While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical (...) and logistical facts in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative (...) data was used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

Moral distress is the sense that one must do, or cooperate in, what is wrong. It is paradigmatically faced by nurses, but it is almost a universal occupational hazard.

Ong, Caroline As health systems become more complex, moral distress is increasingly being recognised as a significant phenomenon amongst health professionals. It can be described as the state of being distressed when one is unable to act according to what one believes to be morally right. It may compromise patient care, the health professional involved and the organisation. Cumulative experiences of incompletely resolved moral distress - a phenomenon which is called moral residue - may leave us susceptible to (...) more frequent and more severe moral distress. Clear open communication, respect, inclusivity, openness to differences, compassion, support, education and the capacity to grow in self-awareness are key aspects in minimising moral distress. Early recognition of its symptoms and addressing both personal and external constraints of actions can also minimise moral residue and build resilience to further distress. (shrink)

When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...) distress that I call “role conflict distress.” Rather than view role conflict distress as a sign that we are falling short, I suggest that it actually speaks to the commitment that we have to the loving relationship that grounds our duty of care. (shrink)

Financial distress in the hospitality industry affects both businesses and their employees. This study explores the perspectives of employees on financial distress within the hospitality sector in Imo State, Nigeria. The study addressed three research questions. Survey research design was adopted for the study. The study was carried out in Imo State Nigeria. 361 financial officers in the hotels within the hospitality industry in Owerri Imo State were the target population and random sampling was used to select 181 (...) hotels whose financial officers served as the study respondents. Structured questionnaire was specifically designed for this study. The data was analyzed using mean, and standard deviation to provide an overview of employee perspectives on financial distress. The results indicate that a wide range of variables, such as economic downturns, irregular revenue, high cost of living, and management concerns within businesses, are responsible for financial hardship among employees in the hotel industry in Imo State. Employees also mentioned that worry, anxiety, and job instability were direct effects of their financial hardship. Based on the results, a number of suggestions are made to lessen financial hardship. These include putting in place financial literacy initiatives for staff members, enhancing management-staff communication and transparency, supporting ethical labor practices, and encouraging social support systems within the workplace. (shrink)

Explaining the "intentional object" some people assign pleasure, I argue that a person is pleased about something when his thoughts about that thing cause him to feel pleasure. Bernard Williams, Gilbert Ryle, and Irving Thalberg, who reject this analysis, are discussed. Being pleased (or distressed) about something is a compound of pleasure (pain) and some thought or belief. Pleasure in itself does not have an "intentional object".

ABSTRACT Objectives There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design The study used a qualitative (...) approach to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. Setting The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. Participants Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. Results PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. Conclusions The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs. (shrink)

This study determined undergraduates’ satisfaction of online food and beverage services amidst financial distress in Nnewi urban, Anambra State, Nigeria. Descriptive survey research design was used by the study. Population consisted of 3,509 students. Sample size was 35. Questionnaire was the instrument used for data collection. Data was analyzed using mean and standard deviation. Findings revealed that different types of food and beverage products were purchased online. The problems undergraduates face in online food and beverage services included delayed delivery, (...) use of artificial food colouring and fear of food contamination. Strategies for enhancing students’ satisfaction of online purchases included timely delivery of products ordered and appropriate delivery mechanism. Findings also showed that the ways online food and beverage purchases can influence undergraduate’s finances included high cost of online food products, additional cost for delivery among others. Among recommendations made was that online food vendors should ensure that food products delivered are same with products ordered by customers in order to enhance customer satisfaction. (shrink)

During the hundred years following its discovery, Adolph Harnack and, after him, his successors succeeded in giving a determined direction to Didache research. In so doing, the Didache took on a discernible identity and was valued as contributing to the pressing academic discussions of the day. During the last forty years, Harnack and his successors have been largely marginalized. As a result, the field of Didache studies has been caught up in a confusing diversity of scholarly opinions. There is no (...) single origination hypothesis, no single methodology, and no single research program to guide our way. The field of Didache scholarship is thus in disarray and unable to substantially contribute to the academic questions of our day. (shrink)

