The aim of this research was to gain insight into the experiences and perspectives of individual members of a Medical Research Ethics Committee regarding their individual roles and possible tensions within and between these roles. We conducted a qualitative interview study among members of a large MREC, supplemented by a focus group meeting. Respondents distinguish five roles: protector, facilitator, educator, advisor and assessor. Central to the role of protector is securing valid informed consent and a proper risk-benefit analysis. The role (...) of facilitator implies that respondents want to think along with and assist researchers in order to help medical science progress. As educators, the respondents want to raise ethical and methodological awareness of researchers. The role of advisor implies that respondents bring in their own expertise. The role of assessor points to contributing to the overall evaluation of the research proposal. Various tensions were identified within and between roles. Within the role of protector, a tension is experienced between paternalism and autonomy. Between the role of protector and facilitator tensions occur when the value of a study is questioned while risks and burdens for the subjects are negligible. Within the role of assessor, a tension is felt between the implicit nature of judgments and the need for more explicit formulations. Awareness of various roles and responsibilities may prevent one-sided views on MREC work, not only by members themselves, but also by researchers. Tensions within and between the roles require reflection by MREC members. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that it indeed has the potential (...) of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

Cross-education is the phenomenon in which repeated practice of a unilateral motor task does not only result in performance improvement of the trained limb, but also in the untrained contralateral limb. The aim of this study was to test whether cross-education or positive transfer of learning is also achieved for tasks in which both limbs contribute in different ways by using modified equipment that switches the limbs’ role. To this end, a reverse field hockey stick was used that requires a (...) mirroring of arm and hand use and dominance. Two groups of young skilled female field hockey players participated in a crossover-design, in which participants received four training sessions with a reverse hockey stick followed by four training sessions with a regular hockey stick, or vice versa. In a pre-test, intermediate test, a post-test and a retention test, participants’ performance on a field hockey skill test with a regular hockey stick was measured. The results revealed that training with the reversed hockey stick led to significantly increased improvements compared to training with a regular hockey stick. We conclude that modified equipment can be used to exploit positive transfer of learning by switching the limbs’ roles. The findings are discussed by referring to the symmetry preservation principle in dynamic systems theory and have clear practical relevance for field hockey trainers and players seeking to further improve field hockey skills. (shrink)

The King Report on Corporate Governance (1994) evoked unprecedented interest in corporate governance in South Africa. This does not mean that corporate governance was not an issue of concern before the release of this historical report. To the contrary, corporate governance in its broader sense has been at stake since the inception of the first publicly owned companies in South Africa. This article intends to give an overview of corporate governance in South Africa. It starts by making a distinction between (...) broad and narrow conceptions of corporate governance. Before applying this distinction to the practice of corporate governance in South Africa, a brief overview of the corporate landscape in South Africa is provided. Then the South African situation with regard to broad and narrow corporate governance respectively is analysed. The article ends with a discussion of the review of corporate governance that currently is in the making in South Africa. Throughout the article both the financial and ethical dimensions of corporate governance is attended to. (shrink)

The explanatory gap refers to the lack of concepts for understanding “how it is that . . . a state of consciousness comes about as a result of irritating nervous tissue.” By assuming that there are colours in the outside world, Block needlessly widens this gap and Lycan and Kitcher simply fail to see the gap. When such assumptions are abandoned, an unnecessary and incomprehensible constraint disappears. It then becomes clear that the brain can use its own neural language for (...) representing aspects of the outside world. While this may not close the gap, it becomes clearer where we need new concepts. (shrink)

Many consumers fail to identify online sponsored content as advertising. This is an ethical problem because consumers need to know when they are exposed to advertising so they can raise counterargu...

Background: Although genetic research into Alzheimer disease (AD) is increasing, the ethical aspects of this kind of research and the differences between ethical issues related to genetic and non-genetic research into AD have not yet received much attention. Objectives: (1) To identify and compare the five ethical issues considered most important by surveyed expert panellists in non-genetic and genetic AD research and (2) to compare our empirical findings with ethical issues in genetic research in general as described in the literature. (...) Method: A modified Delphi study in two rounds Results: Genetic and non-genetic research into AD generated an approximately equal number of topics with a considerable overlap. Different priorities in the ethics of both types of research were found. Genetic research raised new topics such as “confidentiality of genetic information” and “implications of research for relatives” which changes the impact and application of existing ethical topics such as “informed consent” and is judged to have more impact on both individuals and society. A difference with the results of more theoretical approaches on ethical aspects related to AD research was also found. Conclusions: Different priorities are given to ethical issues in genetic and non-genetic research. These arise partly because genetic research causes unique and new questions, mostly related to the position of family members and the status of and access to genetic information. Differences found between the results of our empirical study and the more theoretical literature, suggest an additional value for empirical research in medical ethics. (shrink)

