Transgender care, especially regarding the care of children and adolescents, is a relatively new field, in which developments are rapid, in which there is still relatively little empirical data... Show moreTransgender care, especially regarding the care of children and adolescents, is a relatively new field, in which developments are rapid, in which there is still relatively little empirical data available on long-term outcomes of providing or refraining from early medical treatment, and which is a subject of polarized debate. This thesis describes the themes that lead to controversies surrounding the use of early medical treatment for transgender children and adolescents. For each theme, it describes how the considerations, ideas and newly obtained scientific data, when applicable, have changed and developed over the recent years. It shows that care for transgender children and adolescents inherently involves ethical dilemmas, even if more clinical research data will be provided to underpin the evidence-base. Evidence alone will likely not be able to provide answers to all raised uncertainties concerning adolescent gender-affirming medical care. Ethical dilemmas will therefore probably remain part of this sensitive field of care. Besides illumination of some of these ethical dilemmas, this thesis gives suggestions for future studies and proposes ways of dealing with them in clinical practice. Show less
A significant proportion of the in-hospital antimicrobial consumption is used in the empiric setting, making empiric therapy an important target of stewardship interventions.Empiric antimicrobial... Show moreA significant proportion of the in-hospital antimicrobial consumption is used in the empiric setting, making empiric therapy an important target of stewardship interventions.Empiric antimicrobial therapy is the antimicrobial regimen that is started when the definite clinical diagnosis, causative agent and/or resistance pattern are yet unknown. Empiric therapy is accompanied by a varying level of uncertainty. In daily clinical practice, this uncertainty about the source, pathogen and susceptibility pattern are often managed by prescribing relatively broad-spectrum antimicrobial therapy. This has potential negative effects, such as toxicity and selective pressure resulting in antimicrobial resistance. Balancing the potential benefits and drawbacks of more broad-spectrum therapy is a substantial challenge, in particular when the level of uncertainty is high.This thesis aims to address the uncertainties most relevant in daily clinical practice in empiric antimicrobial therapy, to determine how they affect daily decision making, and to explore how this can be translated in antimicrobial policy making and antimicrobial stewardship. Show less
This thesis is about ethics and neonatal resuscitation. More specifically, this thesis discussed ethical challenges that are raised after the decision to provide active care, when neonatal care... Show moreThis thesis is about ethics and neonatal resuscitation. More specifically, this thesis discussed ethical challenges that are raised after the decision to provide active care, when neonatal care providers strive to provide the best possible care. The provision of the best possible care during neonatal resuscitation can be assured throughconducting research and quality improvement activities. However, conducting these activities can be ethically challenging. By combining empirical research with ethicalreasoning, this thesis aimed to provide guidance for the ethical conduct of activities to study and improve neonatal resuscitation. Show less
Patient outcomes have been tremendously improved through neurosurgical innovation for which there are countless examples. However, how neurosurgical innovation occurs generally lacks structure.... Show morePatient outcomes have been tremendously improved through neurosurgical innovation for which there are countless examples. However, how neurosurgical innovation occurs generally lacks structure. This lack results in several ethical and practical problems related to patient safety. In this thesis, a new framework for neurosurgical innovation is proposed. This framework aims to provide an adequate valuation of structured and careful innovation. In recent neurosurgical innovations, related ethical dillema’s and excisiting frameworks for innovation were evaluated to come to this framework.Based on an extensive review of the literature, several recent neurosurgical innovations were not introduced in a structured fashion. This unstructured introduction holds potentially far-reaching consequences for informed consent, patient safety, and knowledge regarding long-term outcomes.Neurosurgical innovation holds several ethical dilemmas. These dilemmas range from the need to innovate in an emergency setting to the learning curve that every novel procedure brings. This thesis describes these dilemmas in detail and discusses potential solutions.Existing frameworks for innovation in medicine, such as the IDEAL Framework and learning health systems, have limited application to neurosurgery because of its unique patient population. Nevertheless, these frameworks form the inspiration for the beforementioned newly suggested framework for neurosurgical innovation. Show less