Moral distress is a well-documented phenomenon in the nursing profession, and increasingly thought to be implicated in a nation-wide nursing shortage in the US. First identified by the philosopher Andrew Jameton in 1984, moral distress has also proven resistant to various attempts to prevent its occurrence or at least mitigate its effects. While this would seem to be bad news for nurses and their patients, it is potentially good news for philosophical counselors, for whom there is both socially (...) important and philosophically interesting work to be done. In an effort to encourage such work, this paper explicates the philosophical (as opposed to more purely psychological or institutional) contours of the problem. A subsequent paper, titled 'A Philosophical Counseling Approach to Moral Distress,' will highlight ways in which such a response would differ from the strategies so far deployed within the nursing profession. (shrink)

It is important to note that certain mental health disorders are classified as rare conditions, and they have their own ‘cultural concepts of distress’ as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). Cultural concepts of distress are a recent attempt to understand psychological distress influenced by culture, separate from biomedical diagnoses that require equal attention and support for individuals and their families, both physically and emotionally. [1].

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (...) (Nilsson, Sjöberg, Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

Images of species, sets, and containers, combined with an obsolete positivist theory of meaning and a curiously illogical interpretation of a structuralist understanding of meaning, together have driven feminists and their critics to find unavoidable essentialism and binary totalism in feminist theorists' use of the category WOMEN. This paper explores an enriched imagination for how categories can be structured internally and in relations to other categories, and proposes that we need to think categories simultaneously through multiple and mixed metaphors, including (...) the metaphors of a spun thread and family resemblance, and the image of correlational densities in multidimensional quality spaces. (shrink)

Michael H. Mitias argues that friendship is a central moral value constituting an integral part of the good life and therefore deserving a prominent place in ethical theory. He consequently calls upon ethicists to make immediate and decisive adjustments toward accommodating what he regards as a neglected organic relationship between friendship and morality. This is not a fanciful amendment to our standard conception of morality but a radical proposal grounded in a unifying vision to recapture the right way of doing (...) ethics. While the assessment is compelling, and the plea well-placed, neither has been fully understood in the scholarly reception of Mitias. This paper clarifies both. What sets it apart from other reactions to Mitias is a holistic approach drawing on literary considerations as well as philosophical ones. The combined aim is to demonstrate that Mitias is not seeking simply to restore friendship to its rightful place in normative ethical theory, which is indeed the full extent of his formal mission, but that he is seeking to do so specifically within virtue ethics. This interpretation rests on a broad engagement with Mitias’s publications beyond the recent treatise often taken understandably yet erroneously to be his only work on the subject. (shrink)

Culture and socialization influence how individuals perceive and express emotional distress. Research therefore, must consider the context to capture individual experiences. However, the majority of studies on factors associated with emotional distress among migrants use quantitative approaches, limiting an in-depth understanding. This study investigates emic themes of emotional distress among Vietnamese migrants by integrating anthropological and psychiatric approaches. The mixed methods study first quantified differences in reported themes of distress between Vietnamese (n = 104) and German (...) (n = 104) patients, who utilized two psychiatric outpatient clinics in Berlin, Germany. Based on these differences, ethnographic interviews were conducted with 20 Vietnamese patients. In the quantitative part, differences in frequency of reported distress between Vietnamese and German patients indicate cultural and migration-related issues among Vietnamese migrants, such as the upbringing of children in a transcultural context. In the qualitative part, interviews with Vietnamese patients elicited contextualizing information and additional themes of distress. Besides commonly expressed socioeconomic themes, such as work and finances, we identified affectively charged themes concerning roles toward partnership and children. A central emic theme is expressed as “moments of speechlessness,” which go beyond a lack of language proficiency and challenge patients in different spheres of life. Migration entails complex affective dynamics, determined by a specific migratory and post-migratory context. Within this context, norms and values determine which themes of distress patients articulate openly. Therefore, an interdisciplinary, mixed-methods approach can yield a contextualized understanding of emotional distress and the complex nature of migration. (shrink)

Question: Do clinicians providing abortion practicing in states that restrict abortion experience more moral distress than those practicing in states that protect abortion? -/- Findings: In this national, purposive survey study of 310 clinicians providing abortion, moral distress was elevated among all clinicians, with those practicing in restrictive states reporting higher levels of moral distress compared with those practicing in protective states. -/- Meaning: The findings suggest that structural changes addressing bans on necessary health care, such as (...) federal protection for abortion, are needed at institutional, state, and federal policy levels to address clinician moral distress. (shrink)

Suicide among college students is a major public health problem. Research has confirmed that negative focused disposition had a significant effect on suicidal ideation. This study aims to evaluate somatic anxiety, general distress and depression as mediators of the relationship between negative focused disposition and suicidal ideation.

