From the Editors:Such was the topic considered by members of a new discussion club, "The Free Word" [Svobodnoe slovo] , along with specialists from the Institute of Philosophy, USSR Academy of Sciences.

From the Editors:Such was the topic considered by members of a new discussion club, "The Free Word" [Svobodnoe slovo], along with specialists from the Institute of Philosophy, USSR Academy of Sciences.

As it happened, I became acquainted with E.V. Il'enkov quite late, in the mid- or even the late 1960s. It was only a bit more than ten years before his death that I began to feel at home in his house, was able to visit without calling ahead, and was able to call him by his first name and the familiar "you"—that is, like many, many of not only his true friends but also like-minded thinkers, who became his close acquaintances, (...) most of whom justly considered themselves his pupils … The door would open wide, and Olia, Professor K.I. Salimova, Eval'd's wife and most devoted friend, not at all surprised by the unexpected guest and seemingly even quite happy at his arrival , would try first to draw him into the kitchen and feed him … which she more often than not succeeded in doing. I am not talking about myself: there were always many guests, and this is precisely how they arrived at the Il'enkovs' apartment. Recently, a critic in Literaturnaia gazeta recalled those whom he met in Eval'd's apartment in the 1960s: "This was a tight circle of like-minded thinkers," wrote the critic. "But some of them are no longer with us, while most are far away, beyond our borders." Obviously, he had not been in the house often or had forgotten things over the distance of years. There was no "circle," nor could there have been one—not with this host, not with his lifestyle and way of relating to people. I met a good hundred fine and various people in Eval'd's home: I.N. Korzhavin, V. Davydov, A. Meshcheriakov, S. Vinogradova, N. Dubinin, V. Zinchenko, A. Zinov'ev, Iu. Kamiakin, and … indeed, five pages would not be enough to list the quite famous and the not-quite-so-famous, simply ordinary people with no claim to fame. Nazym Khikmet, A.N. Leont'ev, and B.M. Kedrov were friends of the house … Ever new faces, figures, and words come to mind. I cannot forgive myself: once Eval'd Vasil'evich wanted to take me along to Iurii Liubimov's to read his play Neither God nor Tsar nor Hero … [Ni bog, ni tsar' i ni geroi], but I had some other business, something so important that I do not even remember now what it was, and it is probably not worth remembering. But most likely I was too timid to appear uninvited at the house of a person burning with creativity. The same thing happened with Galich … Eval'd liked especially his song about Zoshchenko. He did not sing it; he narrated it, but in such a way that tears always came to one's eyes. (shrink)

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

The article is devoted to almost unknown monastery of the Russian Orthodox Church, a Holy Trinity Zosimo-Savvatievskaya Novo-Solovetskaya Krasnokholmskaya poustinia that was one of the important pilgrimage places of the royal family in the 17th century. Despite the fact that the monastery was founded in the reign of Tsar Alexei Mikhailovich, it is an important link in the historical and cultural development of our Fatherland, primarily because the extant architectural monuments of outstanding artistic qualities. That is why the architectural ensemble (...) of the monastery occupies a prominent place in the history of Russian culture. In addition, Novo-Solovetskaya poustinia is an important historical object providing data on the development of Russian spiritual and artistic culture of the late seventeenth century. The question of cultural-historical and social roles that Orthodox monasteries played in the history of Russia is still not sufficiently studied is. The modern development of the Russian state cannot be complete without the restoration of the positive legacy that has been lost in our culture and morality. In this regard, the study of development and formation of the Orthodox monastic culture may fill this gap. Historical development of the Zosimo-Savvatievskaya Novo-Solovetskaya Krasnokholmskaya poustinia, its architecture can contribute to the restoration of our historical memory, which is an important factor in the revival of our national identity. The author of the article also tells about the history of monastery in tough years of godless power and about the people, who died for their faith and who are called now the new martyrs. (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)

