Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit (...) staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

Long-lasting interference effects in picture naming are induced when objects are presented in categorically related contexts in both continuous and blocked cyclic paradigms. Less consistent context effects have been reported when the task is changed to semantic classification. Experiment 1 confirmed the recent finding of cumulative facilitation in the continuous paradigm with living/non-living superordinate categorization. To avoid a potential confound involving participants responding with the identical superordinate category in related contexts in the blocked cyclic paradigm, we devised a novel set (...) of categorically related objects that also varied in terms of relative age – a core semantic type associated with the adjective word class across languages. Experiment 2 demonstrated the typical interference effect with these stimuli in basic level naming. In Experiment 3, using the identical blocked cyclic paradigm, we failed to observe semantic context effects when the same pictures were classified as younger–older. Overall, the results indicate the semantic context effects in the two paradigms do not share a common origin, with the effect in the continuous paradigm arising at the level of conceptual representations or in conceptual-to-lexical connections while the effect in the blocked cyclic paradigm most likely originates at a lexical level of representation. The implications of these findings for current accounts of long-lasting interference effects in spoken word production are discussed. (shrink)

Behavioural ecologies in themselves can create variation in fitness interdependencies among individuals, and hence modulate the functionality of invoking historical myths. We develop this possibility for the case where coalitions form to attack and exploit enemies, or to defend and protect against hostile out-groups. We propose that invoking historical myths are functional and observed especially when groups aggressively expand.

We anticipate a further decline of patients who eventually will become brain dead. The intensive care unit (ICU) is considered a last resort for patients with severe and multiple organ dysfunction. Patients with primary central nervous system failure constitute the largest group of patients in which life-sustaining treatment is withdrawn. Almost all these patients are unconscious at the moment physicians decide to withhold and withdraw life-sustaining measures. Sometimes, however competent ICU patients state that they do not want to live anymore (...) because of the severity of their illness or the poor prognosis and ask for withdrawal of life-sustaining measures like mechanical ventilation. Do we consider the unconscious patient as potential organ donor before withdrawal of mechanical ventilation? This is paradoxically rare in the case of the conscious ICU patient. Is it practically possible and ethically feasible to obtain consent for organ donation from this group of patients? (shrink)

O’Loughlin and Thagard (2000) present a specific computational implementation of the idea that the problems encountered by a child with autism in classic False Belief tasks derive from a failure to maintain coherence among multiple propositions. They argue that this failure can be explained as a structural feature of a connectionist network attempting to maintain coherence. The current paper criticizes this implementation because it falsely predicts that the same children will have a parallel problem with the False Photographs task. The (...) fact that the content of representations makes a difference while the structure remains constant casts doubt upon their claim. (shrink)

O objetivo principal deste artigo é esclarecer como Brentano define a relação entre (a) o conhecimento de nossos próprios fenômenos de consciência e (b) o conhecimento de fenômenos de consciência de outros sujeitos. Por um lado, Brentano argumenta, seguindo a tradição moderna, que o conhecimento dos próprios atos mentais é absolutamente fundamental. Ao mesmo tempo, porém, ele quer mostrar com sua Psicologia do ponto de vista empírico uma clara alternativa ao introspeccionismo. Mostraremos como Brentano busca unir estes dois objetivos e (...) como ele também aderiu a esta linha em sua Psicologia Descritiva. Sua psicologia como um todo pode, portanto, ser entendida como um apelo ao pluralismo epistemológico. (shrink)

We show that the electromagnetic radiation field, conventionally introduced as a perturbation in quantum mechanics, is actually at the basis of the operator formalism. We first analyze the linear resonant response of the (continuous) variables x(t), p(t) of a harmonic oscillator to the full radiation field, i.e. the zero-point field plus an applied field playing the role of the driving force, and then extend the analysis to the response of a charged particle bound by a non-linear force, typically an atomic (...) electron. This leads to the establishment of a one-to-one correspondence between the response functions and the respective quantum operators, and to the identification of the quantum commutator with the Poisson bracket of the response functions with respect to the normalized variables of the driving field. To complete the quantum description, a similar procedure is used to obtain the field operators as the response functions to the same normalized variables. The results allow us to draw important conclusions about the physical content of the quantum formalism, in particular about the meaning of the quantum expectation values and the coarse-grained nature of the quantum-mechanical description. (shrink)

