Anne-Ruth Mackor

Standardization of spiritual care in health care facilities in the Netherlands

Spiritual care is a profession in transformation. It is evolving from a denominationally bound profession into a specific kind of healthcare profession. In the Netherlands, as elsewhere, debates are going on about the introduction of standards in public services such as health care. Many spiritual counsellors oppose standardization of spiritual care. Most importantly, standards seem to conflict with their sanctuary position as well as with the ‘theory of presence’ that many spiritual counsellors adhere to. A questionnaire was distributed among spiritual counsellors asking them about the nature and number of standards they work with and the positive and negative effects of these standards on their daily work. This exploratory study shows that only a few spiritual counsellors work with standards. It also reveals that those who work with standards are neutral to positive about the ways in which standards influence their work. In particular, spiritual counsellors working with standards state that doing so does not conflict with their sanctuary position, nor with their ‘being present’. The responses suggest that it does not seem to be standards as such but rather the social setting within which the standards are used that determines the effects that standards have on the content and quality of spiritual care. The paper concludes with some recommendations and suggestions for further investigation.

Evaluating the Quality of the Deliberation in Moral Case Deliberations: A Coding Scheme

Moral Case Deliberation (MCD) is an up and coming form of ethics support wherein clinical professionals deliberate about moral questions they face in their work. So far, it has been unclear what quality of deliberation in MCD is entailed and how to evaluate this quality. This article proposes a coding scheme that fits the theoretical background of MCD and allows researchers to evaluate the quality of the deliberation in MCDs. We consider deliberation in MCD to be of good quality when participants enrich their own understanding of a case by being exposed to the viewpoints of others. In order to have such an enriching effect, the deliberation in an MCD ought to involve different kinds of arguments from the perspectives of different stakeholders and in favour of different resolutions to the case; and the process of deliberation ought to be critical but constructive.

Legally Enforced Performance Measurement of Public Services. Crowding-out or crowding-in of motivation?

Abstract This paper discusses the legitimacy of legally enforced performance measurement of public services. Critics argue that performance measurement introduces “economic reason” and “instrumental rationality” and therewith undermines, among others, professional autonomy, self-esteem and motivation. If this critique is correct, it raises serious doubts about the legitimacy and the efficacy of governmental laws that enforce performance measurement on public services. The motivation crowding theory is introduced to answer the question whether and under what conditions we might expect positive or rather negative effects of performance measurement on the autonomy, self-esteem and motivation of public service professionals. I apply the theory to explain why two authors in this issue, Enequist and Hartkamp, valuate performance measurement so differently. The paper concludes that performance measurement does not inevitably and invariably have detrimental effects and that more empirical studies are needed to further unravel under what conditions performance measurement has desirable or rather inexpedient effects on public services, more in particular on the motivation of public service professionals.

Sterbehilfe in den Niederlanden

Entgegen einer verbreiteten Annahme ist die Sterbehilfe in den Niederlanden nicht generell legalisiert. Patienten haben keinen Anspruch auf Sterbehilfe, und Ärzte sind nicht verpflichtet, beim Suizid zu helfen oder das Leben eines Patienten auf dessen Wunsch hin zu beenden. Sowohl die Tötung auf Verlangen als auch die Beihilfe zum Suizid sind nach wie vor Straftaten. Im Jahre 2002 ist jedoch eine besondere gesetzliche Ausnahme von der Strafbarkeit ausschließlich für Ärzte geschaffen worden. Sie greift nur dann ein, wenn der Arzt entsprechend den gesetzlichen Vorgaben gehandelt, sechs Anforderungen an sorgfältiges Verhalten erfüllt und den Vorgang an die zuständige Stelle berichtet hat. Der Begriff der Sterbehilfe wird vielfach verwendet, aber er kommt im Gesetz nicht vor. Bei manchen Autoren umfasst der Begriff sowohl einverständliche Tötung als auch Suizidassistenz, bei anderen nur die erstere Form der Sterbehilfe. Im vorliegenden Beitrag wird unter dem Begriff „Sterbehilfe“ sowohl die Tötung auf Verlangen als auch die Suizidassistenz verstanden. Ich beschränke mich hier auf die Diskussion ärztlicher Sterbehilfe und beschäftige mich weder mit Suizidassistenz durch Nicht-Ärzte noch mit Mitleidstötungen ohne Einwilligung des Opfers. Beides ist nach niederländischem Recht strafbar. Auch gehe ich nicht auf Fragen des Unterlassens oder Abbrechens von Heilbehandlung ein; dabei handelt es sich, im Gegensatz zur aktiven Sterbehilfe, um normale ärztliche Verhaltensweisen. Palliativpflege und palliative

Code of Practice Euthanasie nog weinig bekend

SamenvattingWeet u als huisarts hoe uw handelen bij euthanasie wordt beoordeeld?

The presumption of innocence

The presumption of innocence (PoI) is considered to be a fundamental principle of criminal law. Over the past decades, however, the emphasis on the rights of suspects and defendants has given way to a more instrumental view of criminal law as a means to reduce risk and attain safety. One can think, for example, of recent Acts on Terrorism that do not require ‘suspicion’ but merely ‘indications’ of a terrorist crime, thereby lowering the level of suspicion required for investigative activities in the pre-trial phase; of plea-bargaining that has been introduced in various legal systems; of the verdict of the European Court of Human Rights (ECtHR) in Salabiaku v. France where the Court allows for presumptions of fact or of law to operate in the trial phase; of the possibility of review after wrongful acquittals and of convicts who face special measures after serving their sentence in the post-trial phase, to name just a few examples. Such an instrumental approach puts fundamental principles such as nulla poena, ne bis in idem, nemo tenetur, in dubio pro reo, nullum crimen sine culpa, as well as the PoI under pressure.

The alleged autonomy of psychology and the social sciences.

In the philosophy of mind, several prominent philosophers (Davidson, Fodor and Searle among others) defend the thesis that psychology and the social sciences are autonomous in a strong sense. They argue that there can be no type-identity between mental and physical terms. They also argue that there can be no strict laws and consequently no deductive-nomological explanations in psychology and the social sciences.