Intellectual property in biotechnology invention provides important incentives for research and development leading to advances in genetic tests and treatments. However, there have been numerous concerns raised regarding the negative effect patents on gene sequences and their practical applications may have on clinical research and the availability of new medical tests and procedures. One concern is that licensing policies attempting to capture for the benefit of the licensor valuable rights to downstream research results and products may increase the financial risks (...) and cliniinish potential payoffs of — and therefore motivation for — performing downstream research and development. In addition, very broad patent claims allowed by the U.S. Patent and Trademark Office, the sheer growth in patents claiming genetic sequences, and threats of overlapping patents create a veritable minefield for researchers in both academia and industry. The concern is that research may be stifled because of the high cost and hassle of negotiating access. (shrink)

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Background: The Declaration of Helsinki prohibits the publication of articles that do not meet defined ethical standards for reporting of research ethics board approval and informed consent. Despite this prohibition and a call to highlight the deficiency for the reader, articles with potential ethical shortcomings continue to be published.Objective: To determine what proportion of articles in major medical journals lack statements confirming REB approval and informed consent, and whether accompanying commentary alerts readers to this deficiency.Design: Retrospective, observational study.Setting: Online review (...) of five major medical journals.Population: All clinical research articles published online between 1 January 2005 and 31 December 2006 in the BMJ, Lancet, Annals of Internal Medicine, JAMA and the New England Journal of Medicine.Measurements: Statement of REB approval and informed consent.Results: Of 1780 articles reviewed, 1133 met inclusion criteria , 36 articles lacked a statement of REB approval, 62 lacked disclosure of informed consent and 15 articles lacked both. Articles that did not state REB approval were associated with not stating informed consent . There were no editorial comments to alert readers to the lack of either REB approval or informed consent statements associated with any of the deficient articles.Conclusions: Articles that lack explicit statements of REB approval and informed consent are infrequent but continue to be published in major medical journals without editorial statements to alert the reader to this deficiency. (shrink)

This important contribution to the ground-breaking Radical Orthodoxy series revisits the works of Husserl, Heidegger, Augustine and Derrida to reconsider the challenge of speaking of God through predication, silence, confession and praise. James K. A. Smith argues for God's own refusal to avoid speaking as well as for our urgent need of words to make Him visible to us. This leads to a radical new "incarnational phenomenology" in which God's love endows imperfect signs with the means to indicate true states (...) of infinitude, and in which we may ultimately discover a new theology of the arts. (shrink)

