Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in (...) the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.Ethical considerations:We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.Results:We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.Discussion/Conclusion:Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

Of all the developments in twentieth century physics, none has given rise to more heated debates than the changes in our understanding of science precipitated by the quantum revolution''. In this revolution, Niels Bohr's dramatically non-classical theory of the atom proved to be the springboard from which the new atomic physics drew it's momentum. Furthermore, Bohr's contribution was crucial not only because his interpretation of quantum mechanics became the most widely accepted view but also because in his role as educator (...) and spokesman for atomic physics Bohr was very much the patron spirit of the entire quantum revolution. The conceptual framework which he proposed to provide a new viewpoint for understanding the quantum theoretical description of atomic systems became for most of this century the dominant outlook of countless productive experimental and theoretical physicists. He called this new framework complementarity''. (shrink)

Originally published in 1925. If we are to know what intelligence is, how the brain can think, and what place mind holds in the scheme of things, we must first have a science of the sensory basis and structure of knowledge. This book supplies that need; it also serves as a short introduction to the systematic psychology of cognition.

Originally published in 1925. If we are to know what intelligence is, how the brain can think, and what place mind holds in the scheme of things, we must first have a science of the sensory basis and structure of knowledge. This book supplies that need; it also serves as a short introduction to the systematic psychology of cognition.

Although it is, often considered a form of anti-realism, here it is argued that Bohr's complementarity viewpoint must accept entity realism based on its analysis of the causal interaction involved in observation. However, because Bohr accepts the quantum postulate he must reject the view that the goal of theory is to represent the independently existing object apart from observation. Thus he abandons the spectator account of knowledge and with it the correspondence theory of truth. In this respect his view is (...) parallel to the positions held by Hacking, Cartwright, and Ellis. (shrink)

The ASBH Core Competencies Update Task Force (Tarzian and ASBH Core Competencies Update Task Force 2013) provides useful information for individual consultants performing case consultations. A grow...

This is the first comprehensive study of the sublime in Lucan. Drawing upon renewed literary-critical interest in the tradition of philosophical aesthetics, Henry Day argues that the category of the sublime offers a means of moving beyond readings of Lucan's Bellum Civile in terms of the poem's political commitment or, alternatively, nihilism. Demonstrating in dialogue with theorists from Burke and Kant to Freud, Lyotard and Ankersmit the continuing vitality of Longinus' foundational treatise On the Sublime, Day charts Lucan's complex (...) and instructive exploration of the relationship between sublimity and ethical discourses of freedom and oppression. Through the Bellum Civile's cataclysmic vision of civil war and metapoetic accounts of its own genesis, through its heated linguistic texture and proclaimed effects upon future readers and, most powerfully of all, through its representation of its twin protagonists Caesar and Pompey, Lucan's great epic emerges as a central text in the history of the sublime. (shrink)

According to the naturalistic normative axiology of Laudan's reticulated model of scientific change, empirical discoveries in the advance of science can provide a rational basis for axiological decisions concerning which epistemic goals scientific inquiry ought to pursue. The Bohr-Einstein debate over acceptance of quantum theory is analyzed as a case of axiological change. The participants' aims are incompatible due to different formulations of the goal of objective description, but neither doubts the realist commitment to the existence of microsystems or the (...) intention of quantum mechanics to provide knowledge of them. Thus the general aim of realism is not at issue. (shrink)

The question of whether an «understanding» of quantum phenomena is possible, as raised by Cushing , is considered in terms of a possible revision of basic ontological assumptions which would make rational the pursuit of such an understanding. It is argued that the quantum theory imposes new constraints on ontology which force us to revise classical presuppositions about attributing properties to physical systems, about locality and individuality, and about interaction and space‐like separability. Through such ontological revision, it is argued, one (...) may still rationally hope to satisfy the typically realist thirst for an understanding of quantum phenomena. (shrink)

