ABSTRACTSome people might argue that there are already too many different documents, guidelines, and regulations in bioethics. Some overlap with one another, some are advisory and lack legal force, others are legally binding in countries, and still others are directed at narrow topics within bioethics, such as HIV/AIDS and human genetics. As the latest document to enter the fray, the UNESCO Declaration has the widest scope of any previous document. It embraces not only research involving human beings, but addresses broader (...) concerns in medicine and healthcare. The UNESCO draft declaration has some minor weaknesses, but on the whole, the strengths outweigh the weaknesses. One weakness is that some items in the draft are stated in a way that is too restrictive, thereby appearing to rule out legitimate activities. A strength of the Declaration is that it is relatively brief, yet at the same time contains sufficient detail to make it something more than a rehearsal of mere pieties. As the most recent of the numerous bioethics and human rights documents, the UNESCO draft draws on many of the earlier documents and also includes some of the most recent thinking about ethical norms and obligations. Perhaps its greatest strength lies not in details of the principles or their implementation, but rather in its stature as an international declaration issued by a United Nations organization. (shrink)

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

Since UNESCO launched its Culture of Peace Programme, it has helped mobilize people from all walks of life and from all continents to support the transformation from a culture of war and violence to a culture of pace. This is a report of the Programme's actions.

In lieu of an abstract, here is a brief excerpt of the content:Walking the Bodhisattva Path/Walking the Christ PathU.S. Conference of Catholic BishopsCatholics and Buddhists brought together by Dharma Realm Buddhist Association, the San Francisco Zen Center, and the United States Conference of Catholic Bishops (USCCB) met 20-23 March 2003 in the first of an anticipated series of four annual dialogues. Abbot Heng Lyu, the monks and nuns, and members of the Dharma Realm Buddhist Association hosted the dialogue at the (...) City of Ten Thousand Buddhas in Talmage, California. The community had transformed their Confucius Hall into a chapel, with a large, newly constructed wooden cross on a wall above an altar facing out from a raised platform, so the Catholic delegation would have a space for worship. A special poster announcing the theme of the conference, "Walking the Bodhisattva Path/Walking the Christ Path," showing a Buddhist dharma wheel at one foot of a bridge and a Celtic cross at the other foot, had been created by the hosting community.The daily schedule for the dialogue did not interfere with the monastic routine at the City of Ten Thousand Buddhas, which included early morning chanting (4:00-5:00 am), daily rituals in the Buddha Hall, and the single large meal for monastics before noon to which all participants were invited. Catholics and Buddhists meeting in the dialogue began each day with an optional forty-five minutes of quiet sitting together in the monastery meditation hall, each following their own form of meditation and prayer. There was a Eucharist on Friday and Saturday evenings for the Catholics and to which the Buddhists were invited, and additional meals of breakfast and supper throughout the meeting at the City's Jyun Kang Restaurant.Fourteen Buddhists and fourteen Catholics participated in the formal discussions. Each participant spoke on what it means to them to follow Christ or the way of the Bodhisattvas or enlightened beings. In addition to speaking, each participant distributed a short passage, usually from a traditional text, on this topic. Several passages from Master Dogen's Shobogenzo and the Gospel of John were among those shared by the group. Other passages shared were taken from the Avatamsaka Sutra and the Shurangama Sutra and from the other gospels and the writings of Zen master HakuinZenji, the Dalai Lama, Korean Zen Master I-sahn Hye-yeon, the teachings of Master [End Page 247] Hsuan Hua, Shantideva, Origen, St. Ignatius, St. Benedict, the author of The Cloud of Unknowing, St. John of the Cross, and Chiara Lubich. A minute of silence separated the fifteen-minute segments for each presentation. With so large a group, most of the time in the formal sessions involved listening to series of presentations; however, during discussion periods the participants asked several challenging questions of one another.Some participants noted the tension they felt between belonging to a particular religious group and the need to let go of any consequential narrowness. The goal of the discussion was to promote understanding of the differences and similarities between Christianity and Buddhism. At one point, the participants noted several concerns about mutual enrichment: whether Buddhist methods can be separated from Buddhism and Christian methods from Christianity, and what specific aspects of Christian practice truly enrich Buddhists and which Buddhist practices likewise enrich Christians. Several times participants discussed their understanding of terms such as transformation, grace, the incarnation and the passion of Jesus, discernment of spirits, prayer, Buddha-nature, and related terms. There was consensus that Buddhists and Catholics can practically help one another regarding mental cultivation and religious precepts. They expressed this consensus in their choice of the topic forthe next dialogue, "Transformation of Hearts and Minds: Chan/Zen-Catholic Approaches to Precepts."The group agreed to reconvene in 2004 to respond to six presentations, three from each side, on different aspects of this topic.Chairing the sessions were Rev. Heng Sure for the Dharma Realm Buddhist Association, Rev. Taigen Dan Leighton for the San Francisco Zen Center, and Bishop John Webster for the United States Conference of Catholic Bishops. Their three organizations are the sponsors of the Northern California Chan/Zen-Catholic Dialogue. Chan and Zen are respectively the Chinese and Japanese terms for the meditation school... (shrink)