Research into the phrasing, structure, and nature from the point of view of legal history, as well as the social and religious background of temple oaths from the Ptolemaic period, supplemented... Show moreResearch into the phrasing, structure, and nature from the point of view of legal history, as well as the social and religious background of temple oaths from the Ptolemaic period, supplemented with 21 unpublished texts written in demotic and Greek. Chapter 1. Introduction: Meaning and terminology of the oath in Ancient Egypt; Chapter 2. Juridical oaths from the Old Kingdom through the Ptolemaic period: an overview (ca. 2600-30 B.C.); Chapter 3. The format of temple oaths: a study of their clauses, components and legal contents; Chapter 4. Swearing a temple oath: the procedure; Chapter 5. Unpublished texts. A selection of demotic temple oaths in the Turin Egyptian Museum and Greek temple oaths from various collections. Show less
In literature ghosts have a long history. They manifest themselves in a variety of forms. They are intriguing because of their undecidable nature—their association with death and afterlife, which... Show moreIn literature ghosts have a long history. They manifest themselves in a variety of forms. They are intriguing because of their undecidable nature—their association with death and afterlife, which are irredeemable and inexplicable to the living. Especially in postcolonial literature we encounter the presence of ghosts. Ghostly figures often serve as metaphors of return—the return of repressed history, which continues to haunt the present. Sometimes they mark a present absence of marginalized groups of people. Noting the ineluctable encounters between ghosts, memories, and subjectivities in postcolonial literature, this dissertation tries to reach a deeper and broader understanding of the narrative potential of the ghostly in spatial, cultural and ethical dimensions. By perceiving ghosts as metaphorical concepts, I incorporate a variety of notions of ghosts into my exploration of ‘spectral space,’ ‘ghost language,’ and ‘mediums.’ I also investigate how these ghost-related concepts function to illuminate a new mode of thinking about the realms of knowledge and ethics. I argue that ghosts are ethical subjects rather than objects of social constructions. They provide us a productive way of establishing a new ethics of ghosts, which is reconsidered as the ethics of how to live with and survive as ghosts. Show less
Euthanasia and physicia-assisted suicide are possible in case of Huntington's Disease, also based on an advance directive. Requirements to make this possible are a sound and possibly longstanding... Show moreEuthanasia and physicia-assisted suicide are possible in case of Huntington's Disease, also based on an advance directive. Requirements to make this possible are a sound and possibly longstanding physician-patient relationship. Secondly a thorough knowlegde of the requirements of due care is necessary, for patients as well as for physicians. Physicians and patients should both be educated upon the possibilites provided in the law. Show less
The purpose of this thesis is to articulate a theological metaethic which accepts the nature of ethics as understood under the rubric of evolutionary theory. It will be argued that such a... Show moreThe purpose of this thesis is to articulate a theological metaethic which accepts the nature of ethics as understood under the rubric of evolutionary theory. It will be argued that such a theological methaethic can be interpreted as hopeful and optimistic given the apparent evolution of the moral from the amoral. The relationship between theology and evolutionary theory is presented here not as dichotomic but as dialectic – this is not to suggest that the two fields are mutually communicative, but rather that both can contribute to a cohesive, overarching worldview. In this respect, this thesis threads together the theological presupposition of a God of values with the naturalistic and material presuppositions of the modern scientific worldview (being cognizant of the fact that science may not necessarily be presented with these presuppositions). This dialectic occurs between two different but intertwined levels. One is the level of ethical systems; in this work, a particular understanding of Western Christian ethics. This level is framed by another, broader level of metaethics; in this thesis, an overarching understanding of the character of ethics will emerge from reflections on evolutionary theory and its naturalistic context. This will be a naturalistic view, though one which is understood to fit within a theological framework. Show less
