenheid gebruik maken om inhoudelijk op de oratie van Graafland in te gaan. (shrink)

Is het nog de moeite waard om het op te nemen voor de transcendentale kritiek van Dooyeweerd? Deze vraag suggereert dat de transcendentale kritiek wanneer zij aan zichzelf overgelaten zou worden, niet meer te redden is. Dat is misschien wat overdreven, maar één ding is duidelijk: de transcendentale kritiek is niet onomstreden, zelfs niet onder de meest trouwe volgelingen van Dooyeweerd. En daarin zit iets paradoxaals: het was hem er immers om te doen met zijn transcendentale kritiek ‘de denkgemeenschap in (...) het avondland’ te herstellen, maar het lukt hem niet eens om de denkgemeenschap onder gelijkgezinden op dit punt te bewaren. Intentie en werkelijkheid lopen hier dus ver uiteen. Daar zijn verschillende redenen voor. In de eerste plaats lijkt de transcendentale kritiek geplaagd te worden door een tweetal tegenstrijdige uitgangspunten. Kort gezegd komen deze uitgangspunten hierop neer: 1) de transcendentale kritiek poogt aan te tonen dat ieder theoretisch denken uitgaat van religieuze uitgangspunten; het theoretische denken is dus niet neutraal, zelfgenoegzaam of autonoom; 2) het onder punt 1 genoemde kan worden aangetoond door een stringente analyse van de aard van het theoretische denken zelf, zoals het door ieder die zich bezighoudt met wetenschap en wijsbegeerte beoefend wordt. De vraag is nu of het eerste punt niet impliceert, dat het tweede onmogelijk is. (shrink)

Deze korte studie biedt niet de zoveelste inleiding in het denken van Spinoza, maar doet verslag van de persoonlijke, vijfentwintig jaar durende zoektocht om de vaak moeilijke thema's van Spinoza onder de knie te krijgen. Om via Spinoza's filosofie meer te begrijpen van de wereld en van het eigen leven. Om de vreugde te ervaren die dit verbeterde inzicht, in oorzaken en gevolgen, en ook in de eigen beperktheid, ons biedt. Elk hoofdstuk gaat over een onderwerp dat de auteur bijzonder (...) aanspreekt. Bestaat er een levenswil, Spinoza's conatus, die mensen voort doet leven ook onder de meest bittere omstandigheden? Is kennis en inzicht gradueel van aard? Wat is het verschil tussen adequate en inadequate kennis van de oorzaken van ons handelen? Hoe ontwikkelt een machtsstaat zich tot een rechtsstaat? (shrink)

De drie korte verhandelingen over de positie van hooggeplaatsten moeten gezien worden als een schakel in de lange keten van de literair-filosofische traditie van de Vorstenspiegels, die met name in de Italiaanse Renaissance zeer geliefd waren. Pascal volt echter deze voorbeelden maar gedeeltelijk, omdat hij een nieuwe macht introduceert, waaraan ook de groten der aarde onderworpen zijn, nl. de macht van het geloof. Zijn bespiegelingen over macht, morele plicht en verantwoordelijkheid zijn nog steeds actueel.

Den filosofiske position konsekventialisme er ofte genstand for debat i filosofikredse, men alt for hyppigt opstår der misforståelser blandt de involverede, fordi de ikke er eksplicitte, hvad grundantagelser og væsentlige distinktioner angår. Denne korte artikel vil give en approksimation af, hvad der forstås ved konsekventialisme på et generisk niveau. Målet med artiklen er at klargøre nogle af de grundantagelser og distinktioner, som konsekventialister ofte benytter i deres teoridannelse, og som bør holdes for øje i ønsket om en frugtbar debat.

Asylbarns status og rettigheter i Norge er i kritisk søkelys. En særlig utsatt gruppe er barn av papirløse foreldre som fødes på norske sykehus. Med bakgrunn i Kirkens Bymisjons arbeid med denne gruppen, argumenterer jeg i denne artikkelen for at slike eksempler viser at norsk offentlig politikk overfor disse barna tenderer mot å gradere og dermed underminere deres grunnleggende menneskeverd, slik dette blant annet kommer til uttrykk i barnekonvensjonens krav om hensynet til barnets beste. Ved hjelp av Judith Butlers tenkning (...) om sårbarhet og «framing» samt Giorgio Agambens tenkning om «nakent liv» og unntakstilstanden, analyserer jeg hvordan denne graderingen av asylbarnas menneskeverd skjer. Til slutt viser jeg kort hvordan Helsesenteret uttrykker motstand mot disse mekanismene som bidrar til å underminere asylbarnas og de papirløses menneskeverd.Nøkkelord: menneskeverd, asylbarn, papirløse i Norge, Kirkens Bymisjon, helsesenter, etikk, flyktninger, Judith Butler, Giorgio Agamben, diakonalt arbeidEnglish summary: Children of asylum seekers and human dignity: Ethical reflections based on the experiences of the Health Care Centre for Undocumented MigrantsThe human rights and dignity of children of asylum seekers and undocumented migrants is much debated in Norway. A group that is particularly at risk is children born in Norwegian hospitals whose parents do not possess a legal residence permit. On the basis of the diaconal work of the Church City Mission in Oslo that aims at providing care and defending the rights of these groups through the Health Care Centre for Undocumented Migrants, the purpose of this article is to argue that the inherent human dignity of these children is being undermined in contemporary Norwegian politics. By relating to Judith Butler's thoughts on vulnerability and «framing» and Giorgio Agamben's theory of the «bare life» and the state of exception, the article aims at showing mechanisms that contribute to the undermining of the human dignity and rights of this group. The last part shows how the work of the health care center with its ethical and theological basis can be seen as offering resistance to these mechanisms and tendencies. (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.

