Intensive care units are not always able to admit all patients who would benefit from intensive care. Pressure on ICU beds is likely to be particularly high during times of epidemics such as might arise in the case of swine influenza. In making choices as to which patients to admit, the key US guidelines state that significant priority should be given to the interests of patients who are already in the ICU over the interests of patients who would benefit from (...) intensive care but who have not been admitted. We examine four reasons that in principle might justify such a prioritization rule and conclude that none is convincing. We argue that the current location of patients should not, in principle, affect their priority for intensive care. We show, however, that under some but not all circumstances, maximizing lives saved by intensive care might require continuing to treat in the ICU a patient already admitted rather than transferring that patient out of the unit in order to admit a sicker patient who would also benefit more from intensive care. We conclude that further modelling is required in order to clarify what practical policies would maximize lives saved by intensive care. (shrink)

Intensive Science and Virtual Philosophy cuts to the heart of the philosophy of Gilles Deleuze and of today's science wars.At the start of the 21st Century, ...

A full understanding of emotions and emotion characteristics can only be reached when their dynamic nature is taken into account. As such, a primary objective of the present study is to describe and account for variability in temporal profiles of experienced emotional intensity. Participants were asked to make detailed drawings of intensity profiles of recently experienced episodes of anger, sadness, joy and affection. Functional data analysis revealed three features that together accounted for 84% of the total variability: (i) steepness at (...) onset; (ii) skewness; and (iii) the number of peaks. Emotions differed with regard to the first two features, with the rise at onset being steeper for sadness and joy and affection being the most negatively skewed emotion under study. Individual differences regarding each of the three features were found, however, they did not strongly generalise across emotions. (shrink)

By 2050, global livestock production is expected to double—growing faster than any other agricultural sub-sector—with most of this increase taking place in the developing world. As the United Nation’s four-hundred-page report, Livestock’s Long Shadow: Environmental Issues and Options , documents, livestock production is now one of three most significant contributors to environmental problems, leading to increased greenhouse gas emissions, land degradation, water pollution, and increased health problems. The paper draws on the UN report as well as a flurry of other (...) recently published studies in order to demonstrate the effect of intensive livestock production on global warming and on people’s health. The paper’s goal is to outline the problems caused by intensive livestock farming and analyze a number of possible solutions, including legislative changes and stricter regulations, community mobilizing, and consumers choosing to decrease their demand for animal products. (shrink)

This paper argues that the difference between contemporary software intensive scientific practice and more traditional non-software intensive varieties results from the characteristically high conditionality of software. We explain why the path complexity of programs with high conditionality imposes limits on standard error correction techniques and why this matters. While it is possible, in general, to characterize the error distribution in inquiry that does not involve high conditionality, we cannot characterize the error distribution in inquiry that depends on software. Software intensive (...) science presents distinctive error and uncertainty modalities that pose new challenges for the epistemology of science. (shrink)

Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of (...) moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses’ moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care. (shrink)

Background Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses. Aim This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care. Methods The instrument was developed in 3 phases. Phase 1: item generation; phase 2: a two-round (...) Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2 weeks later. Ethical considerations The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous. Results The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach’s alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2 weeks. Conclusions This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU. (shrink)

_the a priori role_ (for word T). For instance, perhaps anyone who understands the word _water_ is able to know, without appeal to any further a posteriori information, that _water_ refers to the clear, drinkable natural kind whose instances are predominant in our oceans and lakes (if _water_ refers at all.

This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative content analysis identified end-of-life (...) decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies. (shrink)

This paper investigates a limitation of the model of belief and knowledge prevailing in mainstream economics, namely the state-space model. Because of its set-theoretic nature, this model has difficulties in capturing the difference between expressions that designate the same object but have different meanings, i.e., expressions with the same extension but different intensions. This limitation generates puzzling results concerning what individuals believe or know about the world as well as what individuals believe or know about what other individuals believe (...) or know about the world. The paper connects these puzzling results to two issues that are relevant for economic theory beyond the state-space model, namely, framing effects and the distinction between the model-maker and agents that appear in the model. Finally, the paper discusses three possible solutions to the limitations of the state-space model, and concludes that the two alternatives that appear practicable also have significant drawbacks. (shrink)

