Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep (...) this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

The non-governmental organizations (NGOs) that assume the bulk of emergency care during large-scale disasters in the developing world must expend considerable time and resources to ensure donations to sustain their field operations. This long-standing dilemma for the humanitarian community can create a competitive environment that: • Compromises the delivery and quality of services,• Allows the effectiveness of operations to be compromised by a lack of cooperation and collaboration,• Disrupts the timely and accurate coordination and analysis of outcome measures that• Undermines (...) the long-term capacity of indigenous aid organizations. (shrink)

Since physicians began to formally professionalize in the 19th century, we have sought to set ourselves apart from other occupations through the adoption (and variable enforcement) of codes of ethi...

With this issue, we begin a regular feature on bioethics and public health. We welcome Matthew K. Wynia, M.D., M.P.H., Director of the Institute for Ethics of the American Medical Association as our new Contributing Editor. If you have comments or suggestions regarding this feature, please email us at manuscript@ bioethics.net.

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that i...

Volume 20, Issue 10, October 2020, Page W4-W7.

The consent process for publication of clinical images in medical journals varies widely. The extent of this variation is not known. It is also not known whether journals follow their own stated best practices or the guidance of the International Committee of Medical Journal Editors. We assessed consent requirements in a sample of 10 top impact factor general medicine journals that publish clinical images, examining variability in consent requirements for clinical image publication and congruence of requirements with the recommendations of (...) the ICMJE. Clinical image consent requirements varied widely from journal to journal. None of the studied journals, even amongst n = 4 ICMJE members or n = 8 journals who self-report adherence to ICMJE guidelines, comply with all of the recommendations of the ICMJE. Half of studied journals require a journal-specific consent form. Among top medical journals there is significant heterogeneity in consent requirements for clinical images. Variability of consent requirements is neither practical nor rational; inconsistent requirements create uncertainty for authors, present impediments to dissemination of scholarship, and undermine a shared professional understanding of how best to protect patient privacy. We propose adopting a standardized consent form and process for publication of identifiable images in medical journals, with uniform elements and explicit definitions. (shrink)

Merab Konstantinovich [Mamardashvili] met with me immediately, as soon as I requested it, although he forewarned me that he could only dimly remember much of that distant past in which I was most interested. But evidently that past still perturbed him as well, since he agreed to speak with me even though he had not yet completely recovered from his illness, and hence his voice was feeble, at times subsiding to a whisper; he would pronounce his words indistinctly, constantly sticking (...) one onto another; on top of that, for technical reasons the dictaphone was situated a bit away from him. It was therefore very difficult to transcribe the text, and I raised many questions with the idea of asking Merab Konstantinovich about them at our next meeting and clearing up some things. But alas, there was no next meeting … Hence I am permitting myself now to publish only some of the most clearly enunciated fragments of my conversation with him, one of the four "forefathers" of the Moscow Methodological Circle, whose name for us, today's participants (and hence neophytes) in the methodological movement, is enveloped by legends handed down by word of mouth. I kept my questions to a minimum. Mamardashvili's reminiscences, arguments, and reflections will seem contentious to many. But no matter, one can dispute points of substance even with those who have passed on. (shrink)

Causal understanding is a defining characteristic of human cognition. Like many animals, human children learn to control their bodily movements and act effectively in the environment. Like a smaller subset of animals, children intervene: they learn to change the environment in targeted ways. Unlike other animals, children grow into adults with the causal reasoning skills to develop abstract theories, invent sophisticated technologies and imagine alternate pasts, distant futures and fictional worlds. In this Review, we explore the development of human-unique causal (...) learning and reasoning from evolutionary and ontogenetic perspectives. We frame our discussion using an ‘interventionist’ approach. First, we situate causal understanding in relation to cognitive abilities shared with non-human animals. We argue that human causal understanding is distinguished by its depersonalized (objective) and decontextualized (general) representations. Using this framework, we next review empirical findings on early human causal learning and reasoning and consider the naturalistic contexts that support its development. Then we explore connections to related abilities. We conclude with suggestions for ongoing collaboration between developmental, cross-cultural, computational, neural and evolutionary approaches to causal understanding. (shrink)

Background: Hospital nurses are frequently the first care givers to receive a patient’s request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses’ opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. Methods: A phone survey conducted among a random national sample of 1502 (...) French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Results: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Conclusions: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call “good” euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia. (shrink)

The notion of a Sasaki projectionon an orthomodular lattice is generalized to a mapping Φ: E × E → E, where E is an effect algebra. If E is lattice ordered and Φ is symmetric, then E is called a Φ-symmetric effect algebra.This paper launches a study of such effect algebras. In particular, it is shown that every interval effect algebra with a lattice-ordered ambient group is Φ-symmetric, and its group is the one constructed by Ravindran in his proof that (...) every effect algebra that has the Riesz decomposition property is an interval algebra. It is shown that the doubling construction introduced in the paper is connected to the conditional event algebrasof Goodman, Nguyen, and Walker. (shrink)