Introduction: Respiratory distress (RD) is a major emergency to which infants are particularly vulnerable. It can lead to neurological sequelae and even death when treatment is not adequate and rapid. Objective: To evaluate the management of RD in infants at the CNHU-HKM in Cotonou. Methods: The study was of a transversal and analytical nature and took place over a period of 06 months, from 1st January to 30th June 2015. Included in the study were all infants hospitalised for DR. (...) The therapeutic modalities were analysed according to the recommendations of the World Health Organization. Results: A total of 96 infants were included. The hospital frequency of DR was 38%. The average age was 12 months. One in 3 infants had SaO2 less than 90% on admission, and in 58.3% of cases, the infant showed at least 3 signs of struggle. The initial assessment was as recommended. The systematic use of oxygenrequires a revision of the criteria for oxygentherapy in the unit. The three main causes were severe pneumonia (31.3%), severe malaria (18.8%) and bronchiolitis (15.6%), and their treatment was correct. However, none of the infants had been able to benefit from ventilatory support. Mortality was high (31.2%) linked to the intensity of DR (p = 0.04) and sepsis (p = 0.006). Conclusion: The procedures for the diagnosis and treatment of RD in infants at the CNHU are fairly consistent with WHO guidelines. Ventilatory support is necessary for some children with severe RD. (shrink)

Concerns of moral distress in health care have never been more relevant. In her book, Health Care Ethics Through the Lens of Moral Distress, Kristen Jones-Bonofiglio provides a comprehensive review of the effects of moral distress on providers and health care delivery, while highlighting the complexities of making ethical decisions in practice. Jones-Bonofiglio’s thoroughness and use of interdisciplinary, historical, and cultural scholarship makes this book an excellent introductory resource on moral distress for health care providers and (...) researchers alike. (shrink)

The purpose of this article is to examine restructuring procedures according to existing UAE laws and draft legislation on bankruptcy.

The problem we face today is that there is a huge gap between our ethical judgments about the ecological crisis on the one hand and our ethical behavior according to these judgments on the other. In this article, we ask to what extent a phenomenology of the ecological crisis enables us to bridge this gap and display more ethical or pro-environmental behavior. To answer this question, our point of departure is the affordance theory of the American psychologist and founding father (...) of ecological psychology, James Gibson. There are two reasons for taking this approach. First of all, an ontological reading of Gibson’s affordance theory provides a concept of nature which is non-dualistic, non-anthropocentric and eco-centric, but is not seen as an ‘intrinsic value’ or product of ‘human valuation’. Secondly, the affordance ontology provides us with a concept of nature which in itself calls for certain action and behavior. If we indeed face a gap between ethical judgment and ethical behavior with regard to the current ecological crisis, an affordance of nature could bridge this gap. Based on our ontological reading of Gibson’s affordance theory, we open a radically new perspective on the current ecological crisis and the responsibility of mankind with regard to this crisis. (shrink)

Most psychological and philosophical theories assume that we know what we feel. This general view is often accompanied by a range of more specific claims, such as the idea that we experience one emotion at a time, and that it is possible to distinguish between emotions based on their cognition, judgment, behaviour, or physiology. One common approach is to discriminate emotions based on their motivations or ultimate goals. Some argue that empathic distress, for instance, has the potential to motivate (...) empathic concerns; personal distress, on the other hand, is self-oriented and motivates egoistic concerns. In this paper, I argue against this and similarly teleological views of emotions and affect. Through a close study of the emotional breakdown of an American drone operator, I make the case that understanding our emotions entails much more ambiguity than dominant theories assume. In our emotional lives, disorientation and confusion are often the norm. (shrink)

It is argued that to possess the concept of distress is to be able to apply the concept to others, and that this implies a qualified form of altruism, in the sense that to perceive another as being in distress is, other things being equal, to see them as in need of help and be moved to help them.

Margaret Urban Walker argues that hospital ethics committees should think of their task as "keeping moral space open." I develop her suggestion with analogies: Enlarge the windows (i.e., expand what counts as an ethical issue); add rooms and doors (i.e., choose particular issues to engage). Examples include confidentiality defined as information flow, and moral distress in the healthcare workplace.

