Background: The magnitude of bullying and harassment among psychiatrists is reportedly high, yet no peer-review published studies addressing this issue could be found. Therefore, it was decided to conduct a pilot study to assess the degree of the problem, the types of bullying/harassment and to provide some insights into the situation.Methods and Principal Findings: Following multiple focus group meetings, a yes/no response type questionnaire was developed to assess the degree and type of bullying and harassment experienced by psychiatrists. Over a (...) 3-month period the questionnaire was administered to a random sample of 60 psychiatrists. 57 out of the 60 psychiatrists reported harassment and bullying. Frequencies of the following response variables are presented in descending order: rumours 40% ; defamation 20% ; passing remarks 20% ; false accusations 15% ; threats 13.3% ; verbal abuse 13.3% ; unjustified complaints 13.3% ; promotion blocked 13.3% ; humiliation 13% ; bad reference given 10% ; credentials questioned 8.3% ; physical attacks 5% ; termination 5% ; derogatory remarks 1.7% and 1.7% were subjected to personal work. As a result of being subjected to harassment, 66.7% of the psychiatrists did not take any action, whereas 33.3% confronted the person they believed responsible. Asked whether the bullying and harassment caused distress, 18.3% of the psychiatrists did not report any effect, 30% reported mild distress, 40% moderate distress and severe distress was reported by 11.7%.Conclusions: It was concluded that the magnitude of bullying and harassment among psychiatrists may be quite high, as evidenced by this pilot study. There is a need for extensive systematic studies on this subject and to establish strategies to prevent and address this issue at a national and regulatory level. (shrink)

This paper is devoted to the study of some subvarieties of the variety Qof Q-Heyting algebras, that is, Heyting algebras with a quantifier. In particular, a deeper investigation is carried out in the variety Q 3 of three-valued Q-Heyting algebras to show that the structure of the lattice of subvarieties of Qis far more complicated that the lattice of subvarieties of Heyting algebras. We determine the simple and subdirectly irreducible algebras in Q 3 and we construct the lattice of subvarieties (...) (Q 3 ) of the variety Q 3. (shrink)

In his thesis 'Para uma Teoria Geral dos Homomorfismos' (1944) the Portuguese mathematician José Sebastião e Silva constructed an abstract or generalized Galois theory, that is intimately linked to F. Klein’s Erlangen Program and that foreshadows some notions and results of today’s model theory; an analogous theory was independently worked out by M. Krasner in 1938. In this paper, we present a version of the theory making use of tools which were not at Silva’s disposal. At the same time, we (...) tried to keep in mind, so much as possible, the gist of his standpoint. (shrink)

We apply Hrushovski-Fraïssé's amalgamation procedure to obtain a theory of fields of prime characteristic of Morley rank 2 equipped with a definable additive subgroup of rank 1.

In his thesis Para uma Teoria Geral dos Homomorfismos (1944), the Portuguese mathematician José Sebastião e Silva constructed an abstract or generalized Galois theory, that is intimately linked to F. Klein’s Erlangen Program and that foreshadows some notions and results of today’s model theory; an analogous theory was independently worked out by M. Krasner in 1938. In this paper, we present a version of the theory making use of tools which were not at Silva’s disposal. At the same time, we (...) tried to keep in mind, so much as possible, the gist of his standpoint. (shrink)

Mental health practitioners often come across a number of challenges in their clinical practice. One such challenge that posed a management dilemma presented with the history of reincarnation. This subject has been discussed in non-scientific literature at length but there is an absolute paucity in scientific literature. This paper describes a case where a boy presented with memories of previous life that started haunting him and caused significant anxiety. The subject of reincarnation needs extensive research in order to understand and (...) manage the resultant clinical challenges. (shrink)