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

The article starts with a clarification of the economic importance of certain material elements which underlie the agricultural labor process — land and water. Artificial irrigation has the significance of a primary determining factor, for, by requiring relatively intense forms of labor, it excludes slave labor as an essential element. The true „oriental“ form of production first arises when waterworks must be undertaken on a larger scale (for purposes of protection and irrigation). On a lower level of technical development, the (...) state then acquires a specific economic function : public works and astronomy. A differentiated form of society comes into being ; at its base are the peasants, either bound to the village or — later — free ; the upper ranks comprise the autocratic sovereign and an administrative, religious, and military bureaucracy. The pure oriental type in its simple form is exemplified by the old Inca society before its destruction. The higher form (with the development of inner contradictions) was attained by India, Babylonia, Assyria, Egypt, China, among others. The concentrated irrigational type, e.g. Babylonia, displays a different form of crisis from the less compact „B“ type of China. In the latter, the agricultural crisis is conditioned by extensive mobilization of arable land and by the cooperation of commercial capitalists with the centrifugal upper strata of society. Feudal or pseudo-feudal traits may be operative in creating a crisis, as in Egypt or China, but they are not the basis of the society, which is different from feudalism in its system of production, social organization, and state. Japan is feudal, or more correctly, „Asiatic“ - feudal. At most, the true oriental societies pass through an early feudal stage before developing into their own specific form based on large scale water works.The analysis of the organization of the productive forces makes it possible to explain the stagnation of the oriental agricultural society from the particular, centralized structure of the system of production based on irrigation. This is in contrast to the decentralized non-irrigational agriculture of feudal society, which did not hinder the development of towns and of an industrial capitalism fostered by late feudal absolutism.The theory of oriental society constitutes an attempt to describe both the western and eastern worlds as sectors of one human society, which develops and stagnates as movements of the same total historical process.L'article commence par éclaircir le rôle des deux éléments qui constituent le processus de travail agricole : la terre et l'eau. L'irrigation artificielle, premier facteur spécifique, exclut le travail des esclaves comme forme prédominante, du fait qu'il implique un mode de travail relativement intense. Cependant le type de production authentiquement „oriental“ apparaît seulement lorsque sont entreprises des constructions de grande envergure aux fins de protection ou d'irrigation. L'état assume alors une fonction économique propre : travaux publics et astronomie. C'est l'origine d'une société hiérarchisée qui va des paysans — liés d'abord au village, libres par la suite — au souverain autocrate, en passant par la bureaucratie administrative, sacerdotale et guerrière. La vieille société péruvienne des Incas représentait le type oriental pur dans sa forme simple. Les Indes, Babylone, l'Assyrie, l'Égypte, la Chine — entre autres — atteignirent une forme plus élevée avec développement des contradictions internes. Le type à technique hydraulique concentrée, exemple Babylone, manifeste des crises d'un autre caractère que le type à technique plus dispersée comme la Chine. Dans ce dernier pays, la crise était déterminée par une large mobilisation des terres cultivables et par l'action des capitalistes commerçants, jointe à celle du groupe supérieur centrifuge. Des caractères féodaux, ou pseudo-féodaux, peuvent bien contribuer — comme en Égypte et en Chine — à déterminer des crises, mais ne deviennent pas le fondement de la société qui, par la production, l'ordre social et l'État, diffère essentiellement de la féodalité. (Le Japon est féodal : c'est une féodalité „asiatique“ ; les sociétés authentiquement orientales traversent tout au plus une étape „pré-féodale“ avant de développer leur forme spécifique liée à la technique hydraulique.)L'analyse sociologique permet d'expliquer la stagnation de la société agraire orientale à partir de la structure spécifique centralisée du système de production inséparable de la technique hydraulique. En revanche, l'agriculture sans technique hydraulique de la société féodale n'oppose pas d'obstacles au développement des villes bourgeoises et d'un capitalisme industriel, favorisé, au terme de l'époque féodale, par l'absolutisme.La théorie de la Société orientale essaie d'esquisser un tableau où le monde occidental et le monde oriental sont comme des secteurs d'une société humaine. L'évolution de cette société aussi bien que sa stagnation représentent des mouvements partiels du même devenir historique total. (shrink)

