Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

Our paper contributes to the rapidly expanding body of experimental research on transformative decision making, and in the process, marks out a novel empirical interpretation for assessments of subjective value in transformative contexts. We start with a discussion of the role of subjective value in transformative decisions, and then critique extant experimental work that explores this role, with special attention to Reuter and Messerli (2018). We argue that current empirical treatments miss a crucial feature of practical deliberation manifesting across a (...) variety of everyday decisions: often, people attach more weight to decision criteria that they can know—a phenomenon known as the “evaluability bias.” In transformative contexts, if people cannot know the subjective value of an option, they are unlikely to attach it much weight. Despite this, people may care very much about such value. We then use this point to develop and present new empirical results that, in addition to supporting our concerns about evaluability bias, support the hypothesis that people care about subjective value. Our work enriches the current philosophical understanding of transformative decisions and helps to frame the emerging experimental paradigm for the empirical dimensions of the debate. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom (a modification of the Aristotelian phronèsis) has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to (...) be insufficient. However, this solution is unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

Primordial emotions are the subjective element of the instincts which are the genetically programmed behaviour patterns which contrive homeostasis. They include thirst, hunger for air, hunger for food, pain and hunger for specific minerals etc.There are two constituents of a primordial emotion—the specific sensation which when severe may be imperious, and the compelling intention for gratification by a consummatory act. They may dominate the stream of consciousness, and can have plenipotentiary power over behaviour.It is hypothesized that early in animal evolution (...) complex reflex mechanisms in the basal brain subserving homeostatic responses, in concert with elements of the reticular activating system subserving arousal, melded functionally with regions embodied in the progressive rostral development of the telencephalon. This included the emergent limbic and paralimbic areas, and the insula. This phylogenetically ancient organization subserved the origin of consciousness as the primordial emotion, which signalled that the organisms existence was immediately threatened. Neuroimaging confirms major activations in regions of the basal brain during primordial emotions in humans. The behaviour of decorticate humans and animals is discussed in relation to the possible existence of primitive awareness.Neuroimaging of the primordial emotions reveals that rapid gratification of intention by a consummatory act such as ingestion causes precipitate decline of both the initiating sensation and the intention. There is contemporaneous rapid disappearance of particular regions of brain activation which suggests they may be part of the jointly sufficient and severally necessary activations and deactivations which correlate with consciousness [Crick, F. & Koch, C. . A framework for consciousness. NatureNeuroscience,6, 119–126]. (shrink)

Despite hundreds of definitions, no consensus exists on a definition of life or on the closely related and problematic definitions of the organism and death. These problems retard practical and theoretical development in, for example, exobiology, artificial life, biology and evolution. This paper suggests improving this situation by basing definitions on a theory of a generalized particle hierarchy. This theory uses the common denominator of the “operator” for a unified ranking of both particles and organisms, from elementary particles to animals (...) with brains. Accordingly, this ranking is called “the operator hierarchy”. This hierarchy allows life to be defined as: matter with the configuration of an operator, and that possesses a complexity equal to, or even higher than the cellular operator. Living is then synonymous with the dynamics of such operators and the word organism refers to a select group of operators that fit the definition of life. The minimum condition defining an organism is its existence as an operator, construction thus being more essential than metabolism, growth or reproduction. In the operator hierarchy, every organism is associated with a specific closure, for example, the nucleus in eukaryotes. This allows death to be defined as: the state in which an organism has lost its closure following irreversible deterioration of its organization. The generality of the operator hierarchy also offers a context to discuss “life as we do not know it”. The paper ends with testing the definition’s practical value with a range of examples. (shrink)

Solidarity belongs to the basic principles of Catholic Social Teaching (CST) and is part of the ethical repertoire of European moral traditions and European healthcare systems. This paper discusses how leaders of Catholic healthcare organizations (HCOs) can understand their institutional moral responsibility with regard to the preservation of solidarity. In dealing with this question, we make use of Taylor's philosophy of modern culture. We first argue that, just as all HCOs, Catholic ones also can embody and strengthen solidarity by just (...) doing their quintessential job, that is, to care for people with ill health. Second, we focus on the Catholic identity of these organizations and argue that this characteristic can empower a radical commitment to solidarity. Finally, we argue that CST provides a critical ethical framework for approaching solidarity from the perspective of the common good. (shrink)