This dissertation (Leiden University, 2014) presents a fresh reading of Plato’s Laws, that aims to do justice to the peculiarities of the dialogue's form and argumentative structure, often labelled... Show moreThis dissertation (Leiden University, 2014) presents a fresh reading of Plato’s Laws, that aims to do justice to the peculiarities of the dialogue's form and argumentative structure, often labelled intricate by specialists. By interpreting the text along its own lines, as less as possible influenced by expectations arising from its Platonic authorship, my thesis brings to light socio-political perspectives that are at odds with tendencies encountered elsewhere in Plato’s oeuvre (particularly his Republic). The more obvious anomalies, such as the Cretan setting, the absence of Socrates, the absence of a moral expert authority, and the prominence of persuasion, can be explained as features of a political project that is oriented towards a pragmatic rather than a metaphysical, absolute moral norm. This analysis also entails a reassessment of the relation between Republic and Laws. Show less
This study analyses the encyclical Caritas in veritate as a new encyclical in the ongoing development of the __social doctrine__ of the Roman Catholic Church. In this regard, the research questions... Show moreThis study analyses the encyclical Caritas in veritate as a new encyclical in the ongoing development of the __social doctrine__ of the Roman Catholic Church. In this regard, the research questions are: to what extent is Caritas in veritate continuous with earlier pronouncements? To what extent is it new? In as far as there are new elements, can these be understood in relation to the theological thought of Joseph Ratzinger, who became pope Benedict XVI? To what extent can the specific points of view present in Caritas in veritate be seen as responses to contemporary social and economic developments such as globalization, or to new insights in the human sciences and contemporary secular thought? Show less
Nieuwe ontwikkelingen in wetenschap en technologie roepen naast positieve ook negatieve reacties en twijfel op. De reacties worden geuit in debatten. Deze debatten verlopen vaak volgens hetzelfde... Show moreNieuwe ontwikkelingen in wetenschap en technologie roepen naast positieve ook negatieve reacties en twijfel op. De reacties worden geuit in debatten. Deze debatten verlopen vaak volgens hetzelfde stramien: er is een nieuwe ontwikkeling, daarover moet een standpunt worden ingenomen, dit roept vragen op, vragen die vaak gaan over wat 'natuurlijk' is, waar onze grenzen liggen, of alles mag wat kan. Over mogelijke antwoorden bestaan ernstige meningsverschillen. Het debat bloedt dood en er wordt een besluit genomen waarbij aan de (potentiële) rijkheid van de debatten wordt voorbijgegaan. Waarom verlopen debatten op deze manier? Waarom worden deelnemers en argumenten zo vaak gestereotypeerd, uitgesloten of onredelijk genoemd? Dat valt eigenlijk pas goed te begrijpen door te kijken naar wat onder de oppervlakte speelt: de manier waarop we met elkaar in gesprek gaan in publieke discussies. De kwaliteit van debatten kan worden verbeterd. Dat kan door ruimte te creëren voor morele democratisering. Dit vereist een driedubbele verbreding van publieke debatten. Een verbreding van deelnemers, van vragen en argumenten. Hiervoor is redelijkheid, inclusiviteit en moed nodig. Show less
Few medical specialties encounter so many ethical challenges as pediatrics does. It is a specialty that inherently has features that are morally charged. Pediatric ethics examines the broad issues... Show moreFew medical specialties encounter so many ethical challenges as pediatrics does. It is a specialty that inherently has features that are morally charged. Pediatric ethics examines the broad issues of (1) the concept of the child__s best interest; (2) parental responsibility and authority in decision-making about the life and health of a child; (3) the emerging desire and capacity for self-determination of an older child, and (4) the professional obligation of a pediatrician to act in the best interests of the child. Much is written about these issues, but often the literature on these topics is either __academic__ and theoretical in nature, or casuistic. It remains difficult to utilize what is written in the reality of pediatric practice. In this thesis we reflect on the question how the concepts of best interests, parental authority and child participation can and should be translated and made operational in the everyday encounter between parents, physicians and children. We therefore combine theoretical conceptions of the best interest standard, child participation and parental authority with a close look on how these concepts actually function in pediatric practice, and how they are conceived by actors in the pediatric field. Show less
In mijn proefschrift richt ik mij op het probleem dat medisch-ethische toetsingcommissies onder de huidige Wet Medisch-wetenschappelijk Onderzoek met mensen soms onderzoeksvoorstellen moeten... Show moreIn mijn proefschrift richt ik mij op het probleem dat medisch-ethische toetsingcommissies onder de huidige Wet Medisch-wetenschappelijk Onderzoek met mensen soms onderzoeksvoorstellen moeten afkeuren die de zorg voor toekomstige zieke kinderen zouden kunnen verbeteren. In deze wet staat namelijk dat de risico__s en belasting van studies die de deelnemende kinderen niet direct ten goede kunnen komen, nooit meer dan __minimaal__ mogen zijn. Uitgangspunt van mijn onderzoek was mijn overtuiging dat bij verruiming van de wet, de bescherming van de proefpersonen wel gewaarborgd moet blijven. Want de eis van minimale risico__s en belasting mag dan problematisch zijn, maar met de onderliggende ethische