In lieu of an abstract, here is a brief excerpt of the content:Phenomenology and Modern Behavioral PsychologyLindsay B. Fletcher (bio) and Steven C. Hayes (bio)Keywordsacceptance, contextualism, defusion, relational-frame-theoryPérez-Álvarez and Sass (2008) deserve praise for examining the philosophical roots of clinical psychological science. Modern psychology has moved away from the development of philosophy and theory that is needed to ground scientific investigation within a coherent system. The result is increasingly ill-defined constructs and research programs that each operate within their own divergent (...) paradigm. B.F. Skinner is one of the few modern experimental behavioral psychologists who attempted to build a coherent science of behavior based on observable events with testable hypotheses. Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, and Wilson 1999) and its associated basic science of cognition, Relational Frame Theory (RFT; Hayes, Barnes-Holmes, and Roche 2001), build on Skinner’s work to produce a more progressive science.Psychology and philosophy are different disciplines and how they are approached is defined by the objective. The purpose of philosophy from a scientific point of view is not the same as from a philosophical point of view. It is fine to compare radical behaviorism and phenomenology, but it seems important to ask whether and how this will lead to a more progressive science of behavior.In this commentary, we discuss the philosophy and theory that underlie ACT/RFT and show how they reflect on the relevant points made by the authors regarding the shared features of phenomenology and radical behaviorism. We make two adjustments to the explanation of radical behavioral concepts presented in the current paper to create a more coherent analysis. Finally, we show here how the development of a theory based on applied goals directly informs the methods used in clinical settings.Philosophical AssumptionsThe field of behavior analysis that originated with Skinner has different strands. Some are holistic and pragmatic, whereas others are elementalistic and mechanistic (Hayes, Hayes, and Reese 1988). ACT is based on an a-ontological philosophy termed functional contextualism (Hayes 1993), which views behavior analysis from a holistic and pragmatic perspective. Functional contextualism (AKA radical behaviorism) shares some of the assumptions of phenomenology, as has long been noted (Day 1969). For example, Pérez-Álvarez and Sass (2008) identify a-dualism, or monism, as a common feature. In functional contextualism, the whole is divided into functional units for the purpose of prediction and influence. A three-term contingency (antecedent–behavior–consequence) in behavior analysis is viewed as a [End Page 255] whole event with pragmatically distinguishable aspects, not an assemblage. As the authors point out, this results in a dialectic tension between stimulus control, action, and reinforcer because none are distinct units, and each is defined with reference to the others much as the front of a coin cannot exist without the back. These are not ontological entities, but functional units that are abstracted from the whole for pragmatic purposes. What is “radical” about radical behaviorism is that the philosopher, psychologist, or researcher participates in the event they are observing, and their own acts of scientific observation are identified based on their own functional properties.Behavioral ThinkingIn the service of further developing this philosophical and theoretical foundation and considering it along side phenomenology, we need to examine two aspects of the target article. The first regards the role of the environment in shaping behavior that is central to behavioral and contextual theories. The authors object to behaviorism’s notion of environment and suggest replacing it with the concept of the world, stating that “animals have environment, but man has world.” What is missing is an account of that shift. We believe that modern behavior analysis provides that account.Similarly, the paper argues that “reinforcers are not just things that follow behavior, but also, and above all, values that guide our life.” Again what is missing is an account of the precise behavioral basis for the distinction.In an attempt to do this, the authors incorrectly analyze operant behavior as future oriented, even appealing to final causality. In the three-term contingency, the discriminative stimulus sets the occasion for reinforcement of a particular behavior. The behavior of interest has been reinforced in similar contexts in the past, which gives... (shrink)

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)

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 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)

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)

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.

Professor W. B. Anderson'S paper ‘Livy and the Lexica’ in C.Q. XXV., 1931, pp. 38–48, prompts me to put together from my notes this further list of words and idioms used by Livy but not recorded in the lexica as Livian. With one or two clearly indicated exceptions, I have included nothing which is given in Lewis and Short, Forcellini-Corradini-Perin or Georges, and I have included nothing in which Mr. Anderson has anticipated me, except that in a few places I (...) have added to the citations he gives; but my citations make no more claim to be exhaustive than his do. I have given within parentheses the authors who are cited by the lexica for a particular word or use, but I have refrained from adding other authorities. (shrink)

It seems worth while giving some account of this MS., because in recent years it has been said to contain certain pieces of the Moralia which it does not, and not to contain others which it does. At the foot of the first page of the text the MS. carries the pontifical shield with the arms of the Medici, and from this it is reasonable to suppose that there was a time when it belonged either to Leo X., who was (...) Pope from 1513 to 1521, or to Clement VII., who was Pope from 1523 to 1534. This being so, 1534 is established as the terminus ante quem of its writing. Towards the end of this century, about 1598, it was acquired by the Spanish Cardinal Saverio de Zelada. In 1801 the Cardinal Archbishop Antonio de Lorenzana bought in Rome a certain number of Greek and Oriental manuscripts which had formerly been in the collection of Cardinal Saverio de Zelada, and placed them in the Chapter Library at Toledo. Included with these was this MS. of the Moralia, which remains there to this day. (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.