This paper inquires into the nature of intertheoretic relations between psychology and neuroscience. This relationship has been characterized by some as one in which psychological explanations eventually will fall away as otiose, overthrown completely by neurobiological ones. Against this view it will be argued that it squares poorly with scientific practices and empirical developments in the cognitive neurosciences. We analyse a case from research on visual perception, which suggests a much more subtle and complex interplay between psychology and neuroscience than (...) a complete take-over of the former by the latter. In the case of vision, cross-theory influences between psychology and neuroscience go back and forth, resulting in refinement in both disciplines. We interpret this case study as showing that: (1) Mutual co-evolution of psychological and neurobiological theories, exemplifying persisting top-down influences from psychology, is a more empirically adequate way to describe psychoneural theory relations than a view on co-evolution, favoured by reductionists, which regards the cross-theory contributions from psychology as merely heuristically useful with no enduring influence on neurobiological theorizing; (2) In research on vision, discovering (or hypothesizing) the neural basis of functions vindicates psychological approaches, it does not eliminate them; (3) Current work on vision shows that many perceptual phenomena must be understood in terms of dynamical interactions between an observer and his/her environment. Therefore, we argue that internalist characterizations of the visual system must be supplemented with externalist accounts that address these reciprocal observer-environment interactions involved in vision. Such processes seem quite different from (internal) cellular and molecular ones, and as such seem to lie outside the scope of neuroscientific inquiry. We conclude that psychoneural reduction or elimination is implausible as a meta-theoretical prediction of theory choice in empirical work. Instead, this case study of vision shows that both psychology and neuroscience contribute to, and complement one another in the study of visual perception. (shrink)

Judgment aggregation theory, which concerns the translation of individual judgments on logical propositions into consistent group judgments, has shown that group consistency generally cannot be guaranteed if each proposition is treated independently from the others. Developing the right method of abandoning independence is thus a high-priority goal. However, little work has been done in this area outside of a few simple approaches. To fill the gap, we compare four methods based on distance metrics between judgment sets. The methods generalize the (...) premise-based and sequential priority approaches to judgment aggregation, as well as distance-based preference aggregation. They each guarantee group consistency and implement a range of distinct functions with different properties, broadening the available tools for social choice. A central result is that only one of these methods (not previously considered in the literature) satisfies three attractive properties for all reasonable metrics. (shrink)

Non-fiction graphic novels about illness and death created by patients and their loved ones have much to teach all readers. However, the bond of empathy made possible in the comic form may have special lessons for healthcare providers who read these texts and are open to the insights they provide.

We investigated whether (a) people positively reevaluate the characters of recently dead others and (b) supernatural primes concerning an ambient dead agent serve to curb selfish intentions. In Study 1, participants made trait attributions to three strangers depicted in photographs; one week later, they returned to do the same but were informed that one of the strangers had died over the weekend. Participants rated the decedent target more favorably after learning of his death whereas ratings for the control targets remained (...) unchanged between sessions. This effect was especially pronounced for traits dealing with the decedent’s prosocial tendencies (e.g., ethical, kind). In Study 2, a content analysis of obituaries revealed a similar emphasis on decedents’ prosocial attributes over other personality dimensions (e.g., achievement-relatedness, social skills). Finally, in Study 3, participants who were told of an alleged ghost in the laboratory were less likely to cheat on a competitive task than those who did not receive this supernatural prime. The findings are interpreted as evidence suggestive of adaptive design. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

Using the mathematical notion of an entity to represent states in quantum and classical mechanics, we show that, in a strict sense, proper superpositions are possible in classical mechanics.

Hegel raises many real problems on the basis of the phenomenology of spirit: logico-ontological, gnoseological, and philosophico-historical problems. But in all spheres, levels, and forms of consciousness, Hegel investigates particularly the formation of the socially developed and historically oriented universal subject of thought, will, and action in the context of the forms of the manifest spirit, forms that in reality assume the status of being. It is precisely this investigation that constitutes the real problematic of Hegel's Phenomenology of Spirit.

IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

I should like to begin with an observation of a biographical character. I hope this will facilitate discussion of the exceedingly complex task set for me here, the attempt to unify the theory of consciousness with my relationship to philosophy, that is, with what I think about it and what it means to me.

There is no doubt that custard apple diseases are among the important reasons that destroy the Custard Apple plant and its agricultural crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases is a good step to provide the appropriate and correct treatment. Determining the treatment with high accuracy depends on the method used to correctly diagnose the disease, expert systems can greatly help in avoiding damage to these plants. The expert system correctly diagnoses (...) Custard Apple disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: A specialized syllable language system was established for the diagnosis of Custard Apple plant disease. (shrink)

In the article three tragedies: ‘The Battle of Arminius‘ by Christian Dietrich Grabbe, ‘Nibelungs‘ by Friedrich Hebbel, ‘The Ring of the Nibelung‘ by Richard Wagner are considered. The aim of this paper is to investigate how history reception and mythological material correlates with the idea of national identity. The comparative-historical, typological and historical-genetic methods are applied in this publication. The genres of historical, philosophical and mythological tragedy became the most popular genres in the socio-political conditions in the 30s of the (...) 19th century in Germany. Grabbe underlines the idea of the presence of the ‘local‘ regional history within the framework of the ‘big‘ and significant one. Grabbe paid attention to the historical process and historical figures, not to any particular historical event. In his last work, tragedy ‘The Battle of Arminius‘, Grabbe showed his understanding of the country’s historical origins and the creation of a national myth. F. Hebbel and R. Wagner comprehend the images and motifs of Norse mythology as a universal model of human existence. While interpreting the story of Nibelungs, F. Hebbel notes not only its national roots but its universal source; he models the image of the world through the prism of the microcosm of Burgundians/Nibelungs. Wagner’s tetralogy is not so much an interpretation as a creation of the ‘new myth‘. The images of Arminius and Siegfried have the features of the archaic primal forefather, ‘cultural hero‘ of the nation, who intimately related with Nature and home ground. Myth and mythological history are not only the tools of attainment of national identity but the means of reversion the modern man to the lost harmony of the Universe, which pertains to the mythological mind. (shrink)