The target article does not consider neural data on primate spatial representations, which we suggest provide grounds for believing that navigational space may be three-dimensional rather than quasi–two-dimensional. Furthermore, we question the authors' interpretation of rat neurophysiological data as indicating that the vertical dimension may be encoded in a neural structure separate from the two horizontal dimensions.

We extend the discussion in the target article about distinctions between extrinsic coding and the alternative we and the target article both favor, intrinsic coding. Central to our thinking about intrinsic coding is population coding and the concept of high-dimensional neural response spaces.

Although the E-Z Reader model accounts well for eye-tracking data, it will be judged by new predictions and consistency with evidence from brain imaging methodologies. The stage architecture proposed for lexical access seems somewhat arbitrary and calculated timings are conservatively slow. There are certain effects in the literature that seem incompatible with the model.

Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...) distress. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

The naturalistic fallacy is mentionedfrequently by evolutionary psychologists as anerroneous way of thinking about the ethicalimplications of evolved behaviors. However,evolutionary psychologists are themselvesconfused about the naturalistic fallacy and useit inappropriately to forestall legitimateethical discussion. We briefly review what thenaturalistic fallacy is and why it is misusedby evolutionary psychologists. Then we attemptto show how the ethical implications of evolvedbehaviors can be discussed constructivelywithout impeding evolutionary psychologicalresearch. A key is to show how ethicalbehaviors, in addition to unethical behaviors,can evolve by natural selection.

Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. (...) Corley et al. ( 2001 ) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007 ; Schwenzer and Wang 2006 ). Other scholars have proposed variations on Jameton’s core definition (Sporrong et al. 2006 , 2007 ), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006 ), ethics stress (Raines 2000 ), and stress of conscience (Glasberg et al. 2006 ). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered. Content Type Journal Article Pages 1-11 DOI 10.1007/s10730-012-9177-x Authors Ann B. Hamric, School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298-0567, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Recent discussions of boundary theory, particularly in the field of ethnic relations, emphasize varying degrees of porousness of social boundaries and the importance of considering the effects of the intersections of multiple boundaries, most notably those of gender, ethnicity/race, and class. It is also increasingly acknowledged that within-group characteristics, including identities, of subordinate as well as of dominant groups may change, without their becoming less authentic distinctive collectivities. This article examines the changing identities of a specific collectivity—French-speaking Canadian women living (...) in Ontario—who, during the past century, have been either marginalized by, or excluded from, several larger collectivities for various reasons—religion, race/ethnicity, language, nationalism, region, and gender—related to boundary definitions of their multiple, intersecting identities. It explores the emergence of these various marginalities and the ability of these feminists to construct institutions and agendas on their own terms. (shrink)

The main objective of this essay is to validate some of the principal, currently competing, mammalian consciousness-brain theories by comparing these theories with data on both cognitive abilities and brain organization in birds. Our argument is that, given that multiple complex cognitive functions are correlated with presumed consciousness in mammals, this correlation holds for birds as well. Thus, the neuroanatomical features of the forebrain common to both birds and mammals may be those that are crucial to the generation of both (...) complex cognition and consciousness. The general conclusion is that most of the consciousness-brain theories appear to be valid for the avian brain. Even though some specific homologies are unresolved, most of the critical structures presumed necessary for consciousness in mammalian brains have clear homologues in avian brains. Furthermore, considering the fact that the reptile-bird brain transition shows more structural continuity than the stem amniote-mammalian transition, the line drawn at the origin of mammals for consciousness by several of the theorists seems questionable. An equally important point is that consciousness cannot be ruled out in the absence of complex cognition; it may in fact be the case that consciousness is a necessary prerequisite for complex cognition. (shrink)

BackgroundGeneral practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic.MethodsSemi-structured interviews with Dutch general practitioners working in the Netherlands were (...) conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding.ResultsFifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients’ self-determination vs. the general practitioners’ paternalism, (3) the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, (4) the general practitioners’ duty of care vs. adequate care provision.ConclusionsLack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account. (shrink)

Ethics raises questions about what kind of society we ought to be, questions that are at the heart of this case. Increasingly, inequalities in healthcare fueled by lack of access, inadequate insurance coverage, and rising costs are creating dilemmas in the proper distribution of healthcare resources. Questions of distributing scarce and valuable resources are fundamentally questions of justice. The classic definition of justice is the duty to give to each person what they deserve and can legitimately claim so that justice (...) is understood as a moral obligation to help persons exercise their rights. Distributive justice, i.e., what distribution of resources is fair, equitable, and appropriate, thus turns on the concept of rights. One of the key questions in this case is whether and to what extent this patient has a right to treatment for his heart disease. In the classic understanding of justice, he must assert and we as a society must agree that he has a right to treatment for his heart condition before we are morally obligated to provide this care. Are there limits to this patient's right to healthcare? If so, what are they? The differing principles of distributive justice use different criteria to rank or weight decisions regarding the proper and just distribution of healthcare services. In this case, at least two competing but ethically valid principles can be identified: the humanitarian principle and the libertarian principle. (shrink)

One hypothesis of isocortical evolution requires tangential migration of glutaminergic neurons. A second requires invasion of collothalamic afferents into the dorsal pallium, a territory that in sauropsids is solely lemnopallial. A third alternative is noted here – duplication of the original collopallial territory. The duplicated region would be formed by radial migration of excitatory neurons and would maintain its collothalamic innervation.