A multidisciplinary faculty committee designed a curriculum to shape biomedical graduate students into researchers with a high commitment to professionalism and social responsibility and to provide students with tools to navigate complex, rapidly evolving academic and societal environments with a strong ethical commitment. The curriculum used problem-based learning (PBL), because it is active and learner-centred and focuses on skill and process development. Two courses were developed: Scientific Professionalism: Scientific Integrity addressed discipline-specific and broad professional norms and obligations for the ethical (...) practice of science and responsible conduct of research (RCR). Scientific Professionalism: Bioethics and Social Responsibility focused on current ethical and bioethical issues within the scientific profession, and implications of research for society. Each small-group session examined case scenarios that included: (1) learning objectives for professional norms and obligations; (2) key ethical issues and philosophies within each topic area; (3) one or more of the RCR instructional areas; and (4) at least one type of moral reflection. Cases emphasised professional standards, obligations and underlying philosophies for the ethical practice of science, competing interests of stakeholders and oversight of science (internal and external). To our knowledge, this is the first use of a longitudinal, multi-semester PBL course to teach scientific integrity and professionalism. Both faculty and students endorsed the active learning approach for these topics, in contrast to a compliance-based approach that emphasises learning rules and regulations. (shrink)

In order to study early human development while avoiding the burdens associated with human embryo research, scientists are redirecting their efforts towards so-called human embryo-like structures (hELS). hELS are created from clusters of human pluripotent stem cells and seem capable of mimicking early human development with increasing accuracy. Notwithstanding, hELS research finds itself at the intersection of historically controversial fields, and the expectation that it might be received as similarly sensitive is prompting proactive law reform in many jurisdictions, including the (...) Netherlands. However, studies on the public perception of hELS research remain scarce. To help guide policymakers and fill this gap in the literature, we conducted an explorative qualitative study aimed at mapping the range of perspectives in the Netherlands on the creation and research use of hELS. This article reports on a subset of our findings, namely those pertaining to (the degrees of and requirements for) confidence in research with hELS and its regulation. Despite commonly found disparities in confidence on emerging biotechnologies, we also found wide consensus regarding the requirements for having (more) confidence in hELS research. We conclude by reflecting on how these findings could be relevant to researchers and (Dutch) policymakers when interpreted within the context of their limitations. (shrink)

Architectural style is a medium for the promotion of cultural identities and cohesion. South Asian Association for Regional Cooperation nations provide a prism through which all forms of vernacular architecture can be viewed. This study is presented through the lens of the soul of the eye coupled with the power of technological probing. This synthesis affords a most appealing and lyrical exploration of the course of the development of cities within the SAARC nations. It showcases research results combining the above (...) stated synergy—starting from some of SAARC’s sophisticated historic cultures, cultures that ebbed and flowed along its shores and valleys. This paper shall touch upon unique cultural roots stretching back to the Dravidian civilization that flourished over 3500 years ago and also look at the grouping of houses within the Indus Valley Civilization in Lothal and the Sarasvati Valley Civilization in Kalibangan. The sensitivity underlying SAARC architecture and its traditions are seen in many communal settlements, profoundly so in the Indian subcontinent and in Sri Lanka. The paper shall showcase two specific, but nevertheless, distinct styles of communal functioning within unique architectural strongholds in the ancient Ratnagiri University in Odisha, India, and also touch upon a unique blend of styles of landscape architecture in Sri Lanka. The overarching emphasis of this study is that throughout SAARC’s history, architecture has been creatively adopted to the need of its users and the characteristics of its climate and location. It has always fulfilled the needs and nourished the spirit of its people, promoting cultural cohesion even today. In this context, it is interesting to explore traditional techniques of vernacular architecture in houses in Andhra, Tamil Nadu and Kerala. The common thread linking mass housing in Lothal, Kalibangan, Anuradhapura and Ratnagiri about 2 millennia ago, with present day housing patterns, is in the application of sustainable building practices using intelligent building forms, fabric and orientation. This paper explores this commonality from a modern perspective using CFD. As the SAARC countries still struggle to get a fuller understanding of their unique ecology and the complexity of their diverse cultures, revisiting the architectural legacy of their indigenous societies might prove insightful. The need for this revisit becomes even more relevant in the wake of the Paris Agreement and more recently the Kigali Agreement. The discourse on providing indoor thermal comfort to the SAARC people cannot be decoupled from the climate change story—heating, ventilation and cooling consume a large amount of energy and have a deep underlying link with the targets set at Paris and Kigali. The onus will be on a large number of stakeholders to meet these targets—engineers, architects, manufacturers, policy-makers, researchers and consumers. This paper aims at reminding the stakeholders of the richness and the usefulness of their vernacular architecture in upholding the ideal of sustainability. (shrink)