This volume is an introduction to the philosophy of William of Ockham. After a brief account of his life and works, it presents his philosophical ideas under the headings of logic, epistemology, metaphysics, rational theology, philosophy of nature, psychology, ethics, and politics. The work concludes with a bibliography on Ockham and Ockhamism from 1950 to 1970, supplementing that of V. Heynck from 1919 to 1949. This is a well-informed presentation of Ockham’s philosophical ideas. Covering the whole range of his philosophy, (...) it does not treat any part of it in depth; but, as Fr. Bettoni says in his introduction, it offers a new global perspective on Ockham’s thought. There are frequent citations from Ockham’s writings in the notes, indicating the author’s close reading of Ockham’s works. The author is well aware that Ockham was "a philosopher who never ceases to be a theologian". But he does not convey to his reader the fact that Ockham’s interests, like those of Aquinas and Scotus, were primarily theological and not philosophical; that Ockham developed a logic and philosophy in support of a theology. The title of the work "Guglielmo di Ockham" suggests that the Ockham presented in it—Ockham the philosopher, not Ockham the theologian—was the "essential" Ockham.—A. A. M. (shrink)

As humans, we frequently engage in mental time travel, reliving past experiences and imagining possible future events. This study examined whether similar factors affect the subjective experience associated with remembering the past and imagining the future. Participants mentally “re-experienced” or “pre-experienced” positive and negative events that differed in their temporal distance from the present , and then rated the phenomenal characteristics associated with their representations. For both past and future, representations of positive events were associated with a greater feeling of (...) re-experiencing than representations of negative events. In addition, representations of temporally close events contained more sensorial and contextual details, and generated a stronger feeling of re-experiencing than representations of temporally distant events. It is suggested that the way we both remember our past and imagine our future is constrained by our current goals. (shrink)

We get cut-free sequent calculi for the interpolable propositional intermediate logics by translating suitable duplication-free tableau calculi developed within a semantical framework. From this point of view, the paper also provides semantical proofs of the admissibility of the cut-rule for appropriate cut-free sequent calculi.

It has been claimed that the ability to remember the past and the ability to project oneself into the future are intimately related. We sought support for this proposition by examining whether individual differences in dimensions that have been shown to affect memory for past events similarly influence the experience of projecting oneself into the future. We found that individuals with a higher capacity for visual imagery experienced more visual and other sensory details both when remembering past events and when (...) imagining future events. In addition, individuals who habitually use suppression to regulate their emotions experienced fewer sensory, contextual, and emotional details when representing both past and future events, while the use of reappraisal had no effect on either kind of events. These findings are consistent with the view that mental time travel into the past and into the future relies on similar mechanisms. (shrink)

The nature of quantum computation is discussed. It is argued that, in terms of the amount of information manipulated in a given time, quantum and classical computation are equally efficient. Quantum superposition does not permit quantum computers to ''perform many computations simultaneously'' except in a highly qualified and to some extent misleading sense. Quantum computation is therefore not well described by interpretations of quantum mechanics which invoke the concept of vast numbers of parallel universes. Rather, entanglement makes available types of (...) computation processes which, while not exponentially larger than classical ones, are unavailable to classical systems. The essence of quantum computation is that it uses entanglement to generate and manipulate a physical representation of the correlations between logical entities, without the need to completely represent the logical entities themselves. (shrink)

Gaze direction signals another person’s focus of interest. Facial expressions convey information about their mental state. Appropriate responses to these signals should reflect their combined influence, yet current evidence suggests that gaze-cueing effects for objects near an observed face are not modulated by its emotional expression. Here, we extend the investigation of perceived gaze direction and emotional expression by considering their combined influence on affective judgments. While traditional response-time measures revealed equal gaze-cueing effects for happy and disgust faces, affective evaluations (...) critically depended on the combined product of gaze and emotion. Target objects looked at with a happy expression were liked more than objects looked at with a disgust expression. Objects not looked at were rated equally for both expressions. Our results demonstrate that facial expression does modulate the way that observers utilize gaze cues: Objects attended by others are evaluated according to the valence of their facial expression. C 2006 Elsevier B.V. All rights reserved. (shrink)

The dilemma of whether and how to disclose a diagnosis of cancer or of any other terminal illness continues to be a subject of worldwide interest. We present the case of a 62-year-old Japanese woman afflicted with advanced gall bladder cancer who had previously expressed a preference not to be told a diagnosis of cancer. The treating physician revealed the diagnosis to the family first, and then told the patient: "You don't have any cancer yet, but if we don't treat (...) you, it will progress to a cancer". In our analysis, we examine the role of family consent, communication patterns (including ambiguous disclosure), and advance directives for cancer disclosure in Japan. Finally, we explore the implications for Edmund Pellegrino's proposal of "something close to autonomy" as a universal good. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

