IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

Index to the Digha-nikaya. Compiled by M. Yamazaki, Y. Ousaka, K. R. Norman and M. Cone. Pali Text Society, Oxford 1997. vii, 357 pp. £19.75. ISBN 0 86013 355 9.

A Pali Grammar. William Geiger. Translated into English by Batakrishna Ghosh, revised and edited by K. R. Norman. Pali Text Society, Oxford 1994. xxix, 220 pp. Hardback £12.95, paperback £6.75.

Dhammapada. Ed. O. von Hinüber and K.R. Norman. Pali Text Society, Oxford 1994. xv, 148 pp. £10.95.

This paper examines the perceived ethical values of Malaysian managers. It is based on the opinions of 15 hypothetical ethical/unethical business situations from the 81 managers who agreed to participate in the survey. The findings of this study showed that these Malaysian managers have high ethical values. However 53% of the respondents believed that the ethical standards of today are lower than that of 15 years ago. Apparently, this is related to the existence of many unethical business practices prevalent in (...) the modern business world. The behavior of one's immediate superior is the most important factor in influencing managers to commit unethical practices. The results also indicate only a slight variation among the managers in terms of perceived ethical values by virtue of job position, job specialization, type of business activity or the size of the business organization. (shrink)

A crucial debate currently raging in the fields of cognitive and social science centers around general and specific approaches to understanding the actions of others. When we understand the actions of another person, do we do so on the basis of a general theory of psychology, or on the basis of an effort to place ourselves in the particular position of that specific person? Hans Herbert Kögler and Karsten R. Stueber's Empathy and Agency addresses this other issues vital to current (...) social science in an advanced and diverse analysis of the foundations of social-scientific methodology based on recent cognitive psychology. The book serves as both an introduction to the debate for non-academic audiences and as a catalyst for further discussion for serious theorists. Empathy and Agency provides a solid foundation of the fundamental issues in social and cognitive science, but also presents the most influential paradigms in the field at this time. (shrink)

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions (...) the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context. (shrink)

Why do we persist in the relentless pursuit of artificial nourishment and other treatments to maintain a permanently unconscious existence? In facing the future, if not the present world-wide reality of a huge number of persistent vegetative state (PVS) patients, will they be treated because of our ethical commitment to their humanity, or because of an ethical paralysis in the face of biotechnical progress? The PVS patient is cut off from the normal patterns of human connection and communication, with a (...) life unlike other forms of human existence. Why the struggle to justify ending a life which, it is said, has suffered an irreversible loss of the content of consciousness? Elsewhere, the authors have addressed the ethical controversies and confusion engendered by ambiguous terminology, misuse of medical facts and the differing interpretations of what constitutes 'effective' treatment: in particular, the issue of whether in fact artificial nutrition and hydration is a medical treatment, or simply part of the obligatory care owed to all patients, permanently unconscious or not. In this paper, we intend to argue that recent analyses of medical futility, its meaning and ethical implications, despite an absence of public consensus, permit some tentative re-evaluation of our ethical obligations to the PVS patient. (shrink)

In this paper Popper formulates and discusses a new aspect of the theory of mind. This theory is partly based on his earlier developed interactionistic theory. It takes as its point of departure the observation that mind and physical forces have several properties in common, at least the following six: both are located, unextended, incorporeal, capable of acting on bodies, dependent upon body, capable of being influenced by bodies. Other properties such as intensity and extension in time may be added. (...) It is argued that a fuller understanding of the nature of forces is essential for the analysis of the mind-brain problem. The relative autonomy and indeterministic nature of mind is stressed. Indeterminism is treated in relation to a theorem of Hadamard. The computer theory of mind and the Turing test are criticized. Finally the evolution of mind is discussed. (shrink)

Journal of the Pali Text Society, Volume XXVII. Edited by O. von Hinüber and R.F. Gombrich. Pali Text Society, Oxford 2002. 183 pp. £18.75. ISBN 0 86013 407 5.

The Sutra of Golden Light. Translated by R. E. Emmerick. Second revised edition, Pali Text Society, Oxford 1990. xvi, 116 pp. £10.00.

Journal of the Pali Text Society, Volume XXVI. Edited by O. von Hinüber and R.F. Gombrich. Pali Text Society, Oxford 2000. 234 pp. £15.00. ISBN 0 86013 391 5.

Journal of the Pali Text Society. Volumes XXII-XXIV. Ed. O. von Hinüber ad R. F. Gombrich. Pali Text Society, Oxford 1996, 1997, 1998. £17.25 each. ISBN 086013 333 8; 0 86013 356 7; 0 86913 364 8.