This paper presents the results of an empirical study following up on Mizrahi (2021). Using the same methods of text mining and corpus analysis used by Mizrahi (2021), we test empirically a philosophical account of scientific progress that Mizrahi (2021) left out of his empirical study, namely, the so-called functional-internalist account of scientific progress according to which the aim or goal or scientific research is to solve problems. In general, our results do not lend much empirical evidence in support of (...) the problem-solving model of scientific progress over the other philosophical accounts of scientific progress (namely, the epistemic, noetic, and semantic accounts of scientific progress) tested in Mizrahi (2021) and in this follow-up study. Of all the subjects in the JSTOR database we have tested in this study, however, Mathematics is an interesting exception as far as the problem-solving model of scientific progress is concerned. For, in Mathematics alone, we have found that there is significantly more talk of the aims and/or goals of research in terms of solutions than in terms of truth, knowledge, or understanding. (shrink)

Drawing on insights from social learning and social cognitive perspectives and research on the multilevel reality of leadership influences, we developed and tested a multilevel model that examines mechanisms and conditions through which ethical leadership deters work unit- and individual-level ostracism. Based on two field studies using multiple measurement points, we found that at the work unit level of analysis, relational climate partially mediates the negative relationship between ethical leadership and work unit-level ostracism whereas state mindfulness partially (...) mediates the cross-level influence of ethical leadership on individual-level ostracism. Contrary to our hypothesis, we found that the relationship between ethical leadership and relational climate was stronger when work units had a more mechanistic structure, and not when it had an organic work unit structure. Finally, we found that relational climate not only moderates the relationship between state mindfulness and individual-level ostracism, but also moderates the indirect influence of ethical leadership on individual-level ostracism through state mindfulness such that the indirect effect is stronger when relational climate is high as opposed to low. These findings highlight the individual- and work unit-level conditions and mechanisms through which ethical leadership relates to decreased ostracism at work, and thus extends theory and research on ethical leadership and ostracism. (shrink)

Background:Maintaining patient’s dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units.Objectives:The aim of this study was to uncover the cultural factors that impeded maintaining patients’ dignity in the cardiac surgery intensive care unit.Research Design:The study was conducted using a critical ethnographic method proposed by Carspecken.Participants and research context:Participants included all physicians, nurses and staffs working in the study setting. Data collection methods included participant observations, formal and informal interviews, (...) and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace.Ethical Consideration:Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained.Findings:The findings of the study fell into the following main themes: “Presence: the guarantee for giving enough attention to patients’ self-esteem”, “Instrumental and objectified attitudes”, “Adherence to the human equality principle: value-action gap”, “Paternalistic conduct”, “Improper language”, and “Non-interactive communication”. The final assertion was “Reductionism as a major barrier to the maintaining of patient’s dignity”.Discussion:The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches.Conclusion:Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships. (shrink)

