When healthcare professionals feel constrained from acting in a patient’s best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. (...) Appreciation of these dynamics may assist in cross-discipline sensitivity, enabling more constructive dialogue and collaboration. (shrink)

That which constitutes a ‘good death’, or dying well, has long been of interest to philosophers and clinicians alike. While difficult to define due to its deeply personal nature and dependency on spiritual and cultural beliefs and past experiences, Wilkinson1 has drawn parallels from art and music to consider key ethical components. Few in clinical practice would dispute that a ‘good death’ is one that does not rob the person of a valuable life, is aligned with the preferences of the (...) patient and/or their family, where comfort and solace is provided, distress to family and caregivers is minimised or even that dying is not prolonged. However, what is more contentious is how tensions within the principles of a ‘good death’ should be managed or prioritised. In the context of caring for critically ill babies and children, the tension often takes the form of prolonging the dying process through providing life-sustaining interventions to meet the needs of, and to lessen the longer term distress of, the bereaved family, who must live with the decisions that are made. Though often justifiable, such interventions may result in considerable moral distress within caregivers—particularly, as often the case, when interventions are perceived by some clinicians to be of greater benefit to the family than the patient. Some clinicians may have difficulty …. (shrink)

All research tools have limitations. Not all tools will be suited to every purpose. Understanding the limitations and accurately interpreting the output from any tool is essential to conducting mea...

Moral distress is prevalent within the neonatal intensive care unit (NICU) and can negatively affect clinicians. Studies have evaluated the causes of moral distress and interventions to mitigate it...

The idea of “postponed withholding,” proposed by Syltern et al. (2022), is a provocative one, and like all good provocative ideas, provokes deeper thinking from fresh perspectives. Our attention wa...

The output from motor neuron pools is influenced by the integration of synaptic inputs originating from descending corticomotor and spinal reflex pathways. In this study, using paired non-invasive brain and peripheral nerve stimulation, we investigated how descending corticomotor pathways influence the physiologic recruitment order of the soleus Hoffmann reflex. Eleven neurologically unimpaired adults completed an assessment of transcranial magnetic stimulation -conditioning of the soleus H-reflex over a range of peripheral nerve stimulation intensities. Unconditioned H-reflex recruitment curves were obtained by delivering (...) PNS pulses to the posterior tibial nerve. Subsequently, TMS-conditioned H-reflex recruitment curves were obtained by pairing PNS with subthreshold TMS at short and long intervals. We evaluated unconditioned and TMS-conditioned H-reflex amplitudes along the ascending limb, peak, and descending limb of the H-reflex recruitment curve. Our results revealed that, for long-interval facilitation, TMS-conditioned H-reflex amplitudes were significantly larger than unconditioned H-reflex amplitudes along the ascending limb and peak of the H-reflex recruitment curve. Additionally, significantly lower PNS intensities were needed to elicit peak H-reflex amplitude for long-interval facilitation compared to unconditioned. These findings suggest that the influence of descending corticomotor pathways, particularly those mediating long-interval facilitation, contribute to changing the recruitment gain of the motor neuron pool, and can inform future methodological protocols for TMS-conditioning of H-reflexes. By characterizing and inducing short-term plasticity in circuitry mediating short- and long-interval TMS-conditioning of H-reflex amplitudes, future studies can investigate supraspinal and spinal circuit contributions to abnormal motor control, as well as develop novel therapeutic targets for neuromodulation. (shrink)

In a recent unit of study in an undergraduate Health Sciences pathway course, we identified a set of essays which exhibited similarity of content but demonstrated the use of bizarre and unidiomatic language. One of the distinct features of the essays was the inclusion of unusual synonyms in place of expected standard medical terminology.We suspected the use of online paraphrasing tools, but were also interested in investigating the possibility of the use of online language translation tools. In order to test (...) the outputs of these tools, we used as a seed document a corpus of text which had been provided to the students as prompt for the essay. This document was put through six free online paraphrasing tools and six separate iterative language translations through the online Google Translate™ tool.The results demonstrated that free online paraphrasing tools did not identify medical terminology as standardised or accepted nomenclature and substituted synonyms, whereas Google Translate™ largely preserved medical terminology.We believe that textual indicators such as the absence of standard discipline-based terminology may be of assistance in the identification of machine paraphrased text. (shrink)