Les fouilles effectuées au cours de ces dernières dizaines d’années, ont modifié profondément le tableau qu’on se faisait de la préhistoire chinoise. Au début du xxe siècle, les savants les plus connus pouvaient encore mettre en doute l’existence d’une époque néolithique chinoise — mais depuis lors, l’activité de l’archéologie a mis à jour un vaste matériel et paléolithique et néolithique. Le présent article, extrait du premier volume d’une histoire économique et sociale de la Chine, donne une vue d’ensemble du matériel (...) nouvellement acquis et cherche à le mettre en valeur pour une considération sociologique.L’homo pekinensis, l’ancien habitant de la Chine paléolithique du Nord connaissait le feu ; il se servait d’instruments et d’armes en pierre travaillée. Aux deux degrés de son évolution de chasseur primitif et de chasseur évolué, correspondent deux degrés de perfection de ces instruments. Il semble bien que les prisonniers aient été tués (et mangés?) sans distinction d’âge et de sexe. Les chasseurs ne sauraient que faire du travail d’esclave.Vers la fin de l’époque néolithique chinoise se produisit un épanouissement que la rare perfection de la céramique „rouge“ et „noire“ indique assez bien. La filiation somatique de l’homo pekinensis et du Chinois des époques ultérieures est probable ; il semble hors de doute que l’homme de l’époque néolithique soit du même type que celui de la Chine historique. Primitivement, l’agriculture (à la houe) était faite par les femmes, qui en même temps confectionnaient à la main — par la suite au moyen d'une plaque très simple — la céramique,,rouge“ ; les hommes continuaient à s'occuper de la chasse et de la pêche. Dès lors apparaît, encore qu'assez vaguement, une civilisation démocratique et paysanne, caractérisée probablement par des éléments matriarchaux. Vers l'époque de la céramique „noire“ se produit la transition vers l'élevage et à la céramique qui connaît alors le tour de potier — ces deux sortes de travaux incombent aux hommes. L'agriculture se fait plus intense, c'est peut-être ici qu'il convient de supposer les premiers débuts de la construction de terrasses et de l'irrigation. Les esclaves trouvent un emploi, une différenciation sociale se produit, c'est l'origine des villes. La société agraire primitive fait place à un ordre nouveau. Celui-ci s'exprime socialement parlant par une noblesse de clan primitive, politiquement par l'État.Les découvertes les plus récentes de l'archéologie chinoise apportent de nombreuses preuves pour l'évolution telle qu'elle vient d'être esquissée. L'analyse des mythes archaïques et des contes populaires de la Chine confirme, par la suite, au moyen de l'anthropologie ce que l'étude avait jusqu'ici rendu hautement probable par les méthodes de l'archéologie.Die Ausgrabungen der letzten Jahrzehnte haben das Bild der chinesischen Frühgeschichte grundlegend geändert. Während noch zu Anfang des 20. Jahrhunderts führende Gelehrte die Existenz eines chinesischen Neolithikums bezweifelten, hat seither die Tätigkeit der Archäologie sowohl paläolithische wie neolithische Funde in grosser Reichhaltigkeit zutage gefördert. Der vorliegende Aufsatz — Sektion I des ersten Bandes einer Wirtschafts-und Sozialgeschichte Chinas — gibt einen Überblick über das neu gewonnene Material und sucht es sozialwissenschaftlich auszuwerten.Homo pekinensis, der (früh) altsteinzeitliche Bewohner Nordchinas kannte das Feuer ; er benutzte Werkzeuge und Waffen aus behauenem Stein. Zwei Stufen der Bearbeitung seiner Geräte deuten zwei Stufen seiner ökonomischen Entwicklung an, die des „niederen“ und des „höheren“ Jägertums. Gefangene scheinen ohne Unterschied von Alter und Geschlecht getötet (und verzehrt?) worden zu sein. Jäger haben für Sklavenarbeit keine Verwendung.Reich entwickelt ist Chinas (spätes) Neolithikum, dessen „rote“ und „schwarze“ Töpferei von seltener Vollkommenheit ist. Der Zusammenhang des homo pekinensis mit den späteren Chinesen ist somatisch wahrscheinlich, die Zugehörigkeit der Bewohner des chinesischen Neolithikums zu dem geschichtlichen Chinesentum scheint ausser Zweifel. Ursprünglich wurde offenbar der Ackerbau (Hackbau) von Frauen betrieben, die zugleich mit der Hand — und später mit einem einfachen Drehrad — die „rote“ Töpferei herstellten, während die Männer fortfuhren zu jagen und zu fischen. Das Bild einer primitiven demokratischen Dorfkultur mit vermutlich mutterrechtlichen Zügen wird andeutungsweise sichtbar. Es folgt zur Zeit der „schwarzen“ Töpferei der Übergang zur von Männern betriebenen Viehzucht und zu einer mit der Töpferscheibe von Männern durchgeführten Töpferei. Der Ackerbau wird intensiver, die ersten Anfänge von Terrassenbau und Bewässerung liegen vielleicht hier. Sklaven werden verwendbar, soziale Differenzierung tritt ein. Städte entstehen. Die primitive Agrargesellschaft verwandelt sich in eine Ordnung neuer Art, deren sozialer Ausdruck ein primitiver Clan-Adel, deren politischer Ausdruck der Staat ist.Die jüngsten Entdeckungen auf dem Gebiete der chinesischen Archäologie erbringen zahlreiche Beweise für einen derartigen Entwicklungsgang. Die Analyse von Chinas archaischen Mythen und Volkserzählungen bestätigt im Fortgang der Untersuchung mit den Mitteln der Anthropologie, was die hier gebotene Darstellung mit den Methoden der Archäologie bereits in hohem Grad wahrscheinlich gemacht hat. (shrink)

In this close analysis of Hume’s moral psychology, John Bricke treats Hume as a thoroughly systematic thinker who aims for a comprehensive theory of mind. Bricke seeks to reveal the systematic structure of Hume’s thought by a process he calls “regimenting” the text. Bricke also has the aim of placing Hume’s theory in the context of contemporary action theory, the terms of which are inspired in large part by Davidsonian analyses.