In pleas for the recognition of cultural minority rights, claims to educational authority often figure as concrete examples. The right to educational authority is said to be an exemplary minority right. This is striking, for of all minority rights this is one which is impossible to justify. Difficulties invovled in recent attempts to reconcile cultural minority rights with liberal democracy demonstrate that educational minority rights in particular cannot be justified without underestimating civic and liberal risks and ignoring the complicated nature (...) of the relationships between communities and ‘their’ children and between parents and ‘their’ children. (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the (...) contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

In academic research, many attempts have been undertaken to legitimize corporate community involvement by showing a business case for it. However, much less attention has been devoted to building understanding about the actual dynamics and challenges of managing CCI in the business context. As an alternative to existing predominantly static and top-down approaches, this paper introduces a social movement framework for analyzing CCI management. Based on the analysis of qualitative case study data, we argue that the active role of employees (...) pressuring for CCI policies and practices, as well as the organization audience responses to their efforts, are at the core of the challenges involved in managing CCI. These challenges also pose limits to how far CCI can be extended to a “business as usual” activity. (shrink)

Introduction Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. Methods To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content (...) analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Results Three themes emerged: (1) relationships among patient, physician and other professionals—the authority of the physician was more explicit in adapted versions; (2) patient rights and family position—adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Conclusions Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia. (shrink)

Four experiments examined the strategies that individuals develop in sentential reasoning. They led to the discovery of five different strategies. According to the theory proposed in the paper, each of the strategies depends on component tactics, which all normal adults possess, and which are based on mental models. Reasoners vary their use of tactics in ways that have no deterministic account. This variation leads different individuals to assemble different strategies, which include the construction of incremental diagrams corresponding to mental models, (...) and the pursuit of the consequences of a single model step by step. Moreover, the difficulty of a problem (i.e., the number of mental models required by the premises) predisposes reasoners towards certain strategies. Likewise, the sentential connectives in the premises also bias reasoners towards certain strategies, e.g., conditional premises tend to elicit reasoning step by step whereas disjunctive premises tend to elicit incremental diagrams. (shrink)

The present study investigated whether scores on the Autobiographical Memory Test (AMT) in 55 patients with borderline personality disorder (BPD) were modified after long‐term psychotherapy and whether the pretreatment AMT scores would predict improvement in depression severity or BPD symptom severity at the end of treatment. In addition, it was analysed whether changes in ratings of mood, thought suppression, dissociation, and BPD symptom severity following treatment were associated with changes in AMT scores. Only patients with BPD and a comorbid diagnosis (...) of depression at time 1, generated significantly more specific memories and fewer categoric memories after 15 months of therapy. Moreover, these changes were unrelated to type of therapy and changes in depression severity, borderline symptom severity, dissociation, or thought suppression. The AMT scores at initial assessment did not predict depression severity at 15 months. The percentage of negative specific memories tended to predict BPD symptom severity. (shrink)

The parameters governing our behavior are in constant flux. Accurately capturing these dynamics in cognitive models poses a challenge to modelers. Here, we demonstrate a mapping of ACT-R's declarative memory onto the linear ballistic accumulator (LBA), a mathematical model describing a competition between evidence accumulation processes. We show that this mapping provides a method for inferring individual ACT-R parameters without requiring the modeler to build and fit an entire ACT-R model. Existing parameter estimation methods for the LBA can be used, (...) instead of the computationally expensive parameter sweeps that are traditionally done. We conduct a parameter recovery study to confirm that the LBA can recover ACT-R parameters from simulated data. Then, as a proof of concept, we use the LBA to estimate ACT-R parameters from an empirical dataset. The resulting parameter estimates provide a cognitively meaningful explanation for observed differences in behavior over time and between individuals. In addition, we find that the mapping between ACT-R and LBA lends a more concrete interpretation to ACT-R's latency factor parameter, namely as a measure of response caution. This work contributes to a growing movement towards integrating formal modeling approaches in cognitive science. (shrink)