Objectives: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy.Methods: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm (...) patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability.Results: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure.Discussion: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles. (shrink)

Is what could have happened but never did as real as what did happen? What did happen, but isn't happening now, happened at another time. Analogously, one can say that what could have happened happens in another possible world. Whatever their views about the reality of such things as possible worlds, philosophers need to take this analogy seriously. Adriane Rini and Max Cresswell exhibit, in an easy step-by-step manner, the logical structure of temporal and modal discourse, and show that every (...) temporal construction has an exact parallel that requires a language that can refer to worlds, and vice versa. They make precise, in a way which can be articulated and tested, the claim that the parallel is at work behind even ordinary talk about time and modality. The book gives metaphysicians a sturdy framework for the investigation of time and modality - one that does not presuppose any particular metaphysical view. (shrink)

argument fails, and the purpose of this note is to bring out that failure. The view in question which Heck calls the Hybrid Vie~istinguishes between the meanings of names and the contents of beliefs which are expressible using names. According to the Hybrid View the meaning of a name is its referent: names do not have senses. Thus (a) "George Orwell wrote 1984" means the same as (b) "Eric Blair wrote 1984". However, the Hybrid View tells a different story about (...) the beliefs one expresses when one utters (a) or (b). The content of a belief expressed using a sentence that contains a name has more to it than just the referent of the name and whatever properties the sentence ascribes to the name's referent. There is.. (shrink)

Adrian Viens, Guest Editor of this Olivieri symposium, and Julian Savulescu, the Editor of JME, set the scene for the symposium."In failing...[her] when she needed them most, it is now clear that some members of the University’s Faculty of Medicine heard her muffled cries of academic freedom from the back room, yet their response was to serve another round of drinks and turn the music up louder. With the bombshell revelations in the...affair, the plug may have been pulled on this (...) business sponsored party, and hopefully a sober re-examination of the university’s neglected role and responsibility toward independent inquiry and academic freedom can begin.1" "These guys don’t get one thing—we’re not going away. This isn’t a personal vendetta. This is something I want patients to be protected from when I’m dead, fifty years from now.2" "[The Olivieri affair is] not a mystery novel, but instead the latest skulduggery at Toronto’s Hospital for Sick Children.1" "The legal assaults which you have endured in your battle against the drug company, and in your battle against the medical establishment appear to have been fought with the type of uncommon bravery that is rarely seen. It is for this reason that our trustees have unanimously chosen to recognise you for this most prestigious award.3" "[The Olivieri affair resulted from] a fundamental misreading of the issue as a mere contractual and scientific dispute...[it is] Canada’s worst academic and research scandal in decades...[Since 1998, Olivieri has been] demoted, then restored, then harassed. She has been smeared with allegations attacking her competence, integrity, sanity and personality....4"The Olivieri affair is one of the most important events to occur in research ethics. From its dominance in the Canadian and international news media, to changes in the governance of public health, academic medicine, …. (shrink)

The paper examines a single, apparently simple argument for the existence of incompatibilities between the virtues as traits of character. This argument appeals not to empirical truths about human psychology or human nature but to the possibility of conflict between the exercise of different virtues in action. There are, for example, situations in which we can exercise the virtue of truthfulness only at the expense of not exercising the virtue of tact, as when we are asked a question to which (...) the straightforward answer will pain our questioner. The person who in these situations would give a straightforward answer possesses the virtue of truthfulness to a higher degree than the person who would respond more evasively, whereas the latter person possesses the virtue of tact to a higher degree than the former. But since the two responses are mutually exclusive, it follows that the degree to which we possess the virtue of truthfulness must, at least in some measure, correlate inversely with the degree to which we possess the virtue of tact. And similarly for many other pairs of virtues. My paper focusses on the two cardinal assumptions of this argument, viz., (i) that sometimes the exercise of one virtue can conflict with the exercise of another, and (ii) that the degree to which a person possesses a virtue correlates directly with the extent of its exercise, and defends both assumptions against a variety of objections which allege that, in different ways, they are insensitive to the complexity of the virtues. (shrink)

This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking (...) about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed. (shrink)