In the mid-1260s in Paris, a dispute raged that concerned the relationship between faith and the Augustinian theological tradition on the one side and secular leaning as represented by the arrival in Latin of Aristotle and various Islamic and Jewish interpreters of Aristotle on the other. Masters of the arts faculty in Paris represented the latter tradition, indicated by the phrase "double truth theory." In 1269, Thomas Aquinas wrote the polemical work On There Being Only One Intellect, Against the Averroists (...) (De unitate intellectus contra averroistas). Thomas is intent on countering two views: first, that intellect is not a faculty of the soul that animates our body, and second, that there is a single intellect existing separately that suffices for all people. Brief as it is, this work puts into play all the significant strands of Thomas's teaching on man - historical doctrinal, philosophical, and theological. It is a valuable source for discussing Thomas's views on the relationship between Aristotle and Christianity and puts to rest the misleading claim that Thomas baptized Aristotle." The introduction places the work historically and sketches the controversy to which it was a contribution. Part 2 includes the Latin Leonine text and McInerny's translation. Part 3 analyzes the basic arguments of Thomas's work and provides a series of interpretive essays meant to make Thomas accessible to today's readers. (shrink)

The prospective formalization of the Anthropocene as a chronostratigraphic unit by the International Commission on Stratigraphy has been intensely debated. This paper explores and assesses the stakes of this process from a philosophical perspective. I distinguish two senses of formalization—the descriptive and the evaluative—and argue that: 1) there are descriptive and evaluative formalizations of the Anthropocene beyond the confines of the ICS; 2) incoherencies between Anthropocene proposals and the ICS’s current tenets are not a decisive reason for deferring descriptive (...) formalization; and 3) the prospective evaluative formalization of the Anthropocene by the ICS would be impactful. (shrink)

Background:Less sedated and more awake patients in the intensive care unit may cause ethical challenges.Research objectives:The purpose of this study is to describe ethical challenges registered nurses experience when patients refuse care and treatment.Research design:Narrative individual open interviews were conducted, and data were analysed using a phenomenological hermeneutic method developed for researching life experiences.Participants and research context:Three intensive care registered nurses from an intensive care unit at a university hospital in Norway were included.Ethical considerations:Norwegian Social Science Data Services (...) approved the study. Permission was obtained from the intensive care unit leader. The participants’ informed and voluntary consent was obtained in writing.Findings:Registered nurses experienced ethical challenges in the balance between situations of deciding on behalf of the patient, persuading the patient and letting the patient decide. Ethical challenges were related to patients being harmful to themselves, not keeping up personal hygiene and care or hindering critical treatment.Discussion:It is made apparent how professional ethics may be threatened by more pragmatic arguments. In recent years, registered nurses are faced with increasing ethical challenges to do no harm and maintain dignity.Conclusion:Ethically challenging situations are emerging, due to new targets including conscious and aware critical care patients, leaving an altered responsibility on the registered nurses. Reflection is required to adjust the course when personal and professional ideals no longer are in harmony with the reality in the clinical practice. RNs must maintain a strong integrity as authentic human beings to provide holistic nursing care. (shrink)

Although the concept of dignity is commonly invoked in clinical care, there is not widespread agreement—in either the academic literature or in everyday clinical conversations—about what dignity means. Without a framework for understanding dignity, it is difficult to determine what threatens patients’ dignity and, conversely, how to honor commitments to protect and promote it. This article aims to change that by offering the first conceptual model of dignity for patients in the intensive care unit. The conceptual model we present (...) is based on the notion that there are three sources of patients’ dignity—their shared humanity, personal narratives, and autonomy—each of which independently warrants respect. The article describes each source of dignity and draws on examples to illustrate how clinician attitudes, actions, and behaviors can either contribute to, or detract from, expressions of respect for patient dignity. (shrink)