The regulative and semantic ‘distance’ of electronic conferencing may impede the topical alignment and the unambiguous interpretation of messages, hindering collaborative learning processes. Compared to a face-to-face environment, in electronic conferencing this distance may be caused by a reduced strength of online ‘context’. Explicitly defining the context of messages in an electronic environment may increase the writers’ co-intentionality and co-reference. An annotation tool is presented, strengthening the context by providing a document under discussion and enabling users to anchor their messages (...) in specific passages of the document. Preliminary results indicate that the tool does indeed reinforce the context, focusing the online discussion around a certain topic (increasing co-intentionality) and providing a frame of reference for single messages (increasing co-reference). (shrink)

Miracle and miracle narrative against the background of myth and demythologizing.Religio-scientific perspectives on communication, language, reality conception, myth and the world of the sacred, as well as a different angle on demythologizing, are utilised in formulating a broad theological view of miracles, miracle experiences and miracle narratives.

Misinformation about the novel coronavirus is a pressing societal challenge. Across two studies, one preregistered, we assess the efficacy of two ‘prebunking’ interventions aimed at improving people’s ability to spot manipulation techniques commonly used in COVID-19 misinformation across three different languages. We find that Go Viral!, a novel five-minute browser game, increases the perceived manipulativeness of misinformation about COVID-19, improves people’s attitudinal certainty in their ability to spot misinformation and reduces self-reported willingness to share misinformation with others. The first two (...) effects remain significant for at least one week after gameplay. We also find that reading real-world infographics from UNESCO improves people’s ability and confidence in spotting COVID-19 misinformation. Limitations and implications for fake news interventions are discussed. (shrink)

The King Report on Corporate Governance (1994) evoked unprecedented interest in corporate governance in South Africa. This does not mean that corporate governance was not an issue of concern before the release of this historical report. To the contrary, corporate governance in its broader sense has been at stake since the inception of the first publicly owned companies in South Africa. This article intends to give an overview of corporate governance in South Africa. It starts by making a distinction between (...) broad and narrow conceptions of corporate governance. Before applying this distinction to the practice of corporate governance in South Africa, a brief overview of the corporate landscape in South Africa is provided. Then the South African situation with regard to broad and narrow corporate governance respectively is analysed. The article ends with a discussion of the review of corporate governance that currently is in the making in South Africa. Throughout the article both the financial and ethical dimensions of corporate governance is attended to. (shrink)

About a decade ago, the Netherlands Environmental Assessment Agency unwittingly embarked on a transition from a technocratic model of science advising to the paradigm of ‘‘post-normal science’’. In response to a scandal around uncertainty management in 1999, a Guidance for ‘‘Uncertainty Assessment and Communication’’ was developed with advice from the initiators of the PNS concept and was introduced in 2003. This was followed in 2007 by a ‘‘Stakeholder Participation’’ Guidance. In this article, the authors provide a combined insider/outsider perspective on (...) the transition process. The authors assess the extent to which the PNS paradigm has delivered new approaches in the agency’s practice and analyze two projects—on long-term options for Dutch sustainable development policy and for urban development policy—the latter in somewhat more detail. The authors identify several paradoxes PBL encounters when putting the PNS concept into practice. It is concluded that an openness to other styles of work than the technocratic model has become visible, but that the introduction of the PNS paradigm is still in its early stage. (shrink)

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

This contribution is a gentle introduction to so-called dynamic epistemic logics, that can describe how agents change their knowledge and beliefs. We start with a concise introduction to epistemic logic, through the example of one, two and finally three players holding cards; and, mainly for the purpose of motivating the dynamics, we also very summarily introduce the concepts of general and common knowledge. We then pay ample attention to the logic of public announcements, wherein agents change their knowledge as the (...) result of public announcements. One crucial topic in that setting is that of unsuccessful updates: formulas that become false when announced. The Moore-sentences that were already extensively discussed at the conception of epistemic logic in Hintikka’s ‘Knowledge and Belief ’ (1962) give rise to such unsuccessful updates. After that, we present a few examples of more complex epistemic updates. (shrink)

Norman's reconciliation of the two theories of perception is challenged because it directly leads to the nature-nurture dichotomy in the development of the two visual systems. In contrast, the proposition of a separate development of the two visual systems may be better understood as involving different types of information that follow a distinct temporal sequence.