Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is (...) a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged. (shrink)

Latein lernen einmal anders. Gemeinhin gilt Lateinunterricht als nur mäßig spannend, die Autoren von "Latein für Dummies" zeigen Ihnen, wie man mit Spaß Latein lernen, auffrischen oder verbessern kann. Zwischen Konjugationen und Deklinationen erfahren Sie viel über die römische Gesellschaft, Literatur und über den ganzen Rest, der Latein auch noch heute für uns interessant macht. Mit einem kleinen Wörterbuch und vielen Tabellen ist dies der ideale Einsteiger- und Auffrischungskurs für die Lateiner von morgen.

Graphical AbstractDriving patterns of coral bleaching over reefs are a suite of biophysical interactions where the physical environment modulates organism response through an interplay with intrinsic biological functioning. Flow conditions over reefs can mitigate the physiological impacts of thermal stress across multiple spatial scales. More details can be found in article number 1800226 by Charlotte E. Page et al., Seeking Resistance in Coral Reef Ecosystems: The Interplay of Biophysical Factors and Bleaching Resistance under a Changing Climate, DOI: 10.1002/bies.201800226.

This study examines the theory of planned behavior and the multidimensional ethics scale. Variables from both are included to determine which ones significantly correlate with student ethical behavioral intention in an academic setting. Using a survey, responses are collected from undergraduate business students from two southwestern universities in the United States using a scenario-based approach, looking at individual situations and group situations. SmartPLS was used to assess the results for four scenarios. From the theory of planned behavior, attitude was a (...) significant predictor of behavioral intention across all four scenarios while subjective norm was significant in one scenario. From the multidimensional ethics scale, moral equity and relativism were significant in one group scenario while moral equity and utilitarianism were each significant in an individual scenario. The findings indicate support for the use of the TPB and the MES when exploring ethics in an academic setting and for the need to study both individual and group situations. A discussion of the findings and implications is given. (shrink)

BackgroundVarious forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project.MethodsCES (...) practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions.ResultsThe main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices.ConclusionsThe evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA. (shrink)

Ample research demonstrates that parents’ experience-based mental representations of attachment—cognitive models of close relationships—relate to their children’s social-emotional development. However, no research to date has examined how parents’ attachment representations relate to another crucial domain of children’s development: brain development. The present study is the first to integrate the separate literatures on attachment and developmental social cognitive neuroscience to examine the link between mothers’ attachment representations and 3- to 8-year-old children’s brain structure. We hypothesized that mothers’ attachment representations would relate (...) to individual differences in children’s brain structures involved in stress regulation—specifically, amygdala and hippocampal volumes—in part via mothers’ responses to children’s distress. We assessed 52 mothers’ attachment representations and children’s brain structure. Mothers’ secure base script knowledge was significantly related to children’s smaller left amygdala volume but was unrelated to hippocampal volume; we found no indirect links via maternal responses to children’s distress. Exploratory analyses showed associations between mothers’ attachment representations and white matter and thalamus volumes. Together, these preliminary results suggest that mothers’ attachment representations may be linked to the development of children’s neural circuitry related to stress regulation. (shrink)

This study considered representations of divine and human others in the self-understanding of monotheists from three religions. Self-understanding was conceptualized on the basis of semantic and episodic knowledge in narrative response data. Given the importance of social context in the formation of cognitive schemas, the project emphasized self-understanding in a comparative religious design. The sample included sixty nominated religious exemplars who responded to a structured interview. Schemas were subsequently mapped for Jews, Muslims, and Christians by comparison of self and other (...) representations in a computational model known as latent semantic analysis (LSA). Findings indicated that representation of the divine is far removed from parents in cognitive schemas for all participants. Unlike Jews and Christians, Muslims appear to represent human others on the basis of self-understanding which principally references the divine. When considered in a computational semantic space, exemplars generally represent the self in a manner corresponding with divine and peer figures. (shrink)

_Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach_ offers a new, short term psychotherapeutic approach to working dynamically with children who suffer from irritability, oppositional defiance and disruptiveness. _RFP-C_ enables clinicians to help by addressing and detailing how the child’s externalizing behaviors have meaning which they can convey to the child. Using clinical examples throughout, Hoffman, Rice and Prout demonstrate that in many dysregulated children, _RFP-C_ can: Achieve symptomatic improvement and developmental maturation as a result of (...) gains in the ability to tolerate and metabolize painful emotions, by addressing the crucial underlying emotional component. Diminish the child’s use of aggression as the main coping device by allowing painful emotions to be mastered more effectively. Help to systematically address avoidance mechanisms, talking to the child about how their disruptive behavior helps them avoid painful emotions. Facilitate development of an awareness that painful emotions do not have to be so vigorously warded off, allowing the child to reach this implicit awareness within the relationship with the clinician, which can then be expanded to life situations at home and at school. This handbook is the first to provide a manualized, short-term dynamic approach to the externalizing behaviors of childhood, offering organizing framework and detailed descriptions of the processes involved in _RFP-C_. Supplying clinicians with a systematic individual psychotherapy as an alternative or complement to PMT, CBT and psychotropic medication, it also shifts focus away from simply helping parents manage their children’s misbehaviors. Significantly, the approach shows that clinical work with these children is compatible with understanding the children’s brain functioning, and posits that contemporary affect-oriented conceptualizations of defense mechanisms are theoretically similar to the neuroscience construct of implicit emotion regulation, promoting an interface between psychodynamics and contemporary academic psychiatry and psychology. Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach is a comprehensive tool capable of application at all levels of professional training, offering a new approach for psychoanalysts, child and adolescent counselors, psychotherapists and mental health clinicians in fields including social work, psychology and psychiatry. (shrink)

The neural representation of a repeated stimulus is the standard against which a deviant stimulus is measured in the brain, giving rise to the well-known mismatch response. It has been suggested that individuals with dyslexia have poor implicit memory for recently repeated stimuli, such as the train of standards in an oddball paradigm. Here, we examined how the neural representation of a standard emerges over repetitions, asking whether there is less sensitivity to repetition and/or less accrual of “standardness” over successive (...) repetitions in dyslexia. We recorded magnetoencephalography as adults with and without dyslexia were passively exposed to speech syllables in a roving-oddball design. We performed time-resolved multivariate decoding of the MEG sensor data to identify the neural signature of standard vs. deviant trials, independent of stimulus differences. This “multivariate mismatch” was equally robust and had a similar time course in the two groups. In both groups, standards generated by as few as two repetitions were distinct from deviants, indicating normal sensitivity to repetition in dyslexia. However, only in the control group did standards become increasingly different from deviants with repetition. These results suggest that many of the mechanisms that give rise to neural adaptation as well as mismatch responses are intact in dyslexia, with the possible exception of a putatively predictive mechanism that successively integrates recent sensory information into feedforward processing. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

This secondary analysis re‐examined stories of caregiving told by NICU nurses in the southeast US through a trauma theory lens expanding on research surrounding substance‐exposed pregnancies. Narrative analysis identified distress‐related experiences of nurses related to child custody decisions and outcomes, suggesting traumatic stress within this caregiving dynamic. Four distinct story types and three themes were identified across 23 stories, highlighting similarities and differences and illustrating how distress and trauma were experienced and may be manifested in care practices. Study findings suggest (...) cumulative and residual effects from traumatic experiences can impact NICU nurses' well‐being and care provision, in part by promoting anticipatory trauma. The role of relationship‐building with families, as part of family‐centered care, was also implicated in the intensity of distressful experiences and may increase nurses' vulnerability to trauma as well as create pathways to stigmatizing interactions. Incorporating principles of relational ethics into nurse practice guidelines, while recognizing how care work can influence and be influenced by the potential pathways from trauma to stigma, may provide valuable support for nurses. The application of such a framework could potentially reduce distressing and/or traumatic experiences for nurses caring for families with a substance‐exposed pregnancy. (shrink)

During the COVID-19 pandemic, many advocacy groups and individuals criticized governments on social media for doing either too much or too little to mitigate the pandemic. In this article, we review advocacy for COVID-19 elimination or “zero-covid” on the social media platform X (Twitter). We present a thematic analysis of tweets by 20 influential co-signatories of the World Health Network letter on ten themes, covering six topics of science and mitigation (zero-covid, epidemiological data on variants, long-term post-acute sequelae (Long COVID), (...) vaccines, schools and children, views on monkeypox/Mpox) and four advocacy methods (personal advice and promoting remedies, use of anecdotes, criticism of other scientists, and of authorities). The advocacy, although timely and informative, often appealed to emotions and values using anecdotes and strong criticism of authorities and other scientists. Many tweets received hundreds or thousands of likes. Risks were emphasized about children’s vulnerability, Long COVID, variant severity, and Mpox, and via comparisons with human immunodeficiency viruses (HIV). Far-reaching policies and promotion of remedies were advocated without systematic evidence review, or sometimes, core field expertise. We identified potential conflicts of interest connected to private companies. Our study documents a need for public health debates to be less polarizing and judgmental, and more factual. In order to protect public trust in science during a crisis, we suggest the development of mechanisms to ensure ethical guidelines for engagement in “science-based” advocacy, and consideration of cost–benefit analysis of recommendations for public health decision-making. (shrink)