Pornography refers to sexually explicit media that are primarily intended to sexually arouse the audience‘. Pornography representation of sexual behavior in books, pictures, statues, motion pictures, and other media that is intended to cause sexual excitement. Pornography can be the main source of a young person's sex education. Pornography In many historical societies, frank depictions of sexual behavior, often in a religious context, were common. In the 19th century, the inventions of photography and later motion pictures were quickly put to (...) use in the production of pornography. 21st century there were some four million Web sites devoted to pornography, containing more than a quarter of a billion pages—in other words, more than 10 percent of the Web. Pornography may impact young people‘s adoption of certain sexual behaviors. It is possible that viewing non-mainstream sexual practices can give legitimacy to them, and encourage participation in sexually adventurous behaviors (e.g. heterosexual anal sex). Correlations between adolescent viewing of sexual media and sexual behavior are moderated by parental involvement, including such factors as discussions of television content, communication patterns, and home environments. Pornography as distress (for younger children): Premature or inadvertent exposure to sexually explicit content may be distressing for younger children. First, research on children‘s consumption of sexual content in mainstream media documents that its effects are moderated by such variables as age, gender, sexual experience, physical maturation, and parental involvement. (shrink)

"What is the significance of our gut feelings? Can they disclose our deep selves or point to a shared human nature? The phenomenon of perpetrator disgust provides a uniquely insightful perspective by which to consider such questions. Across time and cultures, some individuals exhibit signs of distress while committing atrocities. They experience nausea, convulse, and vomit. Do such bodily responses reflect a moral judgment, a deep-seated injunction against atrocity? What conclusions can we draw about the relationship of our gut (...) feelings to human nature and moral frameworks? Drawing on a broad range of historical examples as well as the latest scholarship from the philosophical and scientific study of emotions, this book explores the relationship of cognition and emotion through the lens of perpetrator disgust. Considering a range of interpretations of this phenomenon, it becomes evident that gut feelings do not carry a straightforward and transparent intentionality in themselves, nor do they motivate any core, specific response; they are templates that can embody a broad range of values and morals. Using this core insight, the book proposes a contextual understanding of emotions, by which an agent's environment shapes their available hermeneutic equipment-concepts, categories, names-that individuals rely on to make sense of their emotions and navigate the world"--. (shrink)

Pornography‘ refers to sexually explicit media that are primarily intended to sexually arouse the audience‘. Pornography representation of sexual behavior in books, pictures, statues, motion pictures, and other media that is intended to cause sexual excitement. Pornography can be the main source of a young person's sex education. Pornography In many historical societies, frank depictions of sexual behavior, often in a religious context, were common. In the 19th century, the inventions of photography and later motion pictures were quickly put to (...) use in the production of pornography. 21st century there were some four million Web sites devoted to pornography, containing more than a quarter of a billion pages—in other words, more than 10 percent of the Web. Pornography may impact on young people‘s adoption of certain sexual behaviours. It is possible that viewing non-mainstream sexual practices can give legitimacy to them, and encourage participation in sexually adventurous behaviors (e.g. heterosexual anal sex). Correlations between adolescent viewing of sexual media and sexual behavior are moderated by parental involvement, including such factors as discussions of television content, communication patterns, and home environments. Pornography as distress (for younger children): Premature or inadvertent exposure to sexually explicit content may be distressing for younger children. First, research on children‘s consumption of sexual content in mainstream media documents that its effects are moderated by such variables as age, gender, sexual experience, physical maturation, and parental involvement. (shrink)

Withdrawal involves emotional pain that motivates much addictive behavior. In this paper, I argue that the emotional pain of withdrawal compels much addictive behavior. Researchers have noticed this possibility but it is widely underappreciated. Among philosophers, only Hanna Pickard has discussed emotional compulsion in addiction, and the emotional aspect of withdrawal has been almost completely neglected. Accounts of emotional compulsion in the philosophical literature (from Tappolet, Elster, and Furrow) probably do not capture how the distress of withdrawal compels, so (...) I propose a more suitable account of “pathodoxastic” compulsion in addiction. On this account, the emotional pain of withdrawal compels when it undermines the ability to believe that one can continue to endure it, and therefore the ability to intend abstinence. (shrink)

Conclusion: The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.