High-hope and low-hope research participants (males and females), as preselected on the basis of a dispositional self-report scale, choose freely between brief audiotaped messages that varied in depressive content. In the first experiment, the messages were of either positive or negative content. Highhope as compared to low-hope persons preferred listening to the positive tapes (no differences related to Gender), and this Hope main effect remained after the shared variance related to depression and positive and negative affectivity were removed. In a (...) modified replication, the contents of the tapes were comprised of successful or unsuccessful goal-attainment statements related to hopeful thinking. High-hope as compared to low-hope persons again preferred to listen to the successful goal pursuit messages (no differences related to Gender), and this Hope main effect on listening choices remained after the shared variances related to depression, positive and negative affectivity, and self-esteem were removed. Implications are discussed. (shrink)

Most parts of the brain are conserved across reptiles and birds (sauropsids) and mammals. Two major qualitative differences occur in the upper part, or pallium, of the telencephalon, the most rostral part of the brain. Mammals have a six‐layered neocortex and also exhibit a different morphological organization in the lateral half, or sector, of their pallium than do sauropsids. These differences of lateral pallial construction may derive from small but crucial differences in migration patterns of neuronal precursors generated at or (...) above the corner of the lateral ventricle, the corticostriatal junction (CS). Sauropsids have a large structure, the dorsal ventricular ridge, that is proliferated from this region, and its anterior part (ADVR) receives ascending projections from the dorsal thalamus. Mammals have multiple structures in this same region—the lateral part of neocortex, amygdala, and claustrum‐endopiriform formation. We propose here that, as the degree of development of structures that form the deeper tier of the pallium varies across the stages of embryology and across phylogeny, mutations may have occurred during evolution at the origin of mammals that had profound consequences for the fate of neural populations generated in the region of the CS and its neighboring pallial germinal zone. BioEssays 24:530–541, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one’s under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.

This paper attempts to outline some of the important concepts and ideas used in system analysis which is taken to be a general mode of analysis used in all sciences. Systems are seen from three perspectives: that involving the relationship between system and environment, that involving interaction between several systems, and that involving one type of system composed of other types of systems. The writers also discuss the concepts "structure" and "equilibrium" as they apply to system analysis, the point being (...) made that the use of these concepts in the social sciences has often been vague or even incorrect. (shrink)

The naturalistic fallacy is mentionedfrequently by evolutionary psychologists as anerroneous way of thinking about the ethicalimplications of evolved behaviors. However,evolutionary psychologists are themselvesconfused about the naturalistic fallacy and useit inappropriately to forestall legitimateethical discussion. We briefly review what thenaturalistic fallacy is and why it is misusedby evolutionary psychologists. Then we attemptto show how the ethical implications of evolvedbehaviors can be discussed constructivelywithout impeding evolutionary psychologicalresearch. A key is to show how ethicalbehaviors, in addition to unethical behaviors,can evolve by natural selection.

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

Activists’ investigations of animal cruelty expose the public to suffering that they may otherwise be unaware of, via an increasingly broad-ranging media. This may result in ethical dilemmas and a wide range of emotions and reactions. Our hypothesis was that media broadcasts of cruelty to cattle in Indonesian abattoirs would result in an emotional response by the public that would drive their actions towards live animal export. A survey of the public in Australia was undertaken to investigate their reactions and (...) responses to. The most common immediate reaction was feeling pity for the cattle. Women were more likely than men to feel sad or angry. Most people discussed the media coverage with others afterwards but fewer than 10 % contacted politicians or wrote to newspapers. We conclude that the public were emotionally affected by the media coverage of cruelty to cattle but that this did not translate into significant behavioral change. We recommend that future broadcasts of animal cruelty should advise the public of contact details for counseling and that mental health support contacts, and information should be included on the websites of animal advocacy groups to acknowledge the disturbing effect animal cruelty exposes can have on the public. (shrink)

School-based education in England has undergone significant changes since 2010, with a huge expansion of academies, schools outside local authority control, funded directly by central government. Academies and local authority (LA) maintained schools are subject to different legislative and regulatory frameworks. This paper focuses on the governance of LA maintained schools, single academy trusts (SATs) and schools that are part of multi-academy trusts (MATs). The research involved analysing legislative provision, policy documents, and documents addressing the governance arrangements of a sample (...) of 23 secondary schools. Our findings reveal a fragmented state-funded secondary school system as regards overall governance, school admissions, the curriculum, and the use of funding. Significantly schools in MATs, which are governed by the trust board, lack the autonomy of either SATs or maintained schools and are instead under the ultimate control of the trust board. The paper argues that there is a need for greater consistency regarding the governance of state-funded schools. (shrink)

This paper attempts to outline some of the important concepts and ideas used in system analysis which is taken to be a general mode of analysis used in all sciences. Systems are seen from three perspectives: (1) that involving the relationship between system and environment, (2) that involving interaction between several systems, and (3) that involving one type of system composed of other types of systems. The writers also discuss the concepts "structure" and "equilibrium" as they apply to system analysis, (...) the point being made that the use of these concepts in the social sciences has often been vague or even incorrect. (shrink)