If we are to ensure the persistence of species in an increasingly warm world, of interest is the identification of drivers that affect the ability of an organism to resist thermal stress. Underpinning any organism's capacity for resistance is a complex interplay between biological and physical factors occurring over multiple scales. Tropical coral reefs are a unique system, in that their function is dependent upon the maintenance of a coral–algal symbiosis that is directly disrupted by increases in water temperature. A (...) number of physical factors have been identified as affecting the biological responses of the coral organism under broadscale thermal anomalies. One such factor is water flow, which is capable of modulating both organismal metabolic functioning and thermal environments. Understanding the physiological and hydrodynamic drivers of organism response to thermal stress improves predictive capabilities and informs targeted management responses, thereby increasing the resilience of reefs into the future. (shrink)

This book has been written in the hopes of equipping teachers-in-training—that is, teacher candidates—with the skills needed for action research: a process that leads to focused, effective, and responsive strategies that help students succeed.

This book offers a collection of reflective essays on current testimonial production by researchers and practitioners working in multifaceted fields such as art and film performance, public memorialization, scriptotherapy, and fictional and non-fictional testimony. 0The inter-disciplinary approach to the question of testimony offers a current account of testimony's diversity in the twenty-first century as well as its relevance within the fields of art, storytelling, trauma, and activism. The range of topics engage with questions of genre and modes of representation, ethical (...) and political concerns of testimony, and the flaws and limitations of testimonial production giving testament to some of the ethical concerns of our present age. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesAustin Morris, Lisa P., Jeanne Kerwin, Jean Watson, Eve Makoff, Brent R. Carr, Anonymous One, Michelle Prong, Laura J. Hoeksema, Tracy R. Wilson, Frances Rieth Maynard, Laura A. Katers, and Maggie Taylor• Against Their Wishes: The Gift of a Goodbye• Lisa’s Story• Unbefriended• The Clinical Ethics Consult: Transforming Ambivalence to Action• Side Stepping The Issues: Disappointment With An Ethics Consult For A Medically High (...) Risk Patient• My Father Dies Alone• Whose Voice Matters? The Role of Ethics Consultation in Supporting the 16-Year-Old Healthcare Decision-Maker of a Critically Ill Neonate• The Healing Power of an Ethics Consult• Clinical Ethicists: Can They Help Families in Their Times of Need?• “It’s All Personal”• Fault Lines• Difficult, Difficult, Lemon, DifficultCopyright © 2024 Johns Hopkins University Press... (shrink)

Background Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting. Methods: how the study was performed and statistical tests used A qualitative case study (...) approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies. Results: the main findings An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Conclusions: brief summary and potential implications Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service’s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating. (shrink)

Objectives: To test the range of beliefs regarding the ethics of testing, in resource poor settings, new therapies that are less efficacious but more affordable and feasible than the best current therapeutic standard. Design: Using a web-based survey, we presented a hypothetical scenario proposing to test a therapy for HIV disease ("therapeutic inoculation") known to be less efficacious than highly active antiretroviral therapy (HAART). Respondents evaluated various trial designs as ethical or unethical. Participants: 604 subscribers to two listservs for individuals (...) interested in international health research ethics. Main outcome measures: Proportion of respondents endorsing trials testing this "substandard" therapy, and proportion endorsing placebo-controlled trials. Results: There were 215 respondents from 47 countries. Forty-five percent of respondents were from low or middle income countries; 96% devoted at least some time to research activities; and 75% had "some" or "considerable" research experience in developing countries. Of respondents, 97% (95% CI 94.7 to 99.4) endorsed testing therapeutic inoculation, without HAART, in patients with HIV disease; 86% (95% CI 81.4% to 90.7%) endorsed testing against placebo. Sixty-eight percent explicitly endorsed principles where the standard of care for subjects in clinical trials is determined by local, not universal, standards. There were no differences in responses based on respondent education-level or the income-level of their country of citizenship. Conclusion: There was broad agreement that a therapy of potential local benefit may be tested, even when that therapy is known to be inferior to the standard of care in wealthy countries. Most agreed that a placebo control may be used in some circumstances. (shrink)

The ability to gain knowledge from text in widely different subject matter areas is key to academic success and lifelong leaming. The process of attaining critical understanding of ideas in text requires a robust repertoire of leaming or study strategies, metacognitive knowledge for regulating their use, and willingness to apply them. Although much is known about the basic design of leaming environments to develop higher-order thinking skills and motivation to learn, educators have, in general, not changed their practices to reflect (...) new knowledge. The lack of procedures that are easy for teachers to administer and provide results that teachers may use in their classrooms for assessment of complex cognitive skill development is a major obstacle to widespread adoption of new approaches. This paper describes a new technology, referred to as HyLighter, and a pedagogically sound implementation of this technology, referred to as the Interaclive Annotation Model. This approach suggests a promising direction for improving the quality of instruction and promoting active reading (i.e., an approach to the development of leaming ability that combines reading with critical thinking and a range of learning-to-Iearn skills) for students in higher education across academic disciplines. (shrink)