Some people feel distressed reflecting on human extinction. Some people even claim that our efforts and lives would be empty and pointless if humanity becomes extinct, even if this will not occur for millions of years. In this essay, I will attempt to demonstrate that this claim is false. The desire for long-lastingness or quasi-immortality is often unwittingly adopted as a standard for judging whether our efforts are significant. If we accomplish our goals and then later in life conclude that (...) these accomplishments were of no significance, then this is a sign that the desire for long-lastingness has crept into our standards. By recognizing this, and refraining from adopting an unreasonable standard to judge whether our efforts are significant, it will be to our advantage. Then, when we look back on life from an external perspective that encompasses times after humanity has become extinct, we will not conclude that our efforts amounted to nothing. Rather, we will conclude that many people made significant accomplishments that made their lives and the lives of other people better than they would have been if their goals had never been pursued. (shrink)

In the first months of the COVID-19 pandemic, we created and implemented from November 2020 to February 2021 a monthly educational pilot program of philosophical management of stress based on Science, Humanism and Epicurean Pragmatism, which was offered to employees of 26 municipalities in the Prefecture of Attica, Greece. The program named “Philosophical Distress Management Operation System” (Philo.Di.M.O.S.) is novel and unique in its kind, as it combines a certain Greek philosophical tradition (Epicurean) that concurs with modern scientific knowledge. (...) The program was designed to be implemented in a period of crisis; therefore, it used a fast-paced, easy to learn and practice philosophical approach to stress management, based on cognitive psychotherapy. The philosophical approach to stress management has the advantage that it can be offered to most people, regardless of age and educational level. The pilot program was effective in achieving its objectives, shown by statistical comparisons of the trainees’ responses to anonymous questionnaires before and after the month-long training. The successful Philo.Di.M.O.S. program, thus, based on a solid scientific and philosophical basis, offers a paradigm of stress management during crises and could be useful in Greece and internationally. (shrink)

Multi-user online environments involve millions of participants world-wide. In these online communities participants can use their online personas – avatars – to chat, fight, make friends, have sex, kill monsters and even get married. Unfortunately participants can also use their avatars to stalk, kill, sexually assault, steal from and torture each other. Despite attempts to minimise the likelihood of interpersonal virtual harm, programmers cannot remove all possibility of online deviant behaviour. Participants are often greatly distressed when their avatars are harmed (...) by other participants’ malicious actions, yet there is a tendency in the literature on this topic to dismiss such distress as evidence of too great an involvement in and identification with the online character. In this paper I argue that this dismissal of virtual harm is based on a set of false assumptions about the nature of avatar attachment and its relation to genuine moral harm. I argue that we cannot dismiss avatar attachment as morally insignificant without being forced to also dismiss other, more acceptable, forms of attachment such as attachment to possessions, people and cultural objects and communities. Arguments against according moral significance to virtual harm fail because they do not reflect participants’ and programmers’ experiences and expectations of virtual communities and they have the unintended consequence of failing to grant significance to attachments that we take for granted, morally speaking. Avatar attachment is expressive of identity and self-conception and should therefore be accorded the moral significance we give to real-life attachments that play a similar role. (shrink)

Sentience is the capacity to have feelings, such as feelings of pain, pleasure, hunger, thirst, warmth, joy, comfort and excitement. It is not simply the capacity to feel pain, but feelings of pain, distress or harm, broadly understood, have a special significance for animal welfare law. Drawing on over 300 scientific studies, we evaluate the evidence of sentience in two groups of invertebrate animals: the cephalopod molluscs or, for short, cephalopods (including octopods, squid and cuttlefish) and the decapod crustaceans (...) or, for short, decapods (including crabs, lobsters and crayfish). We also evaluate the potential welfare implications of current commercial practices involving these animals. (shrink)

Chest pain is the pain felt in the chest by infants, children and adolescents. In most cases the pain is not associated with the heart. It is mainly recognized by the observance or report of pain by the infant, child or adolescent by reports of distress by parents or care givers. Chest pain is not unusual in children. Lots of children are seen in ambulatory clinics, emergency rooms and hospitals and cardiology clinics. Usually there is a benign cause for (...) the pain for utmost children. Certain patients have conditions that are serious and perhaps life-threatening. Chest pain in pediatric patients needs careful physical examination and a detailed history that would point to the possibility of a serious cause. Researches of pediatric chest pain are scarce. It has been difficult to create evidence-based guidelines for evaluation. In this paper we propose an expert system to help doctors and parents, and care giver in diagnosing chest pain in infants and children. This expert System is design and implemented in SL5 Object language. (shrink)