In “A new proof of the completeness of the Lukasiewicz axioms” Chang proved that any totally ordered MV-algebra A was isomorphic to the segment \}\) of a totally ordered l-group with strong unit A *. This was done by the simple intuitive idea of putting denumerable copies of A on top of each other. Moreover, he also show that any such group G can be recovered from its segment since \^*}\), establishing an equivalence of categories. In “Interpretation of AF (...) C *-algebras in Lukasiewicz sentential calculus” Mundici extended this result to arbitrary MV-algebras and l-groups with strong unit. He takes the representation of A as a sub-direct product of chains A i, and observes that \ where \. Then he let A * be the l-subgroup generated by A inside \. He proves that this idea works, and establish an equivalence of categories in a rather elaborate way by means of his concept of good sequences and its complicated arithmetics. In this note, essentially self-contained except for Chang’s result, we give a simple proof of this equivalence taking advantage directly of the arithmetics of the the product l-group \, avoiding entirely the notion of good sequence. (shrink)

Research in the intensive care unit (ICU) is commonly thought to pose 'serious risk' to study participants. This perception may be at the root of a variety of impediments to the conduct of clinical trials in the ICU setting. Component analysis offers a promising approach to the ethical analysis of ICU research. Because clinical trials commonly involve a mixture of study interventions, therapeutic and nontherapeutic procedures must be analyzed separately. Therapeutic procedures must meet the requirement of clinical equipoise. Risks (...) associated with nontherapeutic procedures must be minimized consistent with sound scientific design, and be deemed reasonable in relation to the knowledge to be gained. When research involves a vulnerable population, such as adults incapable of providing informed consent, nontherapeutic risks are limited to a minor increase over minimal risk. Understood in this way, the incremental risk posed by participation in ICU research may be minimal. This realization has important implications for review by institutional review boards of such research and for the informed consent process. (shrink)

Background: In the neonatal intensive care unit, immigrant parents may experience even greater anxiety than other parents, particularly if they and the nurses do not share a common language. Aim: To explore the complex issues of trust and the nurse–mother relationship in neonatal intensive care units when they do not share a common language. Design and methods: This study has a qualitative design. Individual semi-structured in-depth interviews and two focus group interviews were conducted with eight immigrant mothers and eight (...) neonatal intensive care unit nurses, respectively. Data analysis was based on Braun and Clarke’s thematic analytic method. Ethical considerations: Approval was obtained from the hospital’s Scientific Committee and the Data Protection Officer. Interviewees were informed in their native language about confidentiality and they signed an informed consent form. Results: Trust was a focus for mothers and nurses alike. The mothers held that they were satisfied that their infants received the very best care. They seemed to find the nurses’ care and compassion unexpected and said they felt empowered by learning how to care for their infant. The nurses discussed the mother’s vulnerability, dependency on their actions, attitudes and behaviour. Discussion: Lack of a common language created a challenge. Both parties depended on non-verbal communication and eye contact. The nurses found that being compassionate, competent and knowledgeable were important trust-building factors. The mothers were relieved to find that they were welcome, could feel safe and their infants were well cared for. Conclusion: The parents of an infant admitted to the neonatal intensive care unit have no choice but to trust the treatment and care their infant receives. Maternal vulnerability challenges the nurse’s awareness of the asymmetric distribution of power and ability to establish a trusting relationship with the mother. This is particularly important when mother and nurse do not share a verbal language. The nurses worked purposefully to gain trust. (shrink)

BackgroundMoral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela.ObjectiveThe purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants’ MD, clinical ethics knowledge, work satisfaction, (...) and patient care among ICU nurses.Sample and SettingThe sample, 32 nurses from three ICU settings in an 800-bed tertiary academic medical center, participated in six nursing ethics huddles over a two-month period.MethodsAlvita K. Nathaniel’s Theory of Moral Reckoning guided development of the nursing ethics huddle process.1 The Moral Distress Thermometer was administered at three data points: baseline level of MD, and pre- and post-huddle to determine changes in the subjects’ level of MD.2 Focused content analysis was used to analyze qualitative responses from questionnaires about the subjects’ perception of the effect of the huddles on work satisfaction and patient care. Knowledge attainment was evaluated via open-ended short-answer questions.ResultsOverall, use of nurse-ethicist-led nursing ethics huddles was associated with improved quality of work life, patient care, and clinical ethics knowledge. The change in pre- and post-nursing ethics huddles MD scores was statistically significant (p < 0.0001). (shrink)

