Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses’ ethical knowledge and confidence to respond to ethical challenges in practice. (...) Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest “always agree” (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses’ ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method. (shrink)

Do the rich descriptions and narrative shapings of literature provide a valuable resource for readers, writers, philosophers, and everyday people to imagine and confront the ultimate questions of life? Do the human activities of storytelling and complex moral decision-making have a deep connection? What are the moral responsibilities of the artist, critic, and reader? What can religious perspectives—from Catholic to Protestant to Mormon—contribute to literary criticism? Thirty well known contributors reflect on these questions, including iterary theorists Marshall Gregory, James (...) Phelan, and Wayne Booth; philosophers Martha Nussbaum, Richard Hart, and Nina Rosenstand; and authors John Updike, Charles Johnson, Flannery O'Connor, and Bernard Malamud. Divided into four sections, with introductory matter and questions for discussion, this accessible anthology represents the most crucial work today exploring the interdisciplinary connections between literature, religion and philosophy. (shrink)

The Ontology for Biomedical Investigations (OBI) is an ontology that provides terms with precisely defined meanings to describe all aspects of how investigations in the biological and medical domains are conducted. OBI re-uses ontologies that provide a representation of biomedical knowledge from the Open Biological and Biomedical Ontologies (OBO) project and adds the ability to describe how this knowledge was derived. We here describe the state of OBI and several applications that are using it, such as adding semantic expressivity to (...) existing databases, building data entry forms, and enabling interoperability between knowledge resources. OBI covers all phases of the investigation process, such as planning, execution and reporting. It represents information and material entities that participate in these processes, as well as roles and functions. Prior to OBI, it was not possible to use a single internally consistent resource that could be applied to multiple types of experiments for these applications. OBI has made this possible by creating terms for entities involved in biological and medical investigations and by importing parts of other biomedical ontologies such as GO, Chemical Entities of Biological Interest (ChEBI) and Phenotype Attribute and Trait Ontology (PATO) without altering their meaning. OBI is being used in a wide range of projects covering genomics, multi-omics, immunology, and catalogs of services. OBI has also spawned other ontologies (Information Artifact Ontology) and methods for importing parts of ontologies (Minimum information to reference an external ontology term (MIREOT)). The OBI project is an open cross-disciplinary collaborative effort, encompassing multiple research communities from around the globe. To date, OBI has created 2366 classes and 40 relations along with textual and formal definitions. The OBI Consortium maintains a web resource providing details on the people, policies, and issues being addressed in association with OBI. (shrink)

Ariane Lewis provided an insightful review of several controversial cases of death by neurologic criteria (“brain death”) in the UK, focusing on Archie Battersbee, a boy whose tragic illness provok...

Abstract:Disturbing cases continue to be published of patients declared brain dead who later were found to have a few intact brain functions. We address the reasons for the mismatch between the whole-brain criterion and brain death tests, and suggest solutions. Many of the cases result from diagnostic errors in brain death determination. Others probably result from a tiny amount of residual blood flow to the brain despite intracranial circulatory arrest. Strategies to lessen the mismatch include improving brain death determination training (...) for physicians, mandating a test showing complete intracranial circulatory arrest, or revising the whole-brain criterion. (shrink)

In a seminal 1977 article, Rumelhart argued that perception required the simultaneous use of multiple sources of information, allowing perceivers to optimally interpret sensory information at many levels of representation in real time as information arrives. Building on Rumelhart's arguments, we present the Interactive Activation hypothesis—the idea that the mechanism used in perception and comprehension to achieve these feats exploits an interactive activation process implemented through the bidirectional propagation of activation among simple processing units. We then examine the interactive activation (...) model of letter and word perception and the TRACE model of speech perception, as early attempts to explore this hypothesis, and review the experimental evidence relevant to their assumptions and predictions. We consider how well these models address the computational challenge posed by the problem of perception, and we consider how consistent they are with evidence from behavioral experiments. We examine empirical and theoretical controversies surrounding the idea of interactive processing, including a controversy that swirls around the relationship between interactive computation and optimal Bayesian inference. Some of the implementation details of early versions of interactive activation models caused deviation from optimality and from aspects of human performance data. More recent versions of these models, however, overcome these deficiencies. Among these is a model called the multinomial interactive activation model, which explicitly links interactive activation and Bayesian computations. We also review evidence from neurophysiological and neuroimaging studies supporting the view that interactive processing is a characteristic of the perceptual processing machinery in the brain. In sum, we argue that a computational analysis, as well as behavioral and neuroscience evidence, all support the Interactive Activation hypothesis. The evidence suggests that contemporary versions of models based on the idea of interactive activation continue to provide a basis for efforts to achieve a fuller understanding of the process of perception. (shrink)