Looking at responsibility within a Lévinasian sense, human beings are firstly seen not in the philosophically traditional sense, of being egocentric, but rather seen as ethical subjects based on “the other” (Lévinas & Hand, 1989). The purpose of this paper is to examine the notion of responsibility as Lévinas conceptualized in the idea that human beings are responsible for not only themselves but for others. Lévinas within “Ethics as First Philosophy” (Lévinas & Hand, 1989) states that before all other forms (...) of being in the world there must be responsibility to the Other (Lévinas & Hand, 1989). Lévinas defines this to mean that before freedom of the subject, and their subjectivity, before self-consciousness, before the consciousness of consciousness, before being, and before relativity there is “responsibility for the Other pre-exists any self-consciousness” (Lévinas & Hand, 1989, p.75). Perhaps, Lévinas is saying that a human beings obligation comes before all of what follows from our being in this world, our obligation to the Other beginning with the “face to face” (Lévinas & Hand, 1989, p.75), interaction, which is our first and foremost responsibility, the responsibility to the Other. And to be ethical beings who begin with responsibility we rely on the fundamental relationship of others. This notion of responsibility appears when we encounter, in the face-to-face interaction, the unknowable other. However, does this responsibility extend to more than two individuals and to those outside our immediate proximity? For example, Lévinas states that it is the “face to face” notion of seeing one in distress, yet what if it is a group of people, and what if they are not in close proximity but on the other side of the world? What if they are on the other side of a screen that can also be artificial intelligence in our modern era. Are we still responsible? And if we are responsible, how does Lévinas’s concept of responsibility fit into that situation or is it limited? I want to examine responsibility in terms of proximity through a Lévinasian ethical lens and plurality, defined as more than two individuals, by questioning responsibility in terms of relationality, and vulnerability. I will be looking mainly at five authors Emmanuel Lévinas, Ernst Van Alphen, Judith Butler, Kevin Quashi, and Lisa Guenther, to answer the question of whether Lévinas’s definition of responsibility includes proximity, and plurality. (shrink)

In the philosophical literature, self-deception is mainly approached through the analysis of paradoxes. Yet, it is agreed that self-deception is motivated by protection from distress. In this paper, we argue, with the help of findings from cognitive neuroscience and psychology, that self-deception is a type of affective coping. First, we criticize the main solutions to the paradoxes of self-deception. We then present a new approach to self-deception. Self-deception, we argue, involves three appraisals of the distressing evidence: (a) appraisal of (...) the strength of evidence as uncertain, (b) low coping potential and (c) negative anticipation along the lines of Damasio’s somatic marker hypothesis. At the same time, desire impacts the treatment of flattering evidence via dopamine. Our main proposal is that self-deception involves emotional mechanisms provoking a preference for immediate reward despite possible long-term negative repercussions. In the last part, we use this emotional model to revisit the philosophical paradoxes. (shrink)

The wishes of registered organ donors are regularly set aside when family members object to donation. This genuine overruling of the wishes of the deceased raises difficult ethical questions. A successful argument for providing the family with a veto must (a) provide reason to disregard the wishes of the dead, and (b) establish why the family should be allowed to decide. One branch of justification seeks to reconcile the family veto with important ideas about respecting property rights, preserving autonomy, and (...) preventing harm. These arguments are ultimately unsuccessful. Another branch of arguments is consequentialist, pointing out the negative consequences of removing the veto. Whether construed as concerning family distress or as a potential drop in the organs available, these arguments are unsuccessful; the first fails to recognize the tremendous distress associated with waiting for an organ, while the second has little supporting evidence. A final section considers and rejects whether combining some of the arguments just examined could justify the family veto. We should thus remove the family veto in organ donation. (shrink)

Newcomers to the philosophy of mind are sometimes resistant to the idea that pain is a mental state. If asked to defend their view, they might say something like this: pain is a physical state, it is a state of the body. A pain in one’s leg feels to be in the leg, not ‘in the mind’. After all, sometimes people distinguish pain which is ‘all in the mind’ from a genuine pain, sometimes because the second is ‘physical’ while the (...) first is not. And we also occasionally distinguish mental pain (which is normally understood as some kind of emotional distress) from the ‘physical pain’ one feels in one’s body. So what can be meant by saying that pain is a mental state? Of course, it only takes a little reflection shows that this naive view is mistaken. Pain is a state of consciousness, or an event in consciousness, and whether or not all states of mind are conscious, it is indisputable that only minds, or states of mind, are conscious.2 But does the naive view tell us anything about the concept of pain, or the concept of mind? I think it does. In this paper, I shall give reasons for thinking that consciousness is a form of intentionality, the mind’s ‘direction upon its objects’. I shall claim that the consciousness involved in bodily sensations like pain is constituted by the mind’s direction upon the part or region of the body where the sensation feels to be. Given this, it is less surprising that the naive view of pain says what it does: the apparent ‘physicality’ of pain is a consequence of confusing the object of the intentional state—the part of the body in which the pain is felt—with the state of being in pain. (shrink)