After having defined the KARO logic for specifying intelligent agents in earlier work we now turn to the question how to realise agents specified in the KARO framework. To this end we look at agent programming languages that we have defined, and investigate how programs in these languages can be linked to the KARO logic.

This article has two aims. The first is to introduce some novel data that highlight rather surprising pragmatic abilities in autism spectrum disorder (ASD). The second is to consider a possible implication of these data for an emerging empirical methodology in philosophy of language and mind. In pursuing the first aim, we expect our main audience to be clinicians and linguists interested in pragmatics. It is when we turn to methodological issues that we hope to pique the interest of philosophers. (...) Still, the methodological issue becomes pressing precisely because of the empirical finding—thus the first part is important for the philosophical readers as well. The game plan is as follows. Given our intended dual audience, we begin with background on autism and pragmatics. Some of this material will be familiar to some of our readership, but few will know all of it. (Those who do are invited to skip these sections.) We then present some results from our pilot study on a corpus of speech by people with ASD. The heart of our finding is that certain speakers with ASD, who have severe trouble with familiar pragmatic phenomena such as metaphor and conversational implicature, exhibit surprising abilities with respect to what is often called “pragmatic determinants of what is said.” We turn next to a possible implication of this finding: It seems to suggest that hitherto seemingly promising evidence from ASD about the semantics/pragmatics boundary is.. (shrink)

A rapidly emerging hegemonic neuro-culture and a booming neural subjectivity signal the entry point for an inquiry into the status of the signifier neuro as a universal passe-partout. The wager of this paper is that the various appropriations of the neurosciences in the media and in academia itself point to something essential, if not structural, in connection with both the discipline of the neurosciences and the current socio-cultural and ideological climate. Starting from the case of neuroeducation, the genealogy of the (...) neurological turn is linked to the history of psychology and its inextricable bond with processes of psychologisation. If the neurological turn risks not merely neglecting the dimension of critique, but also obviating its possibility, then revivifying a psy-critique might be necessary in order to understand today’s neural subjectivity and its place within current biopolitics. (shrink)

The past 50 years have seen an accumulation of evidence suggesting that associative learning depends on high-level cognitive processes that give rise to propositional knowledge. Yet, many learning theorists maintain a belief in a learning mechanism in which links between mental representations are formed automatically. We characterize and highlight the differences between the propositional and link approaches, and review the relevant empirical evidence. We conclude that learning is the consequence of propositional reasoning processes that cooperate with the unconscious processes involved (...) in memory retrieval and perception. We argue that this new conceptual framework allows many of the important recent advances in associative learning research to be retained, but recast in a model that provides a firmer foundation for both immediate application and future research. (shrink)

It has become something of a truism that people with Autism Spectrum Disorders (ASD) have difficulties with pragmatics. Granting this, however, it is important to keep in mind that there are numerous kinds of pragmatic ability. One very important divide lies between those pragmatic competences which pertain to non-literal contents – as in, for instance, metaphor, irony and Gricean conversational implicatures – and those which pertain to the literal contents of speech acts. It is against this backdrop that our question (...) arises: Are certain pragmatic tasks more difficult than others for people with ASD? (shrink)

This article tackles the current deficit in the supply of cadaveric organs by addressing the family veto in organ donation. The authors believe that the family veto matters—ethically as well as practically—and that policies that completely disregard the views of the family in this decision are likely to be counterproductive. Instead, this paper proposes to engage directly with the most important reasons why families often object to the removal of the organs of a loved one who has signed up to (...) the donor registry—notably a failure to understand fully and deliberate on the information and a reluctance to deal with this sort of decision at an emotionally distressing time. To accommodate these concerns it is proposed to separate radically the process of information, deliberation and agreement about the harvesting of a potential donor's organs from the event of death and bereavement through a scheme of advance commitment. This paper briefly sets out the proposal and discusses in some detail its design as well as what is believed to be the main advantages compared with the leading alternatives. (shrink)

In a 2007 paper, we argued that speakers with Autism Spectrum Disorders exhibit pragmatic abilities which are surprising given the usual understanding of communication in that group. That is, it is commonly reported that people diagnosed with an ASD have trouble with metaphor, irony, conversational implicature and other non-literal language. This is not a matter of trouble with knowledge and application of rules of grammar. The difficulties lie, rather, in successful communicative interaction. Though we did find pragmatic errors within literal (...) talk, the transcribed conversations we studied showed many, many successes. A second paper reinforced our finding of a general level of success. It considered differences within the class of pragmatically-inflected yet literal speech acts. The present paper carries our project forward. It overcomes some of the methodological limitations of the second paper, by increasing sample size, and looking at frequency of use rather than just seeming errors. It also includes a control sample. The emerging results are two-fold. On the one hand, there was a slight, statistically significant difference in frequency of use between our participants and the controls in four sub-categories: indexicals, possessives, polysemy and degree on a scale. In all four, the participants diagnosed with ASDs had fewer occurrences overall, relative to controls. On the other hand, there was no significant difference in error rates between ASDs and controls — not in any of the eight categories of pragmatic determinants of literal content that we coded for. The upshot is that, though there were less-preferred forms for participants with ASDs, they do very well indeed with pragmatic determinants of literal content. (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)

Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features were: all professionals (...) who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement. (shrink)