The people and the value of their experience, by N. T. Pratt.--From kingship to democracy, by J. P. Harland.--Democracy at Athens, by G. M. Harper.--Athens and the Delian League, by B. D. Meritt.--Socialism at Sparta, by P. R. Coleman-Norton.--Tyranny, by M. Mac Laren.--Federal unions, by C. A. Robinson.--Alexander and the world state, by O. W. Reinmuth.--The Antigonids, by J. V. A. Fine.--Ptolemaic Egypt: a planned economy, by S. L. Wallace.--The Seleucids: the theory of monarchy, by G. Downey.--The political status of (...) the independent cities of Asia Minor in the Hellenistic period, by D. Magie.--The ideal states of Plato and Aristotle, by W. J. Oates.--Epilogue, by A. C. Johnson.--Bibliography (p. 225-233).--Index, by H. V. M. Dennis, III. (shrink)

A volume of the Prentice-Hall "Contemporary Perspectives in Philosophy Series," this is largely a second intentional discussion by way of anthology. The articles by Malcolm, Ryle, Austin and Cavell seek to explain and defend their own conceptions of philosophy, the latter in direct reply to Mates, whose article is a critique of the movement. The editor's brief introduction is excellent, and the selection of articles highlights nicely the differences of opinion among ordinary language philosophers, while pointing to the essential (...) unity of their thought and problems.--M. W. (shrink)

Professional identity and competent ethical behaviors of nursing students are commonly developed through curricular inclusion of professional nursing values education. Despite the enactment of this approach, nursing students continue to express difficulty in managing ethical conflicts encountered in their practice. This descriptive correlational study explores the relationships between professional nursing values, self-esteem, and ethical decision making among senior baccalaureate nursing students. A convenience sample of 47 senior nursing students from the United States were surveyed for their level of internalized professional (...) nursing values (Revised Professional Nursing Values Scale), level of self-esteem (Rosenberg’s Self-Esteem Scale), and perceived level of confidence in ethical decision making. A significant positive relationship (p < 0.05) was found between nursing students’ professional nursing values and levels of self-esteem. The results of this study can be useful to nursing educators whose efforts are focused on promoting professional identity development and competent ethical behaviors of future nurses. (shrink)

This project evaluates the impact of the National Science Foundation's policy to promote education in the responsible conduct of research. To determine whether this policy resulted in meaningful RCR educational experiences, our study examined the instructional plans developed by individual universities in response to the mandate. Using a sample of 108 U.S. institutions classified as Carnegie “very high research activity”, we analyzed all publicly available NSF RCR training plans in light of the consensus best practices in RCR education that were (...) known at the time the policy was implemented. We found that fewer than half of universities developed plans that incorporated at least some of the best practices. More specifically, only 31% of universities had content and requirements that differed by career stage, only 1% of universities had content and requirements that differed by discipline; and only 18% of universities required some face-to-face engagement from all classes of trainees. Indeed, some schools simply provided hand-outs to their undergraduate students. Most universities had plans that could be satisfied with online programs such as the Collaborative Institutional Training Initiative's RCR modules. The NSF policy requires universities to develop RCR training plans, but provides no guidelines or requirements for the format, scope, content, duration, or frequency of the training, and does not hold universities accountable for their training plans. Our study shows that this vaguely worded policy, and lack of accountability, has not produced meaningful educational experiences for most of the undergraduate students, graduate students, and post-doctoral trainees funded by the NSF. (shrink)

INTRODUCTION In her "Introduction" to Feeling_and Form Susanne K. Langer writes that nothing in this book is exhaustively treated. ...