The notion of harm is frequently used in the discussion of the nature of mental disorder. Harm also plays important roles in the prominent diagnostic manuals such as DSM and ICD. Recently, however, Cristina Amoretti and Elisabetta Lalumera have questioned the idea that harm should be a necessary constituent of mental disorders. They argue that the notion of harm is underspecified and potentially leads to false negatives in diagnosing mental disorders. Given that harm plays significant roles in medical diagnosis and (...) treatment indicates that we should be reluctant to remove it as a criterion for deciding whether some condition is a mental disorder. Instead, we argue that harm should be understood in the prudential sense and harm in this sense provides a way of responding to worries raised by Amoretti and Lalumera, while staying true to the conception of harm that is relevant for psychiatric practice. (shrink)

On an account of virtue as skill, virtues are acquired in the ways that skills are acquired. In this paper I focus on one implication of that account that is deserving of greater attention, which is that becoming more skillful requires learning from one’s failures, but that turns out to be especially challenging when dealing with moral failures. In skill acquisition, skills are improved by deliberate practice, where you strive to correct past mistakes and learn how to overcome your current (...) limitations. A similar story applies to virtue acquisition, as moral failures will be a part of anyone’s life, and we will all have to learn from these experiences. However, despite the importance of being able to learn from our mistakes, this is very difficult in practice, given that failure of any kind can be distressing, and especially so for moral failure. The distress created by a recognition of moral failure often prompts responses of anger, avoidance, or defensiveness; rather than attempts to make amends and when necessary to work on self-improvement. The most potentially distressing response to moral failure is shame, as it is often associated with defensiveness. It is here where emotion regulation will be important to manage that distress, and I focus on the skill of emotion differentiation. I argue that emotion differentiation is a promising strategy for distinguishing the emotions we may experience in the wake of failure, including shame, and to encourage those emotions that motivate self-improvement. Thus, emotion regulation is important for virtue acquisition. (shrink)

Empathy is essential in story comprehension as it requires understanding of the emotions and intentions of the characters. We evaluated the sensitivity of an emotional perspective-taking task using Aesop’s Fables in relation to empathy. Participants (N = 301) were presented with 15 short fables and were asked to rate the intensity of the emotions they would feel (anger, sadness, disgust, fear, surprise, joy, trust, and anticipation) by adopting the perspective of one of the characters (offender, victim) or the observer’s perspective. (...) A data-driven approach revealed that participants’ responses were aligned with the characters’ intentions, suggesting successful emotional perspective-taking. Participants sympathized with the victim rather than the offender, demonstrating affective sharing processes. Further, participants with higher empathy scores exhibited stronger negative emotions from the victim’s perspective, independently of their level of distress. Our task was not influenced by gender effects. We suggest that the Aesop’s Fables task could provide an indirect instrument to study empathy. (shrink)

Trust is a core feature of the physician-patient relationship, and risk is central to trust. Patients take risks when they trust their providers to care for them effectively and appropriately. Not all patients take these risks: some medical relationships are marked by mistrust and suspicion. Empirical evidence suggests that some patients and families of color in the United States may be more likely to mistrust their providers and to be suspicious of specific medical practices and institutions. Given both historical and (...) ongoing oppression and injustice in American medical institutions, such mistrust can be apt. Yet it can also frustrate patient care, leading to family and provider distress. In this paper, I propose one way that providers might work to reestablish trust by taking risks in signaling their own trustworthiness. This interpersonal step is not meant to replace efforts to remedy systemic injustice, but is an immediate measure for addressing mistrust in occurrent cases. (shrink)