redenering is niets mis: kinderen zouden in principe niet puur voor onderzoeksdoeleinden aan hoge risico__s en belasting moeten worden blootgesteld. Dankzij mijn multidisciplinaire begeleidingsgroep heb ik het onderwerp van verschillende kanten kunnen bekijken, en bevat het proefschrift niet alleen ethisch-theoretische artikelen, maar ook een analyse van de beslissingen van de centrale toetsingscommissie, een overzicht van de Europese regelgeving, en de verslagen van twee studies naar de wijze waarop kinderen verschillende onderzoeksprocedures ervaren. De conclusie is dat in geval van een __verfijning__ van de huidige wet, met als uitgangspunt een __bescherming op maat__, meer onderzoek mogelijk zou worden, en de bescherming van de proefpersonen eerder zou verbeteren dan verslechteren. Show less
Deception is often described as a form of unethical behavior, yet it is frequently used in bargaining. This raises the question why people use deception in bargaining. In this dissertation an... Show moreDeception is often described as a form of unethical behavior, yet it is frequently used in bargaining. This raises the question why people use deception in bargaining. In this dissertation an instrumental approach to deception is presented to help answer this question. In an instrumental approach, the use of deception depends on both the goals bargainers pursue and the means they have to attain their goals. An instrumental approach presupposes that bargainers select the means they consider most instrumental to their current goal. This dissertation demonstrates that pursuing different goals or having different means, has an impact on the use of deception. Furthermore, it demonstrates that reactions to deceit also follow an instrumental pattern. Deceit was judged less harshly when it was employed by someone in a position with limited means. Finally, this dissertation shows that false expectations are an important reason why deception is considered unethical. Show less
In good hands. Nursing practice in a moral perspective. There is much debate about the moral aspects of nursing and the possibilities for moral professionalization. In this study we contribute to... Show moreIn good hands. Nursing practice in a moral perspective. There is much debate about the moral aspects of nursing and the possibilities for moral professionalization. In this study we contribute to the debate by describing the possibilities nurses see for themselves to handle moral problems in patient care. Regarding ethical issues, nurses consider a specific role for themselves as patients advocates, a specific standpoint being based on a nursing domain which they can contribute to multidisciplinary consultation and an ethic of their own, being ethics of care. Analyzing the application of these positions in three pediatric case-study__s reveals that each position offers nurses insufficient support. Advocacy proves to be at odds with team-nursing, the nursing system that is most common. Successful participation in treatment decision-making turns out not to be based on a nursing domain but on a mutual frame of reference with doctors. Although a care-ethical analysis helps to understand the problems that may arise during care and treatment, important problems can not be solved with the aid of care ethics. Elements of all positions are used to construct a new ethical framework that can serve as a fundament for the moral professional practice of nurses and offer assistance to nurses in handling moral problems in patient care. Show less
This dissertation sheds more light on ethics in economic decision-making. Over the course of nine experiments, I studied (a) when people adhere to ethical standards like the do-no-harm principle,... Show moreThis dissertation sheds more light on ethics in economic decision-making. Over the course of nine experiments, I studied (a) when people adhere to ethical standards like the do-no-harm principle, and (b) how people respond to situations in which ethical standards are violated by studying not only punishing behavior but also compensation behavior. I show that when people know that by furthering their self-interest they harm another person (either by taking from or by allocating a loss to the other person), people become reluctant to benefit themselves. In addition, I show that when people observe a situation of distributive injustice, they are not only willing to give up money to punish persons causing this injustice but also to compensate persons suffering injustice. Empathic concern moderates the preference for punishment and compensation. Theoretical implications of these results are discussed in te rms of altruism, empathy, and motives of self-interest and fairness. Show less