The paediatric intensive care unit is a high-stress environment for parents, families and health care professionals alike. Family members experiencing stress or grief related to the admission of their sick child may at times exhibit challenging behaviours; these exist on a continuum from those that are anticipated in context, through to unacceptable aggression. Rare, extreme behaviours include threats, verbal or even physical abuse. Both extreme and recurrent ‘subthreshold’ behaviours can cause significant staff distress, impede optimal clinical care and compromise (...) patient outcomes. The unique PICU environment and model of care may magnify stressors for both families and staff and the family-centred approach to care central to paediatric practice, may also contribute to contextual challenges. Pervasive conflict in paediatric healthcare is harmful for patients, families, PICU staff and the institution more broadly. We propose that caring for children and caring for staff are inseparable goals and the latter has been inadvertently but detrimentally deprioritised as FCC has become a primary focus. A transparent and graded hierarchy of responses to variable levels of challenging behaviour is necessary to ensure that families are supported, while HCPs remain protected in the workplace. This requires establishing firm limits supported by all teams and levels of the institution. As such, we aim to identify and clarify the context and impact of challenging parent and family behaviour in the PICU and to offer potential, proactive mitigation strategies, based on reflections and stakeholder discussion following recent clinical challenges and experiences in our unit. (shrink)

Nonassociative Lambek Calculus (NL) is a syntactic calculus of types introduced by Lambek [8]. The polynomial time decidability of NL was established by de Groote and Lamarche [4]. Buszkowski [3] showed that systems of NL with finitely many assumptions are decidable in polynomial time and generate context-free languages; actually the P-TIME complexity is established for the consequence relation of NL. Adapting the method of Buszkowski [3] we prove an analogous result for Nonassociative Lambek Calculus with unit (NL1). Moreover, we (...) show that any Lambek grammar based on NL1 (with assumptions) can be transformed into an equivalent context-free grammar in polynomial time. (shrink)

What should be the role of an institutional ethics committee in resolving conflict concerning patient care decisions in the neonatal intensive care unit? This question takes on added importance in light of recent court decisions which suggest that IEC deliberations may serve as persuasive evidence in court, of proposed state regulations that would establish an IEC as an alternative to judicial review, and of recent Joint Commission on Accreditation of Healthcare Organizations guidelines that require an institutional policy on limitation (...) or withdrawal of treatment to include a specified mechanism for resolving conflict. Unfortunately, despite these developments, prospective case consultation remains one of the most controversial and poorly understood aspects of IEC functions. Questions and concerns persist about the relation the IEC has and should have to actual decisions in specific cases.We briefly examine the clinical, organizational, and regulatory complexity of the NICU environment and suggest five potential sources of uncertainty, disagreement, and conflict among parent and NICU staff. (shrink)

Two major clarifications have greatly abetted the understanding and fruitful expansion of the theory of natural selection in recent years: the acknowledgment that interactors, not replicators, constitute the causal unit of selection; and the recognition that interactors are Darwinian individuals, and that such individuals exist with potency at several levels of organization (genes, organisms, demes, and species in particular), thus engendering a rich hierarchical theory of selection in contrast with Darwin’s own emphasis on the organismic level. But a piece (...) of the argument has been missing, and individuals at levels distinct from organisms have been denied potency (although granted existence within the undeniable logic of the theory), because they do not achieve individuality with the same devices used by organisms and therefore seem weak by comparison. We show here that different features define Darwinian individuality across scales of size and time. In particular, species-individuals may develop few emergent features as direct adaptations. The interactor approach works with emergent fitnesses, not with emergent features; and species, as a consequence of their different mechanism for achieving individuality (reproductive exclusivity among subparts, that is, among organisms), express many effects from other levels. Organisms, by contrast, suppress upwardly cascading effects, because the organismic style of individuality (by functional integration of subparts) does not permit much competition or differential reproduction of parts from within. Species do not suppress the operation of lower levels; such effects therefore become available as exaptations conferring emergent fitness—a primary source of the different strength that species achieve as effective Darwinian individuals in evolution. (shrink)