There is a claim that clinical ethics support services (CESS) improve healthcare quality within healthcare organisations. However, there is lack of strong evidence supporting this claim. Rather, the current focus is on the quality of CESS themselves or on individual learning outcomes. In response, this article proposes a theoretical framework leading to empirical hypotheses that describe the relationship between a specific type of CESS, moral case deliberation and the quality of care at the organisational level. We combine insights from the (...) literature on CESS, organisational learning and quality improvement and argue that moral case deliberation causes healthcare professionals to acquire practical wisdom. At the organisational level, where improving quality is a continuous and collective endeavour, this practical wisdom can be aggregated into morisprudence, which is an ongoing formulation of moral judgements across cases encountered within the organisation. Focusing on the development of morisprudence enables refined scrutinisation of CESS-related quality claims. (shrink)

Hoewel in de laatste jaren sterk de nadruk is gelegd op de “autonomie” van het geschrevene ten opzichte van de schrijver en diens belevingswereld, wil deze auteur graag beginnen met een persoonlijke betuiging van erkentelijkheid. Een mens is toch wel zodanig verbonden met een geesteskind dat hij lang bij zich gedragen heeft, dat hij de aandacht en de grondigheid die uit de hiervoor geplaatste reacties spreekt, alleen maar in hoge mate kan waarderen. Hij heeft ze ervaren als toonbeelden van “ontmoeting”. (...) De verschillen tussen de drie reacties laten nog eens zien dat ontmoeting verre van monotoon is. Juist ook die verschillen vond ik leerzaam. Bij de opzet van mijn repliek wil ik aan de diversiteit zo goed mogelijk recht doen door de reacties stuk voor stuk te bespreken. Af en toe zal een “intertekstuele” opmerking wenselijk of onvermijdelijk zijn. Overigens vrees ik dat binnen het bestek van deze repliek niet voldoende ingegaan kan worden op alle vragen en tegenwerpingen. (shrink)

ABSTRACT Match-fixing is a major ethical issue in sports. Although research interest in match-fixing has increased in recent years, we remain largely in the dark regarding how both betting- and non-betting-related match-fixing relate to the moral decision-making of those involved. Drawing on Rest’s theory of morality and on the perceptions of a large sample of participants in Flemish sports, this study indicates that most match-fixing incidents are non-betting-related, while moral motivation and associated challenges clearly differ according to the type of (...) match-fixing. Therefore, each type of match-fixing requires different preventive measures. (shrink)

Bijdragen over de actuele betekenis van de filosofie, met name de Reformatorische Wijsbegeerte.

Dit artikel is, samen met een nog volgend tweede, bedoeld als aanzet tot een bredere studie. Die studie zal, naar ik hoop, binnen twee jaar voltooid zijn. Ze maakt in zekere mate deel uit van een onderzoeksprogramma dat in uitvoering is aan de Faculteit der Wijsbegeerte van de Vrije Universiteit. Het is nu niet van belang de eigen plaats ervan binnen dat programma nauwkeuriger te omschrijven. Wel kan worden gezegd dat de studie een sterk historische inslag heeft, maar uitmondt in (...) een meer persoonlijke, systematische beschouwing. Dat artikelen met dit thema een plaats krijgen in Philosophia Reformata, behoeft waarschijnlijk weinig betoog. Een tijdschrift dat ontstaan is uit een herbezinning op reikwijdte en functie van “rede”, een herbezinning die ertoe leidde “liefde” als dieptemotief in de werkelijkheid te honoreren, —zo’n tijdschrift lijkt geen ongeschikte plek. (shrink)

Diverse omstandigheden hebben het schrijven en verschijnen van het in jaargang 62, nr. 2 aangekondigde slotartikel vertraagd. Ook toen al uitte ik het voornemen de vier denkers die in het tweede artikel besproken waren nog even te groeperen. Zo’n korte groepering lijkt nu, na meer dan twee jaar, des te meer wenselijk. De vier besproken filosofen waren allen, zij het op uiteenlopende wijze, op zoek naar een nieuwe bepaling van de verhoudingen, — niet alleen tussen “Leidenschaft” en “Vernunft”, maar ook (...) tussen “Leidenschaft” als in-zet — meer actief — en als “passio”, in de zin van “lijden”. (shrink)