Background The consistency of codes governing disclosure of terminal illness to patients and families in Islamic countries has not been studied until now. Objectives To review available codes on disclosure of terminal illness in Islamic countries. Data source and extraction Data were extracted through searches on Google and PubMed. Codes related to disclosure of terminal illness to patients or families were abstracted, and then classified independently by the three authors. Data synthesis Codes for 14 Islamic countries were located. Five codes (...) were silent regarding informing the patient, seven allowed concealment, one mandated disclosure and one prohibited disclosure. Five codes were silent regarding informing the family, four allowed disclosure and five mandated/recommended disclosure. The Islamic Organization for Medical Sciences code was silent on both issues. Conclusion Codes regarding disclosure of terminal illness to patients and families differed markedly among Islamic countries. They were silent in one-third of the codes, and tended to favour a paternalistic/utilitarian, family-centred approach over an autonomous, patient-centred approach. (shrink)

_ Source: _Volume 40, Issue 1, pp 104 - 115 It is intended in this study to present initial reliability and validity data for the Russian adaptation of the Multidimensional Inventory of Religious/Spiritual Well-being, as being related to personality factors and psychopathology. Therefore, the first version of the MI-RSWB-R was applied to a sample of 192 non-clinical subjects, together with the NEO Five Factor Inventory and the Symptom-Check-List. The original six-factor structure of the scale could be replicated for the MI-RSWB-R, (...) which also provides satisfying psychometric properties. In accordance with previous research the RSWB total score was linked to more favorable personality traits such as Extraversion, Openness to Experience, and Agreeableness, which was paralleled by substantial negative correlations with increased psychopathology. Our findings support the reliability and structural validity of the MI-RSWB-R as a standardized instrument for addressing the spiritual dimension in Russian populations. Further research in clinical surroundings is now recommended. (shrink)

This paper analyses mass media exposure and its effect on family planning in Bangladesh using data from the Bangladesh Demographic and Health Survey (BDHS) 1993s place of residence, education, economic status, geographical region and number of living children appeared to be the most important variable determining mass media exposure to family planning. Multivariate analysis shows that both radio and TV exposure to family planning messages and ownership of a radio and TV have a significant effect on current use of family (...) planning methods. These factors remain significant determinants of contraceptive use, even after controlling socioeconomic and demographic factors. The study reveals that both socioeconomic development policies and family planning programmes with a special emphasis on mass media, especially radio, may have a significant effect on contraceptive use in Bangladesh. The principal policy challenge is to design communications strategies that will reach the less privileged, rural and illiterate people who are by far the majority in Bangladesh. (shrink)

The present epoch is one of socialist and national liberation revolutions, an epoch in which more and more peoples are taking the path of socialism. However, the distinguishing characteristic of this period is that world war has ceased to be a fatal inevitability. This means that many problems having to do with the relation of war and revolution must be posed differently than they were when wars were inevitable. The question arises as to the degree to which contemporary revolutionary processes (...) are associated with wars, whether the revolutionary process can develop under conditions of peace among peoples and, if it can, then how? All these questions are at present matters of the most acute ideological struggle. Therefore examination of the question of the relation between war and revolution is not only of theoretical but of practical political interest. (shrink)

I have three types of interrelated comments. First, on the choice of the proposed criteria, I argue against any list and for a system of criteria. Second, on grading, I suggest modifications with respect to consciousness and development. Finally, on the choice of “theories” for evaluation, I argue for Edelman's theory of neuronal group selection instead of connectionism (classical or not).