The context of compliance creates special challenges for research ethics education. It can serve as a positive force in promoting research integrity because it forces academic institutions to provide research ethics training, and it forces some people to complete research ethics training. However, when compliance mandates create patchwork coverage with inconsistent requirements, they can have the paradoxical effect of trivializing the very thing they intend to promote. After providing a background on research ethics education mandates from US federal funding agencies, (...) I review the way in which academic institutions tend to respond to these mandates and I explore the impact of these compliance requirements on the goals of research ethics education. Finally, I consider recent calls to harmonize federal agency requirements, and close by sharing the way in which we are trying to harmonize the requirements at my own institution. (shrink)

Offering cash payments to research subjects is a common recruiting method but there is significant debate about whether and in what amount such payments are appropriate. This paper is concerned with exploitation and whether there should be a lower limit on the amount researchers can pay their subjects. When subjects participate in research as a way to make money, fairness requires that researchers pay them a fair wage. This call for the establishment of a lower limit meets resistance in two (...) places: (1) denial that the payments offered by researchers are wages for participation; and (2) concern about undue inducement. This paper critically examines these arguments for and against a lower limit. It shows that the need for a lower limit cannot be avoided by adopting a non-wage payment model and that concerns about undue inducement are unjustified in all trials except those that present greater than minimal risk. This analysis suggests the following compromise position: there should be an unconditional lower limit on payment amounts so that researchers cannot offer less than a fair wage, and when researchers cannot satisfy this limit because fairness requires a problematically large payment, then researchers should offer no payment at all. (shrink)

The debate around vaccine passports has been polarising and controversial. Although the measure allows businesses to resume in-person operations and enables transitioning out of lockdown due to the COVID-19 pandemic, some have expressed concerns about liberty violations and discrimination. Understanding the splintered viewpoints can aid businesses in communicating such measures to employees and consumers. We conceptualise the business implementation of vaccine passports as a moral decision rooted in individual values that influence reasoning and emotional reaction. We surveyed support for vaccine (...) passports on a nationally representative sample in the United Kingdom in 2021: April (n = 349), May (n = 328), and July (n = 311). Drawing on the Moral Foundations Theory—binding (loyalty, authority, and sanctity), individualising (fairness and harm), and liberty values—we find that individualising values are a positive predictor and liberty values a negative predictor of support for passports, suggesting adoption hinges on addressing liberty concerns. Longitudinal analysis examining the trajectory of change in support over time finds that individualising foundations positively predict changes in utilitarian and deontological reasoning over time. In contrast, a fall in anger over time predicts increased support towards vaccine passports. Our study can inform business and policy communication strategies of existing vaccine passports, general vaccine mandates, and similar measures in future pandemics. (shrink)

Offering cash payments to research subjects is a common recruiting method, but this practice continues to be controversial because of its potential to compromise the protection of human subjects. Some critics question whether researchers should be allowed to offer money at all, citing concerns about commodification of the research subject, invalidation of study results, and increased risks to subjects. Other critics are comfortable with the idea of monetary payments but question how much researchers can pay their subjects, citing concerns about (...) undue inducement, crowding out, and monetary exploitation. Focusing only on the amount researchers can pay their subjects, this paper argues that the federal regulations and guidelines should implement a standard payment formula. It argues for a wage payment model, and critically examines three candidates for a base wage: the nonfarm production wage, the FLSA minimum wage, and a living wage. (shrink)

It is well known that, for example, the Continuum Hypothesis can’t be proved or disproved from the standard axioms of set theory or their familiar extensions. Some think it follows that CH has no determinate truth value; others insist that this conclusion is false, not because there is some objective world of sets in which CH is either true or false, but on logical grounds. Claims of indeterminacy have also been made on the basis of such considerations as the existence (...) of non-standard models of arithmetic, with similar rejoinders. We’ll read some representative examples of the various positions and replies. (For background on second-order logic, see Stewart Shapiro. (shrink)