This research is a socio-legal study of developments in the profession of notaries. The enactment of a new act in 1999, aimed at enhancing competition and abolishing the guilt-like structure of the... Show moreThis research is a socio-legal study of developments in the profession of notaries. The enactment of a new act in 1999, aimed at enhancing competition and abolishing the guilt-like structure of the profession of notaries, is a first pillar of this research, The study focuses as well on developments in the ethics of notaries and the qualities of their services. Liberalization, through the abolition of fixed fees as well as regulated establishment, would bring about the flux of young notaries, innovation and dynamics in the profession and better prices for the customers. Making up the balance after eight years of enhanced competition in the notaries’profession one must say, that not all of the intentions and goals of the legislator were translated into the practice of notaries. The flux of new firms run by young notaries, lagged behind. Price differentiation entered the stage, but so did higher prices in the consumer’s sector. The guilt-like and old fashioned flavour of the profession is a thing of the past. Scaling up, specialization and innovation enter the stage. Franchises of firms of notaries arise. Ratings of notaries’firms and their tariffs appear on the Internet and the services of notaries become more consumers friendly. While a more entrepreneurial orientation can be traced, one cannot speak of an ethical decay. Liberalisation is rather a catalyst for new thoughts on quality and ethics on firm level. Show less
This thesis describes the results of the Leiden Follow-Up Project on Prematurity (LFUPP): a prospective study in three health regions in the Netherlands, which included all live born infants with... Show moreThis thesis describes the results of the Leiden Follow-Up Project on Prematurity (LFUPP): a prospective study in three health regions in the Netherlands, which included all live born infants with gestational age (GA) <32 weeks, born in 1996/1997. Mortality, neonatal morbidity and the neurological examination as well as mental and psychomotor development according to the BSID I are described until the corrected age of 2 years. Special attention is paid to the infants with GA <27 weeks and the ethics of maintaining these extremely preterm infants. Growth (length, weight and head circumference) until 2 years of age is compared with the Dutch reference group. The influence of preterm growth restraint is compared with the influence of intrauterine growth restriction. The development and respiratory status at 2 years of age in infants with bronchopulmonary dysplasia are described. Finally, a comparison was made between the outcome of 2 cohorts, POPS (1983) and LFUPP (1996/1997) at time of hospital discharge and at 2 years of age. Show less
In the Naturales Quaestiones, the Roman philosopher Seneca discusses several natural phenomena in different books. These books are introduced and concluded by mainly moralizing prefaces and... Show moreIn the Naturales Quaestiones, the Roman philosopher Seneca discusses several natural phenomena in different books. These books are introduced and concluded by mainly moralizing prefaces and epilogues. Scholars disagree about the question how, and to what extent, the different parts of the work are related to each other. In my dissertation, I have adduced material that had not yet been used for the understanding of the Naturales Quaestiones. Thus, I have studied the literary conventions of antiquity concerning prefaces, and concluded, among other things, that in certain genres it was possible to write a preface that was unconnected to the work that followed. I have also placed the Naturales Quaestiones in the context of the discussion about the moral relevance of the study of nature in antiquity. The main part of my dissertation is devoted to a study of the text of the prefaces and epilogues: in my opinion, these texts, which often have a repetitive character, should be understood in the context of Seneca's moral philosophy. For instance, in the preface to his discussion of earthquakes, Seneca emphasizes that earthquakes may happen at any moment or place: this insight is supposed to strengthen man against his fear of dying in an earthquake. Show less
This study surveys the theory about 'Christendom' developed by the Anglican theologian Oliver O'Donovan. The author defines 'Christendom' as a state of affairs in which the Christian faith in one... Show moreThis study surveys the theory about 'Christendom' developed by the Anglican theologian Oliver O'Donovan. The author defines 'Christendom' as a state of affairs in which the Christian faith in one way or another gives public direction to society and/or politics. The investigation is positioned within the present debate about the role of religion in Dutch society. The Anglo-Saxon Christendom debate illustrates that the discussions about the societal role of religion should not deny the theological dimension to this question. The Christendom debate of our time has been for the most part initiated by two American theologians, John Howard Yoder and Stanley Hauerwas. They take a critical view of Christendom. Besides this option there are four other positions in the Christendom debate: the Christian faith as civil religion, the liberal vision, the theocratic approach, and confessional or principled pluralism. A comparison between them and O'Donovan's theory shows out that the latter has the potential to unite what usually only exists in mutual tension and to open up a fruitful continuation of the 'Christendom' debate as well as the discussions about the role of religion in society. Show less