Approximately three decades ago the question was first answered whether parasitoids are able to assess the number or origin of eggs in a host for a solitary parasitoid, Leptopilina heterotoma, by fitting theoretically derived distributions to empirical ones. We extend the set of different theoretically postulated distributions of eggs among hosts by combining searching modes and abilities in assessing host quality. In the models, parasitoids search either randomly (Poisson) (1) or by vibrotaxis (Negative Binomial) (2). Parasitoids are: (a) assumed to (...) treat all hosts equally, (b) able to distinguish them in unparasitised and parasitised hosts only, (c) able to distinguish them by the number of eggs they contained, or (d) able to recognise their own eggs. Mathematically tractable combinations of searching mode (1 and 2) and abilities (a,b,c,d) result in seven different models (M1a, M1b, M1c, M1d, M2a, M2b and M2c). These models have been simulated for a varying number of searching parasitoids and various mean numbers of eggs per host. Each resulting distribution is fitted to all theoretical models. The model with the minimum Akaike's information criterion (AIC) is chosen as the best fitting for each simulated distribution. We thus investigate the power of the AIC and for each distribution with a specified mean number of eggs per host we derive a frequency distribution for classification.Firstly, we discuss the simulations of models including random search (M1a, M1b, M1c and M1d). For M1a, M1c and M1d the simulated distributions are correctly classified in at least 70% of all cases. However, in a few cases model M1b is only properly classified for intermediate mean values of eggs per host. The models including vibrotaxis as searching behaviour (M2a, M2b and M2c) cannot be distinguished from those with random search if the mean number of eggs per host is low. Among the models incorporating vibrotaxis the three abilities are detected analogously as in models with random search. (shrink)

A review is given on statistical and modelling issues in ecotoxicology. The issues discussed are:1. How to estimate an (almost) no effect concentration chemicals in the laboratory.

The differential field of transseries extends the field of real Laurent series and occurs in various contexts: asymptotic expansions, analytic vector fields, and o-minimal structures, to name a few. We give an overview of the algebraic and model-theoretic aspects of this differential field and report on our efforts to understand its elementary theory.

Background Notwithstanding the need to produce evidence-based knowledge on medications for pregnant women, they remain underrepresented in clinical research. Sometimes they are excluded because of their supposed vulnerability, but there are no universally accepted criteria for considering pregnant women as vulnerable. Our aim was to explore whether and if so to what extent pregnant women are vulnerable as research subjects. Method We performed a conceptual and empirical analysis of vulnerability applied to pregnant women. Analysis A conceptual analysis supports Hurst's definition (...) of vulnerability. Consequently, we argue that pregnant women are vulnerable if they encounter an identifiably increased likelihood of incurring additional or greater wrong. According to the literature, this increased likelihood could exist of four alleged features for pregnant women's vulnerability: informed consent, susceptibility to coercion, higher exposure to risk due to lack of knowledge, vulnerability of the fetus. Discussion Testing the features against Hurst's definition demonstrates that they all concern the same issue: pregnant women are only vulnerable because a higher exposure to risk due to lack of scientific knowledge comprises an increased wrong. Research Ethics Committees have a responsibility to protect the vulnerable, but a higher exposure to risk due to lack of scientific knowledge is a much broader issue and also needs to be addressed by other stakeholders. Conclusions The only reason why pregnant women are potentially vulnerable is to the extent that they are increasingly exposed to higher risks due to a lack of scientific knowledge. Accordingly, the discussion can advance to the development of practical strategies to promote fair inclusion of pregnant women in clinical research. (shrink)

There is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as (...) a case-study. We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands. Three themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals’ individual perception of risk may influence recruitment. Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women. (shrink)

It is often argued that clinical research should not violate the Kantian principle that people must not be used merely as a means for the purposes of others. At first sight, the practice of clinical research itself, however, seems to violate precisely this principle: clinical research is often beneficial to future people rather than to participants; even if participants benefit, all things considered, they are exposed to discomforts which are absent both in regular care for their diseases and in other (...) areas of daily life. Therefore, in this paper we will consider whether people are used merely as a means by being enrolled in clinical research. On the basis of recent studies of Kantian scholars we will argue that clinical research is compatible with the Kantian principle if the conditions of possible consent and end-sharing have been met. Participants are not used merely as a means if they have sufficient reasons to consent to being enrolled in clinical research and can share the ends of the researchers who use them. Moreover, we will claim that even if people are used merely as a means by participating in clinical research, it may not always be morally wrong to use them in this way. (shrink)