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)

The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert’s) suggests that there is no reform of morality , but (...) of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured. (shrink)

Objective: To provide an ethical analysis of whether the Ethiopian and Tanzanian national HIV/AIDS treatment guidelines can be considered legitimate and fair rationing tools.Method: Qualitative study and ethical analysis involving guideline documents and interviews with nine key members involved in the development of the guidelines. The analysis followed an editing organising style. The theoretical framework was a guideline-specific framework based on theories of just resource allocation in healthcare and conditions that ensure fair processes in guideline development. According to this framework, (...) legitimate rationing requires reasons for patient selection to be explicit, public and relevant, and decisions must be open to question and revision.Results: The only explicit rationing criteria that both guidelines recommended were clinical antiretroviral treatment indications. Explicit non-clinical rationing criteria were expressed in a separate Ethiopian implementation guideline. Neither of the guideline development processes fully satisfies minimal requirements of procedural fairness. There is a lack of transparency. The reasons for decisions are rarely given and are not publicly available. This reduces the opportunity for public questioning, debate and revisions. The guidelines were based on expert opinion and consensus. Recommendations from the WHO were copied without much discussion, disagreement or adjustment.Conclusions: The two national HIV treatment guidelines discussed are de facto mechanisms for rationing but were developed using methods that do not fully satisfy the requirements of fair processes. (shrink)

At the beginning of the study of physical phenomena, the idea of "force" was widely used to explain the non-stationarity of observed phenomena, such as the movement of bodies. However, as mechanics and physical theories developed, the force notions gained own formal definitions and names, without the use of the term "force". So, the concept of kinetic energy arose instead of "vis viva", and "current" instead of "current strength" ets. Additionally, a number of new physical theories have been formulated without (...) the use of force concept. As a result, different types of forces have gradually been replaced by other more important concepts, such as energy and action, which are closely linked to fundamental physical principles. It is interesting to note that the general trend in the development of civilizations has been a shift from unrestricted power (expressed in the thesis "might makes right") to its subordination and incorporation into a legal framework. This is similar to the evolution of physics, which has seen the notion of force become eliminated or subordinated to more general principles and laws. (shrink)

The founders of reformational philosophy, H. Dooyeweerd and D.H.Th. Vollenhoven, each published in short succession, viz. 1949 and 1950, a voluminous study in the history of philosophy. Whoever reads both works is struck by the remarkable differences in treatment. In this contribution these differences are analysed, but there is also indication of agreement. The article ends with a number of conclusions based on the analysis.

This article presents an overview ofregulations, guidelines and societal debates ineight member states of the EC about a)embryonic and fetal tissue transplantation(EFTT), and b) the use of human embryonic stemcells (hES cells) for research into celltherapy, including `therapeutic' cloning. Thereappears to be a broad acceptance of EFTT inthese countries. In most countries guidance hasbeen developed. There is a `strong' consensusabout some of the central conditions for `goodclinical practice' regarding EFTT.International differences concern, amongstothers, some of the informed consent issuesinvolved, and the (...) questions whether anintermediary organisation is necessary, whetherthe methods of abortion may be influenced bythe possible use of EFT, and whether EFTTshould only be used for the experimentaltreatment of rare disorders. The potential useof hES cells for research into cell therapy hasgiven a new impetus to the debate about (human)embryo research. The therapeutic prospects withregard to the retrieval and research use of hEScells appear to function as a catalyst for theintroduction of less restrictive regulationsconcerning research with spare embryos, atleast in some European countries. It remains tobe seen whether the prospect of treatingpatients suffering from serious disorders withtransplants produced by therapeutic cloningwill decrease the societal and moral resistanceto allowing the generation of embryos for`instrumental' use. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

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)