The purpose of this study was to determine whether accounting students’ perception of moral intensity could be enhanced through a limited ethics intervention in an Advanced Accounting course. Ethical decisions are heavily influenced by the intensity of the moral problem: the more egregious the act, the more the people view it as unethical. This controlled experiment measures the change in perceptions of moral intensity with the pre- and post-test instruments using five accounting specific vignettes containing moral dilemmas which are progressively (...) more intense. While other studies have shown that perceived moral intensity directly influences a persons’ moral decision-making process, as far as we are aware, this is the first study that assesses and tests whether the coverage of specific ethics content integrated into an accounting class can positively influence the students’ perception of moral intensity, moral sensitivity/awareness, moral judgment, and moral intentions. Positively influencing students’ moral sensitivity/awareness, moral judgment, and moral intentions is a critical first step to ensuring that our courses and curricula provide the learning environment in which students can develop knowledge and competencies required to become the ethical leaders of tomorrow. (shrink)

Decades of research conducted in Western, Educated, Industrialized, Rich, & Democratic (WEIRD) societies have led many scholars to conclude that the use of mental states in moral judgment is a human cognitive universal, perhaps an adaptive strategy for selecting optimal social partners from a large pool of candidates. However, recent work from a more diverse array of societies suggests there may be important variation in how much people rely on mental states, with people in some societies judging accidental harms just (...) as harshly as intentional ones. To explain this variation, we develop and test a novel cultural evolutionary theory proposing that the intensity of kin-based institutions will favor less attention to mental states when judging moral violations. First, to better illuminate the historical distribution of the use of intentions in moral judgment, we code and analyze anthropological observations from the Human Area Relations Files. This analysis shows that notions of strict liability—wherein the role for mental states is reduced—were common across diverse societies around the globe. Then, by expanding an existing vignette-based experimental dataset containing observations from 321 people in a diverse sample of 10 societies, we show that the intensity of a society's kin-based institutions can explain a substantial portion of the population-level variation in people's reliance on intentions in three different kinds of moral judgments. Together, these lines of evidence suggest that people's use of mental states has coevolved culturally to fit their local kin-based institutions. We suggest that although reliance on mental states has likely been a feature of moral judgment in human communities over historical and evolutionary time, the relational fluidity and weak kin ties of today's WEIRD societies position these populations' psychology at the extreme end of the global and historical spectrum. (shrink)

This encyclopedia entry describes intensions and extensions as aspects of the meanings of pieces of language.

This article examines whether the likelihood and amount of firm charitable giving in response to catastrophic events are related to firm advertising intensity, and whether industry competition level moderates this relationship. Using data on Chinese firms’ philanthropic response to the 2008 Sichuan earthquake, we find that firm advertising intensity is positively associated with both the probability and the amount of corporate giving. The results also indicate that this positive advertising intensity-philanthropic giving relationship is stronger in competitive industries, and firms in (...) competitive industries are more likely to donate. This study thus provides evidence suggesting that even in the wake of catastrophic events, corporate philanthropic giving is strategic. (shrink)

Previous work suggests that moral intensity and the perceived importance of an ethical issue can influence individual ethical decision making. However, prior research has not explored how the various dimensions of moral intensity might differentially affect PIE, or how moral intensity might function together with (or in the presence of) PIE to influence ethical decision making. In addition, prior work has also not adequately investigated how the operational context of an organization, which may embody conditions or practices that create barriers (...) to ethical decision making, may differ from other functional areas of an organization. Consequently, this study investigated the relationships among moral intensity, perceived ethical issue importance, and three stages of the ethical reasoning process: recognition of an ethical issue, ethical judgment, and ethical intention. Using an internet-based, self-report survey containing two operations management scenarios and various ethics measures, information was collected from business professionals working for a Midwestern financial services organization. The hierarchical regression results indicated that some dimensions of moral intensity were positively related to PIE, ethical issue recognition, and ethical judgment, and that PIE was associated with increased ethical issue recognition and ethical judgment. The steps of ethical reasoning were also positively interrelated. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, (...) we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

In his 'Why We Need A-Intensions', Frank Jackson argues that "representational content [is] how things are represented to be by a sentence in the communicative role it possesses in virtue of what it means," a type of content Jackson takes to be broadly descriptive. I think Jackson overstates his case. Even if we agree that such representational properties play a crucial reference-fixing role, it is much harder to argue the case for a crucial communicative role. I articulate my doubts (...) about Jackson's views on this point by contrasting them with the views of John Stuart Mill, usually regarded as an early believer in something like a direct reference account of content for names, but someone who, on my reading, teaches us a salutary lesson about the importance of separating the question of how reference is determined from the question of how we succeed in communicating. (shrink)