The present narrative review seeks to unravel where we are now, and where we need to go to delineate the active ingredients in psychotherapy delivered by conversational agents (e.g., chatbots). While psychotherapy delivered by conversational agents has shown promising effectiveness for depression, anxiety, and psychological distress across several randomized controlled trials, little emphasis has been placed on the therapeutic processes in these interventions. The theoretical framework of this narrative review is grounded in prominent perspectives on the active ingredients in (...) psychotherapy. Based on search terms derived from various theoretical perspectives, we conducted a systematic literature search of four scientific databases and identified 17 studies. Across the selected studies, three themes emerged: relationship variables, emotional venting, and cognitive factors. While methodological issues compromise the epistemic value of this evidence base, core questions also remain to be answered. Such questions include, but are not limited to, whether humans can form affectionate bonds to inanimate beings and whether these kind of mental health treatments should be understood as psychotherapy or something else. Researchers should therefore be cautious when applying theories of psychotherapy in the realm of conversational agents. We conclude the paper by introducing recommendations for future research, which we hope will help instigate methodologically sound studies in this field. (shrink)

Here are four examples of “seeing.” You see that something green is wriggling. You see that an iguana is in distress. You see that someone is wrongfully harming an iguana. You see that torturing animals is wrong. The first is an example of low-level perception. You visually represent color and motion. The second is an example of high-level perception. You visually represent kind properties and mental properties. The third is an example of moral perception. You have an impression of (...) moral properties. The fourth is an example of intuition. You intellectually grasp a general moral truth. Should moral perceptions be thought of as high-level perceptions or as intuitions? Most proponents of moral perception have thought of them as high-level perceptions. I give epistemological and methodological reasons for thinking that at least some are examples of what I call low-level intuitions—experiences in which we both apprehend abstract generalities and apply them to concrete particulars. (shrink)

Meursault, the protagonist of Camus' The Stranger, is unable to grieve, a fact that ultimately leads to his condemnation and execution. Given the emotional distresses involved in grief, should we envy Camus or pity him? I defend the latter conclusion. As St. Augustine seemed to dimly recognize, the pains of grief are integral to the process of bereavement, a process that both motivates and provides a distinctive opportunity to attain the good of self-knowledge.

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

In his account of Pyrrhonism, Sextus Empiricus talks about the disturbance concerning matters of opinion that afflicts his dogmatic rivals and that he himself was afflicted by before his conversion to Pyrrhonism. The aim of the present paper is to identify the distinct sources of doxastic disturbance that can be found in that account, and to determine whether and, if so, how they are related. The thesis to be defended is that it is possible to discern three sources of doxastic (...) disturbance and that two of them are to be explained by reference to the third, which is the real cause of mental distress. The paper also considers whether the thesis in question entails that there is no reason for the Pyrrhonist to suspend judgment across the board, but only to suspend judgment about evaluative matters. (shrink)

Many accounts of the morality of abortion assume that early fetuses must all have or lack moral status in virtue of developmental features that they share. Our actual attitudes toward early fetuses don’t reflect this all-or-nothing assumption: early fetuses can elicit feelings of joy, love, indifference, or distress. If we start with the assumption that our attitudes toward fetuses reflect a real difference in their moral status, then we need an account of fetal moral status that can explain that (...) difference. I argue that we can have or lack relational obligations to early fetuses in light of our own activities or choices, independent of the fetus’s own features or properties. Those relational obligations make the early fetus morally considerable to the persons who stand in a moral relation to it. Pregnant persons (and other participants in the procreative process) can come to have relational obligations to an early fetus just in virtue of their own decision to create a person, either by intentionally getting pregnant or by deciding to continue a pregnancy. That decision not only makes it appropriate for them to care about the fetus, but it also generates obligations to the fetus that they didn’t have before that decision. (shrink)

Fear, anger and hopelessness were the most frequent traumatic emotional responses in the general public during the first stage of outbreak of the COVID-19 epidemic in the Czech Republic (N = 1,000). The four most frequent categories of fear were determined: (a) fear of the negative impact on household finances, (b) fear of the negative impact on the household finances of significant others, (c) fear of the unavailability of health care, and (d) fear of an insufficient food supply. The pessimistic (...) communications used by the Czech mass media contributed to intensifying traumatic feelings, fears and psychological distress in the general public during the outbreak of the COVID-19 epidemic. The anxious emotional tone of the messages and the presentation of selectively chosen “bad ending stories” contributed to the psychological traumatization of the Czech population. This form of communication was motivated by an effort to reach the broadest audience possible. Older adults were the most affected part of the population because of their isolation and their very limited opportunity to share their worries and emotions with others. The communication used by the Czech mass media during the outbreak of the COVID-19 epidemic is a representative example of a traumatizing form of media communication during an epidemic. (shrink)