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)

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)

In this study of the functionally referential alarm calls in the meerkats, we tested the hypothesis that the ability to refer to a specific location was an important factor in the evolution of discrete vocalizations. We investigated what information receivers gained about the location of the predator from alarm calls with high stimulus specificity compared to alarm calls with low stimulus specificity. Furthermore, we studied whether visual cues about the localization of the predator may be available from the posture of (...) the caller. We described the general behaviour of the caller, the caller’s posture, and in particular its gaze direction. We then observed receivers responding to the different call types, to determine whether the acoustic structure of the calls was enough for them to respond in the appropriate way, or whether they used additional visual cues from the caller. We tested this with specific manipulation experiments, using three set ups of playback experiments: no caller visible; model guard with specific gaze direction; and live sentinel. Natural observations and experiments confirmed that in high urgency situations the meerkats have enough information from the acoustic structure of the call to respond appropriately. When hearing low urgency calls that are less stimuli specific, meerkats used visual cues as an additional source of information in a few cases. This may indicate that functionally referential calls evolved to denote the location of the predator, rather than the predator type or its velocity of approach. However, when discussing this result in comparison to other functionally referential calls, such as the food associated calls and recruitment calls, this localization hypothesis does not appear to apply to the functionally referential calls in general. (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)

Professor W. B. Anderson'S paper ‘Livy and the Lexica’ in C.Q. XXV., 1931, pp. 38–48, prompts me to put together from my notes this further list of words and idioms used by Livy but not recorded in the lexica as Livian. With one or two clearly indicated exceptions, I have included nothing which is given in Lewis and Short, Forcellini-Corradini-Perin or Georges, and I have included nothing in which Mr. Anderson has anticipated me, except that in a few places I (...) have added to the citations he gives; but my citations make no more claim to be exhaustive than his do. I have given within parentheses the authors who are cited by the lexica for a particular word or use, but I have refrained from adding other authorities. (shrink)

Legalized gambling has all the hallmarks of a large-scale moral and social concern, yet, remarkably, philosophers have paid scarce attention to the moral issues surrounding this phenomenon. I believe that this neglect is unjustified. While much could be said about gambling in terms of its social impact, I offer an account on the moral status of gambling and avoid the temptation to give a “thin” account in simply categorizing gambling as “permissible” or “impermissible.” I attempt to assess its impact on (...) character and the moral life, felt in five closely interrelated ways. In particular, I will argue that gambling A) injures self-control, fosters moral incontinence, and indeed courts addiction; B) involves greed; C) shows a disregard for money that is incompatible with responsible care of one’s resources; D) cultivates indifference to others’ welfare; and E) represents a reckless assault on practical rationality, the faculty necessary for the moral life and the discharge of one’s responsibilities. (shrink)

Mapping the paths that stem and progenitor cells take en route to differentiate and elucidating the underlying molecular controls are key goals in developmental and stem cell biology. However, with population level analyses it is difficult − if not impossible − to define the transition states and lineage trajectory branch points within complex developmental lineages. Single‐cell RNA‐sequencing analysis can discriminate heterogeneity in a population of cells and even identify rare or transient intermediates. In this review, we propose that using these (...) data, one can infer the lineage trajectories of individual stem cells and identify putative branch points. Clonal lineage tracing of stem cells allows one to define the outcome of differentiation. Integrating these single cell‐based approaches provides a robust strategy for establishing and testing models of how an individual stem cell changes through time to differentiate and self‐renew. (shrink)

In his recent book, Until Justice and Peace Embrace, Nicholas Wolterstorff claims that in ethics there exist “sustenance rights,” also called “positive rights,” which demand that people be provided the requirements of productive social living, including food, clothing, shelter, healthful environments, and elementary health care. I defend Wolterstorff’s claims against attacks by social theologian Richard John Neuhaus, who argues in effect that to grant sustenance rights implies both personal and theoretical acceptance of an unreasonable obligation which I call the Duty (...) of Sacrifice (DOS) to transfer all one’s wealth to meet those needs, a charge which Wolterstorff interprets as a demand that he sell his house. (shrink)

Annals, i. 31. 4: ‘implere ceterorum rudes animos: uenisse tempus quo…’. Implore has been suspected and impellere has been suggested. Andresen says ‘implere… womit, zeigen die folgenden Reden. Curt. x. 1. 28 credulas regis aures implebat’. The passage of Curtius continues not with an accusative and infinitive but with the words dissitnulans causam irae. A better defence is to be seen in Livy, xlv. 31. 6.

It seems worth while giving some account of this MS., because in recent years it has been said to contain certain pieces of the Moralia which it does not, and not to contain others which it does. At the foot of the first page of the text the MS. carries the pontifical shield with the arms of the Medici, and from this it is reasonable to suppose that there was a time when it belonged either to Leo X., who was (...) Pope from 1513 to 1521, or to Clement VII., who was Pope from 1523 to 1534. This being so, 1534 is established as the terminus ante quem of its writing. Towards the end of this century, about 1598, it was acquired by the Spanish Cardinal Saverio de Zelada. In 1801 the Cardinal Archbishop Antonio de Lorenzana bought in Rome a certain number of Greek and Oriental manuscripts which had formerly been in the collection of Cardinal Saverio de Zelada, and placed them in the Chapter Library at Toledo. Included with these was this MS. of the Moralia, which remains there to this day. (shrink)