Maher proposed in 1974 that schizophrenic delusions are hypotheses formed to explain anomalous experiences. He stated that they are “rational, given the intensity of the experiences that they are developed to explain.” Two-factor theorists of delusion criticized Maher’s theory because 1) it does not explain why some patients with anomalous experiences do not develop delusions, and 2) adopting and adhering to delusional hypotheses is irrational, considering the totality of experiences and patients’ other beliefs. In this paper, the notion of the (...) intensity of experience is reappraised to uphold Maher’s basic conception. Regarding 1), I propose that differences in the intensity of anomalous experience are vital to whether the patient forms delusions, while partially reforming his rationality claim regarding 2). Although adopting delusions is irrational, it is inevitable and excusable, given the intensity of the patient’s anomalous experience. With the aid of this notion, it is maintained that anomalous experience is sufficient for the development of delusions, at least in some cases of schizophrenia. Compared to other theories of schizophrenic delusion, Maher’s theory, which embraces the notion of intensity of experience, better explains why such irrational mental states as delusions develop from anomalous experiences, and why delusional patients persist in believing specific thematic content. (shrink)

Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses’ patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the researchers, Maslach Burnout (...) Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses’ job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine. (shrink)

Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses’ patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the researchers, Maslach Burnout (...) Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses’ job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine. (shrink)

An experimental survey was undertakento explore the links between thecharacteristics of a moral issue, the degree ofmoral intensity/moral imperative associatedwith the issue, and people'sstated willingness to pay for policy toaddress the issue. Two farm animal welfareissues were chosen for comparison and thecontingent valuation method was used to elicitpeople's wtp. The findings of the surveysuggest that increases in moral characteristicsdo appear to result in an increase in moralintensity and the degree of moral imperativeassociated with an issue. Moreover, there was apositive link (...) between moral intensity/moralimperative associated with an issue andpeople's stated wtp for policy to address theissue. The paper discusses the relevance of thefindings of the survey in the context of thedebate concerning the relationship betweenmoral and economic values and the use of thecontingent valuation method to estimatepeople's wtp of policy options with moraldimensions. (shrink)

This study integrates the resource dependence perspective and the stakeholder perspective to analyze local Chinese suppliers’ environment strategies in response to environmental requirements of different types of customers. With a sample of 1,215 local Chinese manufacturing suppliers, we examine the impact of export intensity and environmental requirements of multinational enterprises on local Chinese suppliers’ environment strategies. The results show that local Chinese suppliers with high levels of export intensity are more likely to adopt positive environment strategies to reduce environmental risks. (...) In addition, local Chinese suppliers respond actively to environmental requirements of MNE customers but not to those of local customers. The linkage between MNE customers’ environmental requirements and local Chinese suppliers’ environment strategies remains significant, even after we control for the impact of export intensity. Implications of the findings conclude the article. (shrink)

I think recent discussions of content and reference have not paid enough attention to the role of language as a convention-governed system of communication. With this as a background theme, I explain the role of A-intensions in elucidating one important notion of content and correlative notions of reference.

Following an extensive review of the moral intensity literature, this article reports the findings of two studies (one between-subjects, the other within-subject) that examined the effect of manipulated and perceived moral intensity on ethical judgment. In the between-subjects study participants judged actions taken in manipulated high moral intensity scenarios to be more unethical than the same actions taken in manipulated low moral intensity scenarios. Findings were mixed for the effect of perceived moral intensity. Both probable magnitude of consequences (a factor (...) consisting of magnitude of consequences, probability of effect, and temporal immediacy) and social consensus had a significant effect; proximity did not. In the within-subject study manipulated moral intensity had a significant effect on ethical judgment, but perceived moral intensity did not. Regression of ethical judgment on age, gender, major, and the three perceived moral intensity factors was significant between-subjects, but not within-subject. Ethical judgment was found to be a more robust predictor of intention than perceived moral intensity using a within-subject design. (shrink)

(1981). Intension, identity, and the Colourless Physical World: A revision and further discussion. Australasian Journal of Philosophy: Vol. 59, No. 2, pp. 203-205.

BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...) 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival, life expectancy, and cost of treatment. In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment. (shrink)

The measurement of sensory intensity has had a long history, attracting the attention of investigators from many disciplines including physiology, psychology, physics, mathematics, philosophy, and even chemistry. While there has been a continuing doubt by some that sensation has the properties necessary for measurement, experiments designed to obtain estimates of sensory intensity have found that a general rule applies: Equal stimulus ratios produce equal sensory ratios. Theories concerning the basis for this simple psychophysical rule are discussed, with emphasis given to (...) the physical correlate theory, which considers judgments of subjective magnitudes to be based upon estimates of physical dimensions that vary regularly with changes in degree of stimulation. For the most thoroughly investigated sensory scales, brightness and loudness, the physical correlate is considered to be distance. Our “tacit knowledge” of the sensory effects of changing distance plays an essential role in matching motor activities to environmental conditions and in ensuring accurate perceptual evaluations through brightness and loudness constancies. In psychophysical experiments, subjects apparently use this same tacit knowledge when required to estimate relative subjective magnitudes. The evidence related to the physical correlate theory is summarized, and it is concluded that, while under appropriate conditions we demonstrate considerable skill in evaluating environmental relationships, we are quite unable to estimate the neurophysiological nature or quantity of sensory response. A psychophysics devoted to studying conditions required for accuracy and conditions producing errors in the perception of environmental relationships would seem to be more valuable than one devoted to subjective magnitudes. (shrink)

BackgroundThe Authors have laid out an analysis of Italian COVID-19 confirmed data and fatality rates, pointing out how a dearth of health care resources in northern regions has resulted in hard, ethically challenging decisions in terms of granting patient access to intensive care units (ICU).Main textHaving to make such decisions certainly entails substantial difficulties, and that has led many health care professional to seek ethical guidance. The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has attempted to meet (...) that growing need by a set of recommendations, applying “clinical soundness” as a beacon standard; that approach tends to prioritize patients with higher life expectancy, which could be characterized as a “moderately utilitarian” approach. Yet, such a selection has engendered daunting ethical quandaries. The authors believe it can only be warranted and acceptable if rooted in a transparent decision-making process and verifiable, reviewed criteria. Moreover, the authors have stressed how clinical experimentation in a pandemic setting is a subtext of great interest from an ethical perspective. In Italy, no drug therapy and trials were undertaken for COVID-19 patients for a rather long period of time. When the epidemic was already circulating, an intervention proved necessary on the system of administrative procedures, aimed at expediting the authorization and validation of protocols, then bogged down by bureaucracy. A new system has since been instituted by a government decree that was signed about one month after the first Covid-19 case was officially recorded in the country. Such a swift implementation, which took just a few weeks, is noteworthy and proves that clinical trials can be initiated in a timely fashion, even with a pandemic unfolding. The concerted, action of supportive care and RCTs is the only way to attain effective forms of treatments for COVID-19 and any other future outbreak.ConclusionsThe authors have arrived at the conclusion that the most effective and ethically sound response on the part of any national health care system would be to adequately reconfigure its organizational mechanisms, by making clinical trials and all related administrative procedures consistent with the current state of emergency. (shrink)

Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by (...) nurses nor a study conducted on the issue.Aim/objective:The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.Method:The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.Ethical considerations:The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.Results:In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.Conclusion:Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some (...) specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011). (shrink)

Intensive motherhood (IM) has become an established social norm in many countries, especially Western ones. Centred upon the mother providing lengthy full-time, intensive care focused on the child’s needs, these social norms can be seen in the actions of mothers in diverse social locations. However, recent research has demonstrated that women’s ability to engage in IM is affected by factors like education, race, ethnicity, religion or socioeconomic status as well as by cultural and structural conditions. The goal of this paper (...) is to analyse IM in the Czech context by focusing on factors that most affect a mother’s ability to engage in IM. Biographical interviews were held with 17 mothers, and the following three areas were discussed most in their narratives: (a) use of information on childrearing, (b) attitude to paid employment and juggling family and work, and (c) the financial, mental and emotional costs of motherhood. (shrink)