Consumers are bombarded with labels and claims that are intended to address their concerns about how food products are produced, processed, and regulated. Among those are the natural or all-natural claims and the certified organic label. In this study, two focus groups were conducted to explore consumers’ attitudes toward all-natural and organic pork and to gather their reactions to the USDA organic standards for meat, and the policy for natural claims. Results indicated that participants had positive associations with the terms (...) “organic” and “all-natural” with exceptions regarding the trustworthiness of all-natural claims. Participants perceived the “no” labeling theme (no antibiotics, no hormones, no chemicals, etc.) often coupled with the all-natural label on pork products as identifying potential health and animal welfare risks. In response to the USDA standards and policies for labeling pork products as organic or all-natural, participants expressed confusion and had many unanswered questions. (shrink)

Edwin Hartman argues that ethical principles should not derive from abstract theory, but from the real world of experience in organizations. He explains how ethical principles derive from what workers learn in their communities (firms), and that an ethical firm is one that creates the good life for the workers who contribute to its mission. His approach is based on the Aristotelian tradition of refined common sense, from recent work on collective action problems in organizations, and from social contract (...) theory. (shrink)

The received view is that Kant denies all moral luck. But I show how Kant affirms constitutive moral luck in passages concerning radical evil from Religion within the Boundaries of Mere Reason. First, I explicate Kant’s claims about radical evil. It is a morally evil disposition that all human beings have necessarily, at least for the first part of their lives, and for which they are blameworthy. Second, since these properties about radical evil appear to contradict Kant’s even more famous (...) claims about imputation, ‘ought implies can’, and free will, I unpack Henry Allison’s proof of radical evil and show how it is consistent with interpretations of Kant’s broader views about morality. Third, I define and illustrate the category of constitutive moral luck and argue that Kant embraces the existence of constitutive moral luck given Allison-style interpretations of radical evil. This provides a reason for philosophers to reject the received view, and it creates an occasion for Kantians and Kant scholars to check their reasons if they deny moral luck. (shrink)

It is conventional wisdom that appreciating the role of luck in our moral lives should make us more sparing with blame. But views of moral responsibility that allow luck to augment a person’s blameworthiness are in tension with this wisdom. I resolve this tension: our common moral luck partially generates a duty to forgo retributively blaming the blameworthy person at least sometimes. So, although luck can amplify the blame that a person deserves, luck also partially generates a duty not to (...) give the blameworthy person the retributive blame that he deserves at least sometimes. (shrink)

In this, the first Reader of Geoffrey Hartman's work, significant essays reflect his abiding interest in English and American poetry, focusing not only on Romanticism but also on the transition from early modern to modern and including reflections on the radical elements in artistic representation.

Recent changes to the Criminal Code of Canada have resulted in the right of competent adult Canadians to request medical assistance in dying (MAID). Healthcare professionals now can participate if the individual meets specific outlined criteria. There remains confusion and lack of knowledge about the specific role of nurses in MAID. MAID is a controversial topic and nurses may be faced with the challenge of balancing the duty to provide routine care, with moral reservations about MAID. The role of a (...) nursing leader is to support nurses by ensuring they have the knowledge they require to care for patients requesting the service, whether or not the nurse is directly involved in the MAID process. The moral dilemmas raised by MAID provide an opportunity to look at a relational ethics approach to nursing leadership both for MAID and other difficult situations that arise in nursing practice. Relational ethics is a framework that proposes that the ethical moments in healthcare are based on relationships and fostering growth, healing, and health through the foundational concepts of mutual respect, engagement, embodiment, and environment. This article will use a relational ethics framework to examine how nursing leadership can support nurses who care for patients requesting MAID. (shrink)

This article tracks how group egotists disavow their hate group identity. Group egotists are individuals born and raised in hate groups. The well-documented exit cases of Megan Phelps-Roper (Westboro Baptist Church) and Derek Black (White Nationalism) prove that hate group indoctrination can be undermined. A predominantly epistemic approach, which focuses on argument and conversational virtues, falls short in capturing the complexity of their apostasies. I turn to pragmatism for conceptual support. Using the work of Richard Rorty and William James, I (...) explain how redemptive relationships and alternative lifeworlds participate in weakening belief-systems, leading to the disavowal of the hate group. (shrink)