This review uses nutritional markers of normal and impaired development to address the question; what makes a viable mammalian preimplantation embryo? Resolution of this question is important to ensure the long‐term safety of embryo‐based biotechnologies in man and domestic animals, the optimisation of embryo production and culture conditions and the development of methods to select viable embryos for replacement. After considering the nutrition of embryos and somatic cells, and the phenomenon of caloric restriction, it is concluded that preimplantation embryo survival (...) is best served by a relatively low level of metabolism; a situation achieved by reducing the concentrations of nutrients in culture media and encouraging the use endogenous resources. BioEssays 24:845–849, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

Background Studies have shown that medical students and residents believe that their ethics preparation has been inadequate for handling ethical conflicts. The objective of this study was to determine the self-perceived comfort level of medical students and residents in confronting clinical ethics issues. Methods Clinical medical students and residents at the University of Maryland School of Medicine completed a web-based survey between September 2009 and February 2010. The survey consisted of a demographic section, questions regarding the respondents’ sense of comfort (...) in handling a variety of clinical ethics issues, and a set of knowledge-type questions in ethics. Results Survey respondents included 129 medical students (response rate of 40.7%) and 207 residents (response rate of 52.7%). There were only a few clinical ethics issues with which more than 70% of the respondents felt comfortable in addressing. Only a slight majority (60.8%) felt prepared, in general, to handle clinical situations involving ethics issues, and only 44.1% and 53.2% agreed that medical school and residency training, respectively, helped prepare them to handle such issues. Prior ethics training was not associated with these responses, but there was an association between the level of training (medical students vs residents) and the comfort level with many of the clinical ethics issues. Conclusions Medical educators should include ethics educational methods within the context of real-time exposure to medical ethics dilemmas experienced by physicians-in-training. (shrink)

The so-called “orthodox” interpretation of quantum physics attributed to Niels Bohr is commonly regarded as abandoning realism. I have already opposed this view elsewhere (Folse 1985) but partially in response to criticism of my position (Shimony 1985), here I propose to relate Bohr’s realism to recent contributions to the realism debate given by Hacking (1983), Cartwright (1983), and Ellis (1985). Specifically, I argue that Bohr’s complementarity viewpoint requires a causal entity realism. Furthermore, labeling Bohr an anti-realist with respect to theories (...) is misleading because it assumes the correspondence theory of truth that Bohr holds quantum theory forces us to reject.Although there are many realist views, I take the root of realism to be the quest for knowledge about the reality producing the phenomena we experience. It is realism in this sense that Bohr defended and that makes science significant to metaphysics. (shrink)

Up to date Scholasticism is quite proud of its close union with Science. That bond has been strengthened considerable of late by the Physiology course described and recommended in the present article. The Editor.

Since the publication of Science and Values in which Laudan unveiled his “reticulated model of scientific change” (Laudan (1984)), he has published a series of articles emphasizing the naturalistic axiology inherent in this model. (Laudan (1986), (1987a), (1987b), (1989), and (forthcoming)). His epistemic naturalism makes the business of fixing rational beliefs about facts, theories, methodologies, and aims all together “cut from the same piece of empirical cloth.” Laudan’s position has numerous attractive qualities: It allows one to accept a great deal (...) of the wisdom in historicism without caving in to relativism. It allows one to accept the seemingly inevitable annexation of the theory of knowledge by the sciences and yet still maintain a normative epistemology. Finally, it awakens philosophers of science’s dogmatic slumbers regarding the axiology of scientific inquiry, and stimulates historical research into the relation between practiced means and professed ends in the sciences. (shrink)

SummaryUnder the assumption of the materialistic‐mechanistic ontology implicit in classical physics, quantum theory as interpreted through Niels Bohr's epistemology of complementarity is not formally objective; i. e., it is not informative of the state of physical systems independent of particular phenomenal manifestations of them. However, an analysis of the notion of the “physical system”, in theory, as experienced, and as existing “in‐itself”, reveals that if the older ontology is replaced, quantum mechanics through complementarity becomes formally objective, points the way toward (...) a new ontology based on the notion of the power to structure interaction between systems, and provides new insights into the relations between theory, observation, and the natural world. (shrink)

Perkinson provides an original historical interpretation that shows how our intellectual, political, economic, and social institutions emerged out of and are ...