We seek to advance place-sensitive theory on cross-sector partnerships (CSPs) by investigating how partners cope with difficult place characteristics that affect their collaboration. To this end, we conduct an in-depth case study of a disaster relief CSP in which the partners had to cope with what we label _place intensity_ of disasters, as well as with what emerged as _place diversity_ of pre-/post-disaster contexts. Our findings illustrate the collaborative effects of these different place contexts and reveal two practices of _CSP (...) place work_ by which the partners sought to leverage their cross-fertilizing potential: They used the pre-/post-disaster contexts to anticipate and prepare for the place intensity and conveyed such intensity to pre-/post-disaster contexts to manage the place diversity and sustain the collaborative commitment. These insights advance CSP research, first, by outlining places’ agentic forces and exposing their different collaborative effects. Second, by introducing practices of cognitive and emotional CSP place work, we show how partners may integrate places into their CSP management to better handle their adverse effects. (shrink)

Faster R-CNN architecture is used to solve the problems of moving path uncertainty, changeable coverage, and high complexity in cold-air induced large-scale intensive temperature-reduction detection and classification, since those problems usually lead to path identification biases as well as low accuracy and generalization ability of recognition algorithm. In this paper, an improved recognition method of national ITR path in China based on faster R-CNN in complicated meteorological systems is proposed. Firstly, quality control of the original dataset of strong cooling processes (...) is carried out by means of data filtering. Then, according to the NITR standard and the characteristics of NITR, the NITR dataset in China is established by the intensive temperature-reduction areas located through spatial transformation. Meanwhile, considering that the selection of regularization parameters of Softmax classification method will cause the problem of probability calculation, support vector machine is used for path classification to enhance the confidence of classification. Finally, the improved faster R-CNN model is used to identify, classify, and locate the path of NITR events. The experimental results show that, compared to other models, the improved faster R-CNN algorithm greatly improves the performance of NITR’s path recognition, especially for the mixed NITR paths and single NITR paths. Therefore, the improved faster R-CNN model has fast calculation speed, high recognition accuracy, good robustness, and generalization ability of NITR path recognition. (shrink)

This article explains some of the technical terms used in semantic theory and philosophy of language.

Abstract:Discussions of conscientious objection (CO) in healthcare often concentrate on objections to interventions that relate to reproduction, such as termination of pregnancy or contraception. Nevertheless, questions of conscience can arise in other areas of medicine. For example, the intensive care unit is a locus of ethically complex and contested decisions. Ethical debate about CO usually concentrates on the issue of whether physicians should be permitted to object to particular courses of treatment; whether CO should be accommodated. In this article, I (...) focus on the question of how clinicians ought to act: should they provide or support a course of action that is contrary to their deeply held moral beliefs? I discuss two secular examples of potential CO in intensive care, and propose that clinicians should adopt a norm of conscientious non-objection (CNO). In the face of divergent values and practice, physicians should set aside their personal moral beliefs and not object to treatment that is legally and professionally accepted and provided by their peers. Although there may be reason to permit conscientious objections in healthcare, conscientious non-objection should be encouraged, taught, and supported. (shrink)

There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with.

Background Moral distress has negative effects on physical and mental health. However, there is little information about nurses’ coping strategies reducing moral distress. Aim The purpose of this study was to investigate the coping strategies of intensive care unit nurses reducing moral distress in Iran. Study design This is a qualitative study with a content analysis approach. Participants and research context The research sample consisted of nurses working in intensive care units of teaching hospitals affiliated to Tehran University of Medical (...) Sciences. Samples were selected among eligible nurses by purposive sampling. Data were obtained through 17 in-depth, individual, and semi-structured interviews with 17 nurses. Graneheim and Lundman’s (2004) 6-step content analysis method was used to analyze the data. Data management was also performed by MAXQDA software version 20. The COREQ checklist was used to report the study. Ethical considerations This project was approved by the Ethics Committee of Tehran University of Medical Sciences. All ethical guidelines in research were followed. Finding The data analysis resulted in the formation of two main categories of desirable coping strategies (with two subcategories of compensation and rejuvenation) and less desirable coping strategies (with three subclasses of indifference over time, escape and concealment). Discussion The intensive care unit nurses in dealing with ethical problems first try to solve the problem through discussion, but when they fail to resolve it peacefully, they resort to several coping strategies. Factors, such as increasing experience, lack of support from hospital managers and officials, poor communication between colleagues, the need to maintain hierarchy, fear of reprimand, and a sense of powerlessness, changed the nurses’ preferred strategies. It is important for managers to provide a blame/punishment-free atmosphere for expression of ethical experiences; a supportive atmosphere in which staff can engage in ethical discussions without fear of punishment. They should also provide opportunities for rest, rejuvenation, and adequate training for their employees. (shrink)