The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent for simple (...) medical decisions but not for consequential medical decisions such as whether to refuse further life-sustaining therapy. Emerging technologies including computer-tracking assistance of retained partial motor function and brain-computer interfaces promise to improve the communication ability of LIS patients and, when better developed, will allow them to fully exercise their right to actively participate in consequential medical decisions about their own medical care. Although so-called “covert cognition” patients clinically diagnosed as vegetative state that are shown to be aware by functional neuroimaging maybe metaphorically considered locked-in, it is nosologically more coherent not to categorize them formally as LIS. (shrink)

The overall purpose of this paper is to clarify the physical meaning and epistemological status of the term 'measurement' as used in quantum theory. After a review of the essential logical structure of quantum physics, Part I presents interpretive discussions contrasting the quantal concepts observable and ensemble with their classical ancestors along the lines of Margenau's latency theory. Against this background various popular ideas concerning the nature of quantum measurement are critically surveyed. The analysis reveals that, in addition to internal (...) mathematical difficulties, all the so-called quantum theories of measurement are grounded in unjustifiable, classical presuppositions. (shrink)

I consider the role of cognitive modeling in cognitive science. Modeling, and the computers that enable it, are central to the field, but the role of modeling is often misunderstood. Models are not intended to capture fully the processes they attempt to elucidate. Rather, they are explorations of ideas about the nature of cognitive processes. In these explorations, simplification is essential—through simplification, the implications of the central ideas become more transparent. This is not to say that simplification has no downsides; (...) it does, and these are discussed. I then consider several contemporary frameworks for cognitive modeling, stressing the idea that each framework is useful in its own particular ways. Increases in computer power (by a factor of about 4 million) since 1958 have enabled new modeling paradigms to emerge, but these also depend on new ways of thinking. Will new paradigms emerge again with the next 1,000‐fold increase? (shrink)

The concept of quantum transition is critically examined from the perspective of the modern quantum theory of measurement. Historically rooted in the famous quantum jump of the Old Quantum Theory, the transition idea survives today in experimental jargon due to (1) the notion of uncontrollable disturbance of a system by measurement operations and (2) the wave-packet reduction hypothesis in several forms. Explicit counterexamples to both (1) and (2) are presented in terms of quantum measurement theory. It is concluded that the (...) idea of transition, or quantum jump, can no longer be rationally comprehended within the framework of contemporary physical theory. (shrink)

In this interview, James L. McClelland responds to questions regarding connectionist models of cognition, a theory inspired by information processing in the brain. McClelland explains the distinction between symbolic and non-symbolic processing for a better understanding of mental processes. He argues that connectionist models can perform the computations which we know the brain can perform. In addition, he responds to several general questions on the perspectives of computational models of cognition.

Among the old and new controversies over brain death, none is more fundamental than whether brain death is equivalent to the biological phenomenon of human death. Here, I defend this equivalency by offering a brief conceptual justification for this view of brain death, a subject that Andrew Huang and I recently analyzed elsewhere in greater detail. My defense of the concept of brain death has evolved since Bernard Gert, Charles Culver, and I first addressed it in 1981, a development that (...) paralleled advances in intensive care unit treatment. The century‐old concept of the organism as a whole provides the fundamental justification for the equivalency of brain death and human death. In our technological age, in which increasing numbers of components and systems of an organism can be kept alive, and for longer intervals, the permanent cessation of functioning of the organism as a whole is the phenomenon that best corresponds to its death. (shrink)

The identification of a set of mutually exclusive and exhaustive propositions concerning the states of quantum systems is a corner stone of the information-theoretic foundations of quantum statistics; but the set which is conventionally adopted is in fact incomplete, and is customarily deduced from numerous misconceptions of basic quantum mechanical principles. This paper exposes and corrects these common misstatements. It then identifies a new set of quantum state propositions which is truly exhaustive and mutually exclusive, and which is compatible with (...) the foundations of quantum theory. (shrink)

Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long‐standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of respiration and circulation. Critics of this standard argue that while the cessation of respiration and circulation (...) may be permanent, it may not be irreversible at the moment death is declared because, if cardiopulmonary resuscitation were performed, it might succeed. And because irreversibility of cessation of respiration and circulation is required by both the statute and the biological concept of death, the donor must be alive. Who is correct?Making two related distinctions clarifies the cause of the disagreement over whether the DCDD donor is dead and points to a possible resolution. First, in a determination of death, there is an important distinction between the permanent and the irreversible cessation of circulation and respiration—two associated phenomena that are often confounded. Second, there is an important distinction between the medical practice standard for death determination, in which physicians certify the permanent cessation of vital functions as sufficient for death declaration, and the underlying biological concept of death that requires the irreversible cessation of vital functions because death, by definition, is an irreversible event. (shrink)

Scepticism about ought simpliciter is the view that there is no such thing as what one ought simpliciter to do. Instead, practical deliberation is governed by a plurality of normative standpoints, each authoritative from their own perspective but none authoritative simpliciter. This paper aims to resist such scepticism. After setting out the challenge in general terms, I argue that scepticism can be resisted by rejecting a key assumption in the sceptic’s argument. This is the assumption that standpoint-relative ought judgments bring (...) with them a commitment to act in accordance with those judgments. Instead, I propose an alternative account of our normative concepts according to which only ought simpliciter judgments commit one to acting in accordance with those judgments. In addition to answering the sceptical challenge, the proposal offers an independently motivated account of what makes a concept normatively authoritative. (shrink)

A PERSONAL PHILOSOPHY FOR WAR TIME BY THE AUTHOR OF STREAMLINE YOUR MIND A Personal Philosophy for War Time JAMES L. MURSELL Professor of Education Teachers ...

Patrick Olivelle’s two volumes presenting first the four oldest dharmasūtras, in updated and refurbished editions and new translations, and next his critical edition and translation of the Mānavadharmaśāstra are both meticulous works of fundamental scholarship that will stand as the normative forms of these five texts for decades to come. Olivelle’s contributions as an editor in each volume are very different, and these contributions are examined and discussed in some detail, particularly in the case of the critical edition of the (...) Manu, which presents a number of important issues of lower and higher textual criticism. In the case of the sūtra volume, the discussion turns to a general comparison of Olivelle’s translations of the sūtras to Bühler’s and then to a closer examination of Olivelle’s translational policies for the word dharma and two words in particular used by the sūtras to describe the good of doing dharma, kṣema and niḥśreyasa. In the discussion of the edition of Manu, particular attention is given to his assembly, analysis, and presentation of the fifty-three witnesses used for the new edition of the Manu. Following that, there is a discussion of the nature of the tradition that gave rise to the text and used it, a discussion that calls into question some of Olivelle’s basic conclusions about the formation and development of the text of the Manu śāstra. (shrink)

The lesson is familiar. Kripke’s arguments in favor of a posteriori necessary truths annul the idea that conceivability is a guide to metaphysical possibility because determining that which is a priori is a separate issue from determining that which is necessary. Modal rationalists do not completely agree with this conclusion. Following recent work on two-dimensional semantics, David Chalmers suggests that two distinct semantic values can be assigned to a statement, depending on whether we consider possible worlds as counterfactual or counteractual. (...) The idea is that counterfactual possibilities yield familiar Kripkean intuitions, but that counteractuals fulfill the desired link between a priori conceivability and metaphysical possibility. In this paper, I discuss a problem for modalrationalism that arises through the use of material conditionals, or conditionals in the indicative mood. I then turn to Chalmers’ response, and suggest reasons why it is inadequate. I turn to another response from Chalmers, and suggest that, whilst it solves the fi rst issue, it is incapable of grounding modal rationalism. In conclusion I will suggest a way in which a tempered version of modal rationalism can be salvaged. (shrink)

The purpose of this paper is to explore the spiritually formative experiences of fifteen female seminary spouses who participated in a phenomenological research study. Graduate theological education is not limited to married, male students. Seminaries are diverse educational institutions that equip married and single students, as well as men and women from every country in the world for gospel ministry. Because of this broad population in theological education, the qualitative proposals in this essay are not generalizable to all schools, students, (...) and settings equally, but the perspectives of these seminary spouses are useful in cultivating a robustly holistic education for students who are married during their academic pursuits. It is the intent here to explore how theology can crossover from the academy to the home so that it is experienced in marriage. The goal then is to equip students, professors, and administrators to actively nurture the faith formation of the second-person of the ministry dyad. In order for these stakeholders to understand how to nurture this faith formation of the seminary spouse, we must first hear and understand the experiences of these wives as they share their reflections on these formational years as a part of their husband's education. (shrink)