Informed consent enjoys an unassailable position in both clinical and research situations as a safeguard of patients’ rights. Keeping the patient involved in the decision making process is easier when there is direct communication with the individual. The Pakistani milieu offers challenges to this process because crucial decision making is often done by family members or is left entirely up to the attending physician. There seems to be a general acceptance of this shifting of focus from the individual to other (...) players. This also raises certain ethical dilemmas for physicians who may feel uncomfortable with communication which excludes the patient or in accepting a paternalistic primary decision making role. The objective of this informal qualitative study was to ascertain physicians’ perceptions regarding the process of information delivery to the patient in the Pakistani context and the various influences acting upon it. (shrink)

Is what could have happened but never did as real as what did happen? What did happen, but isn't happening now, happened at another time. Analogously, one can say that what could have happened happens in another possible world. Whatever their views about the reality of such things as possible worlds, philosophers need to take this analogy seriously. Adriane Rini and Max Cresswell exhibit, in an easy step-by-step manner, the logical structure of temporal and modal discourse, and show that every (...) temporal construction has an exact parallel that requires a language that can refer to worlds, and vice versa. They make precise, in a way which can be articulated and tested, the claim that the parallel is at work behind even ordinary talk about time and modality. The book gives metaphysicians a sturdy framework for the investigation of time and modality - one that does not presuppose any particular metaphysical view. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Parents’ freedom to choose infant male circumcision is the correct policyIndividuals and groups lobbying to have infant male circumcision prohibited or restricted often argue that the practice of routinely circumcising infants is unjustified. For instance, in this issue of the journal, John Hutson argues that it is virtually impossible to justify a policy in which the medical establishment should be able to embark on a “mass circumcision” campaign of 100% of the infant male population [see page 238].1Indeed, I would be (...) hard pressed to find anyone who could rationally disagree with this contention. However, this is because no one is currently arguing for the enactment of a policy that stipulates that all healthy male infants should be routinely circumcised . Arguments seeking to support a prohibition of “routine infant circumcision”, such as the one by Hutson, are arguing against a straw man—and a pitiful one at that.2 Such arguments only serve to misconstrue the debate and avoid engaging in the real and pressing issues concerning the legitimacy of the provision of this procedure.The questions that should be considered, and the ones which I shall be interested in discussing here, are what reasons are justifiable for allowing parents to choose to have their son circumcised? After well informed and careful deliberation should parents have the freedom to choose to have their son circumcised? These are the most relevant questions to be considered because there is a growing collection of citizens, medical practitioners, and lawyers who are currently lobbying for the practice of infant male circumcision to be outlawed—for example, there is a bioethicist who argues that the criminal law should be used …. (shrink)

What is colour vision for? In the popular imagination colour vision is for “seeing the colours” — adding hue to the achromatic world of shape, depth and motion. On this view colour vision plays little more than an ornamental role, lending glamour to an otherwise monochrome world. This idea has guided much theorising about colour within vision science and philosophy. However, we argue that a broader approach is needed. Recent research in the psychology of colour demonstrates that colour vision is (...) integral to a variety of visual processes, helping us to perform many types of visual tasks. We discuss some of this research and consider its implications for philosophical theories of colour. (shrink)

In psychiatry, caregivers try to get free and informed consent of patients, but often feel required to restrict freedom and to use coercion. The present article develops ethical advice given by an Ethics Committee for Mental Health Care. The advice recommends an ethical ideal of shared deliberation, consisting of information, motivation, consensus and evaluation. For the exceptional use of coercion, the advice develops three criteria, namely incapacity to deliberate, threat of serious harm and proportionality between harm and coercion.The article also (...) discusses the viewpoints of the ethical advice and of the European Convention on Human Rights and Biomedicine: is the advice in agreement with the Convention and can the advice refine the guidelines of the Convention for the particular context of psychiatry? Although the Convention emphasises the autonomy of the individual patient, whereas the advice focuses on the relationships between the partners involved, the advice enjoys a complementary and supportive function in the application of the Convention. (shrink)

The controversies in Bristol, Alder Hey and elsewhere in the UK surrounding the removal and retention of human tissue and organs have led to extensive law reform in all three UK legal systems. This paper reports a short study of the reactions of a range of health professionals to these changes. Three main areas of ethical concern were noted: the balancing of individual rights and social benefit; the efficacy of the new procedures for consent; and the helpfulness for professional practice (...) of the new legislation and regulation. Recognition of these concerns may help in forging a new partnership between professionals and patients and their families. (shrink)