BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

В монографии представлены взгляды авторов на возникновение и развитие либеральной и консервативной идеологий в политической истории российского государства.

Malgré l’accent porté sur les aspects publics, ritualistes de la pratique ancienne, les images et les objets grecs attestent des rencontres privées et personnelles avec des dieux. Cet article recourt à la documentation archéologique pour explorer les traits personnels, vécus, de la vie religieuse de l’Athènes attique. Bien qu’elles soient parfois décrites comme des « transactions », le développement des relations personnelles avec les dieux et de la manipulation de choses matérielles semble être l’un des éléments les plus saillants de (...) l’expérience religieuse des Grecs. Cette étude examine la matérialité religieuse et l’attitude dévotionnelle telle qu’elle existait en dehors de systèmes rituels organisés et des espaces sacrés. La documentation grecque suggère que la culture matérielle était « de la religion » sous forme physique et une part des méthodes des dévots pour développer des relations remarquablement intimes avec des figures sacrées dans un processus appelé « dévotionalisme ». Les femmes athéniennes utilisaient un objet commun de la vie quotidienne comme une forme de médium religieux: la tainia (ruban). Les femmes l’employaient dans tous les lieux de leur vie, y compris les maisons, les lieux de fêtes et les sanctuaires. La céramique suggère que les Athéniens ont employé de tels média dévotionnels pour interagir avec les défunts dans les cimetières. (shrink)

Self-understanding is to a great extent defined by narrative: who we are as human beings is determined by the stories we, and others, tell about ourselves. Yet many are unable to compose coherent personal narratives, as their experiences do not fall within the scope of an accepted conceptual framework. Survivors of trauma are particularly apt to fall into this “narrative rift,” where there can be no words to describe, and hence can be no assimilation of, their experiences. Using the example (...) of child sexual abuse, and drawing on the work of Bass, Spence, Schafer, and Guignon, I propose an examination of the nature of narrative fragmentation itself. Philosophical counselling may succeed where psychoanalysis might not: for where the latter has theoretical commitments to specific narratives, the former, through its reluctance to force epistemological or metaphysical assumptions on the narrator, may well facilitate a more comprehensive self-understanding. (shrink)

Изложено понимание рассуждения как метода рационального познания, рассмотрены его разновидности: аргументативные, интерпретативные, прогностические, квалификационные и вычислительные. Для аспирантов и соискателей.

The Societal Marketing Concept represents a shift in the focus of business activities from fulfilling the desires of “individual” consumers in the “short-term” (marketing concept) to protecting the “collective” interests of the society in the “longterm.” In this research we develop a conceptual framework that identifies three processes through which the transition from marketing to societal marketing concept takes place. These three processes are Socially Responsible Marketing, Environmentally-Friendly Marketing, and Morally Just Marketing. Each of these three components is developed by (...) reviewing the relevant literature in the related fields, examples are given, and marketing implications are discussed. We evaluate the acceptance of the Societal Marketing concept, identify reasons for its limited success, and discuss how the acceptance and practice of Societal Marketing Concept by businesses, consumers, and public policy makers can possibly be increased. The final section of the paper identifies Global Societal Marketing Concept as the next possible paradigm. (shrink)

L’hypothèse d’un trompeur suppose la validité du critère des idées claires et distinctes. Le doute vient de ce que notre créateur peut nous avoir faits tels que, quelque soin que nous prenions d’atteindre des idées claires et distinctes, ce qui nous semble clair puisse ne pas l’être. Ce doute est fondé sur l’ignorance de la nature de notre créateur, et on peut y échapper, en appliquant le critère à la question : « Notre créateur peut-il nous tromper? » Bien que (...) le doute ne puisse être que rétrospectif, il n’a rien à voir avec l’exactitude de la mémoire. (shrink)

This collection by a distinguished group of philosophers, psychologists, and physiologists reflects an interdisciplinary approach to the central question of cognitive science: how do we model the mind? Among the topics explored are the relationships (theoretical, reductive, and explanatory) between philosophy, psychology, computer science, and physiology; what should be asked of models in science generally, and in cognitive science in particular; whether theoretical models must make essential reference to objects in the environment; whether there are human competences that are resistant, (...) in principle, to modelling; whether simulated thinking and intentionality are really thinking and intentionality; how semantics can be generated from syntactics; the meaning of the terms "representations" and "modelling;" whether the nature of the "hardware" matters; and whether computer models of humans are "dehumanizing." Contributors include Donald Davidson, Daniel C. Dennett, Margaret A. Boden, Adam Morton, Dennis Noble, T. Poggio, Colin Blakemore, K.V. Wilkes, P.N. Johnson-Laird, and Jonathan St. B.T. Evans. (shrink)