Dans la seconde moitié du me siècle britannique, le nombre de textes traitant des rapports entre l'esprit et le corps est particulièrement conséquent. Cette époque est caractérisée par la formulation de la théorie de l'évolution de Darwin, par l'émergence des sciences du cerveau, et par une lutte pour l'autorité intellectuelle entre les élites traditionnelles et certains hommes de science. Le problème des rapports de l'esprit et du corps constitue à nos yeux une nouvelle porte d'entrée dans les débats de cette (...) époque et nous a permis d'identifier un mouvement philosophique, la philosophie psychophysiologique victorienne. Les auteurs étudiés sont les suivants : T.H. Huxley, Tyndall, Clifford, Maudsley, Bain, Carpenter, Lewes et Romanes"--Page 4 of cover. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Résumé : Le PPBS a été conçu comme un instrument destiné à ceux qui décident de l'allocation des ressources publiques : il doit leur permettre de prendre de meilleures décisions. S'il est très difficile de repérer et de juger les choix que le développement du système a inspirés aux Etats-Unis, il n'en est pas mains certain que ses résultats tangibles sant maigres car la masse des anciens programmes, principale source potentielle de moyens nouveaux, n'a guère été remise en question.La valeur (...) intrinsèque du PPBS ne peut être mise en cause. Ce qui doit l'être, c'est la lenteur de son développement, qui demeure peu avancé. Cette lenteur s'explique, car le système ne peut produire des fruits dans une terre stérile qu'on n'a pas préparée.La brutalité et les maladresses de l'opération déclenchée en 1965 dans le gouvernement fédéral américain ne pouvaient que renforcer la résistance au changement et retarder, sinon compromettre, le succès final. Les perspectives demeurent heureusement favorables, puisque la nouvelle administration ne semble pas décidée à faire machine arrière et que les Etats et Villes ont démarré sous de bien meilleurs auspices.La principale conclusion qu'imposent les expériences américaines est que toute juridiction intéressée par le PPBS doit impérativement développer, de la façon la plus générale, la volonté d'instaurer le système et s'assurer les moyens de le faire. C'est dire qu'il est peu sage d'engager la bataille sur tous les fronts à la fois : il faut tenter des percées. Mais c'est dire aussi combi en l'information et la formation sant essentielles. A cet égard, l'installation généralisée de certains éléments du système, à savoir la structure de programmes et le budget-programme, loin de présenter des inconvénients, peut constituer un excellent exercice en dehors de son utilité directe pour le preneur de décision. La bataille en cause est surtout celle de la conviction: l'outil est prêt, il est bon, encore faut-il que l' ouvrier accepte de s'en servir.Samenvatting:Planning-programming-budgeting werd ontworpen als een instrument voor diegenen die beslissen over de toewijzing van de overheidsmiddelen.Dit instrument moet de beslissers in staat stellen betere beslissingen te treffen. Het is niet makkelijk deze beslissingen op te sporen en te beoordelen welke in de Verenigde Staten getroffen werden onder invloed van de ontwikkeling van deze systeembenadering. Toch is het met vrij grote zekerheid te stellen dat de tastbare resultaten gering zijn omdat de veelheid aan oude programma's die tenslotte toch de voornaamste potentiële bronnen zijn van nieuwe middelen, nooit werden aangevochten.De intrinsieke waarde van PPBS kan daarom evenwel niet worden genegeerd. Wat wel dient aangeklaagd is de traagheid van zijn aanslepende ontwikkeling. Deze traagheid is te verklaren door het feit dat het systeem slechts vruchten kan afwerpen zo het ingeplant wordt in degelijk voorbereid terrein.De brutaliteit en de onhandigheden bij de operatie die in 1965 werd ingezet in het amerikaans federaal overheidsbestel konden niets anders dan de weerstand tegen de verandering versterken en afbreuk doen aan het uiteindelijk slagen van het systeem. Gelukkiglijk blijven de vooruitzichten gunstig want de nieuwe beleidsvoerders sinds de presidentsverkiezingen, blijken ermee te willen doorgaan en de staten en lokale overheden zijn ermee van wal gestoken onder veel betere omstandigheden. Het doorslaggevend besluit uit de amerikaanse ervaringen terzake is wel dat elke instantie welke belangstelling heeft voor PPBS, nodig moet op zo breed mogelijk vlak de wil doen groeien om het systeem te ontwikkelen en er ook de nodige middelen toe ter beschikking stellen. Dit betekent tevens dat het weinig aan te bevelen is de strijd op alle fronten terzelvertijd aan te binden maar wel geleidelijk doorbraken te verwezenlijken. Dit brengt dan evenwel ook met zich dat informatie en vorming essentieel zijn bij deze strategie. In dit verband moet dan ook gezegd worden dat reeds het invoeren van sommige deelementen van het systeem, zoals de programmastructuur en het programmabudget, voor de beslisser nuttig kan zijn voor zijn persoonlijk inzicht en vorming.De te voeren actie dient nog slechts te worden toegespitst op het overtuigen van de verantwoordelijken. Het instrument is immers gebruiksklaar en degelijk, er is alleen nog het wachten op de wil van de gebruiker dit instrument ter hand te nemen. (shrink)

L'État pluriculturel est devenu un concept majeur du début du XXIe siècle, tant au Nord qu'au Sud de la planète. La plupart des États sont confrontés à l'éveil ou à l'affirmation des différentes cultures des différentes communautés en leur sein. Pour nos sociétés plurielles, voici venu le temps des droits aux différences. En réalité, devant ce phénomène universel, les positions de l'État varient : il aménage la coexistence des communautés culturelles ; ou il ne veut pas les connaître. Entre ces (...) deux pôles, bien des nuances existent, du refus des différences à leur tolérance, et enfin à leur reconnaissance. La France est un exemple typique de déchirement : elle est arc-boutée sur le principe fondateur de la République une et indivisible, mais elle prévoit à ce principe de telles exceptions qu'elle est en plein bouleversement. Comment l'État démocratique va-t-il régir sa pluriculturalité? Comment les différentes options praticables peuvent-elles, chacune, impliquer une part de cohésion et une part de fragmentation sociale? Comment concilier droits à la différence et droit à l'indifférence? De telles questions ne peuvent être traitées qu'en analysant les diverses expériences. C'est ce que fait le présent ouvrage, publiant les travaux d'un colloque tenu à Nouméa en juillet 2002, avec la participation de juristes et de politistes, d'anthropologues et de tous chercheurs en sciences sociales en général. Les États les plus divers, de tous les continents, sont analysés. Les expériences de contextes extrêmement contrastés sont évoquées : les différences ont un long chemin à faire, pour s'affirmer en droit. Le cas très particulier de la Nouvelle-Calédonie est approfondi : à la fois symbole de la France pluriculturelle et consécration d'institutions fortement dérogatoires. Cet ouvrage est une contribution au code universel du Vivre ensemble. (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)