BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

Adolescents often create social relationships with their gaming peers who take on the role of offline friends and peer groups. Through collaboration and competition in the games, the social relationships of adolescents are becoming broader and thicker. Although this is a common phenomenon in online games, few studies have focused on the formation and roles of social capital among adolescent gamers. In particular, longitudinal research that examines the role of social capital in terms of influencing gaming time on adolescent gamers’ (...) psychosocial factors has been minimal. This study was designed to fill this gap to see the long-term effect of social capital among adolescent gamers. Specifically, by using the three-year longitudinal data involving 403 adolescents, we analyzed the effect of gaming time on psychological factors with the moderating role of social capital. Results showed that social capital played a crucial moderating role. In the higher social capital group, gaming time enhanced the degree of self-esteem and life satisfaction. However, a vicious circle was found in the lower social capital group: Gaming time increased the degree of depression but decreased self-esteem, which in turn led to increase in gaming time. These results indicate that games work as an important tool for social capital cultivation among adolescent gamers, which imply successful cultivation of social capital is a key to positive gaming effects. Theoretical and practical implications are discussed. (shrink)

Background Conventional consent practices face ethical challenges in continuously evolving digital health environments due to their static, one-time nature. Dynamic consent offers a promising solution, providing adaptability and flexibility to address these ethical concerns. However, due to the immaturity of the concept and accompanying technology, dynamic consent has not yet been widely used in practice. This study aims to identify the facilitators of and barriers to adopting dynamic consent in real-world scenarios. Methods This scoping review, conducted in December 2022, adhered (...) to the PRISMA Extension for Scoping Reviews guidelines, focusing on dynamic consent within the health domain. A comprehensive search across Web of Science, PubMed, and Scopus yielded 22 selected articles based on predefined inclusion and exclusion criteria. Results The facilitators for the adoption of dynamic consent in digital health ecosystems were the provision of multiple consent modalities, personalized alternatives, continuous communication, and the dissemination of up-to-date information. Nevertheless, several barriers, such as consent fatigue, the digital divide, complexities in system implementation, and privacy and security concerns, needed to be addressed. This study also investigated current technological advancements and suggested considerations for further research aimed at resolving the remaining challenges surrounding dynamic consent. Conclusions Dynamic consent emerges as an ethically advantageous method for digital health ecosystems, driven by its adaptability and support for continuous, two-way communication between data subjects and consumers. Ethical implementation in real-world settings requires the development of a robust technical framework capable of accommodating the diverse needs of stakeholders, thereby ensuring ethical integrity and data privacy in the evolving digital health landscape. (shrink)

Background: An association between gaming disorder and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs.Methods: Five representative GD instruments were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on (...) either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized.Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 and a mean test-retest estimate of 0.86. Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression, 0.29 with anxiety, 0.30 with aggression, –0.22 with quality of life, 0.29 with loneliness, 0.56 with internet addiction, and 0.40 with game playtime, respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented.Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies.Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781]. (shrink)

Acknowledging separable factors underlying negative symptoms may lead to better understanding and treatment of negative symptoms in individuals with schizophrenia. The current study aimed to test whether the negative symptoms factor (NSF) of the Positive and Negative Syndrome Scale (PANSS) would be better represented by expressive and experiential deficit factors, rather than by a single factor model, using confirmatory factor analysis (CFA). Two hundred and twenty individuals with schizophrenia spectrum disorders completed the PANSS; subsamples additionally completed the Brief Negative Symptom (...) Scale (BNSS) and the Motivation and Pleasure Scale—Self-Report (MAP-SR). CFA results indicated that the two-factor model fit the data better than the one-factor model; however, latent variables were closely correlated. The two-factor model’s fit was significantly improved by accounting for correlated residuals between N2 (emotional withdrawal) and N6 (lack of spontaneity and flow of conversation), and between N4 (passive social withdrawal) and G16 (active social avoidance), possibly reflecting common method variance. The two NSF factors exhibited differential patterns of correlation with subdomains of the BNSS and MAP-SR. These results suggest that the PANSS NSF would be better represented by a two-factor model than by a single-factor one, and support the two-factor model’s adequate criterion-related validity. Common method variance among several items may be a potential source of measurement error under a two-factor model of the PANSS NSF. (shrink)

Solidarity as a social phenomenon means a sharing of feelings, interests, risks and responsibilities. The Western-European Welfare State can be seen as an organized system of solidarity, historically grown from group solidarity among workers, later between workers and employers, moving towards solidarity between larger social groups: between healthy people and the sick, between the young and the elderly, between the employed and the unemployed. This sharing of risks at a societal level however, has revealed the risks of sharing. In (...) the postwar development of the welfare state, solidarity has been organized mainly in administrative forms, run by anonymous bureaucracies and giving way to free riders and calculative citizens. This article describes this development and provides arguments for a reorientation of the welfare state and for the re-allocation of rights, risks and responsibilities. (shrink)

The article presents the findings from a survey of over 400 young people in metropolitan areas in the Netherlands and England concerning their views on identity and school history. The research explored pupils' ideas about which facets of history were of interest to them, what history they believed should be taught in schools, and their views on the purposes of school history and history in general. The coding of the data made it possible to delineate between those from different (...) ethnic minority backgrounds, boys and girls, age and level of education and first or second generation of migration. The study revealed significant differences between young people's ideas about history and identity, and those advanced by politicians and policy makers in the Netherlands, England and elsewhere. The concluding section of the paper considers the implications of the findings for policy makers in the field of history education in schools. (shrink)

To what extent do moral judgments depend on conscious reasoning from explicitly understood principles? We address this question by investigating one particular moral principle, the principle of the double effect. Using web-based technology, we collected a large data set on individuals' responses to a series of moral dilemmas, asking when harm to innocent others is permissible. Each moral dilemma presented a choice between action and inaction, both resulting in lives saved and lives lost. Results showed that: (1) patterns of moral (...) judgments were consistent with the principle of double effect and showed little variation across differences in gender, age, educational level, ethnicity, religion or national affiliation (within the limited range of our sample population) and (2) a majority of subjects failed to provide justifications that could account for their judgments. These results indicate that the principle of the double effect may be operative in our moral judgments but not open to conscious introspection. We discuss these results in light of current psychological theories of moral cognition, emphasizing the need to consider the unconscious appraisal system that mentally represents the causal and intentional properties of human action. (shrink)

: To what extent do moral judgments depend on conscious reasoning from explicitly understood principles? We address this question by investigating one particular moral principle, the principle of the double effect. Using web-based technology, we collected a large data set on individuals’ responses to a series of moral dilemmas, asking when harm to innocent others is permissible. Each moral dilemma presented a choice between action and inaction, both resulting in lives saved and lives lost. Results showed that: patterns of moral (...) judgments were consistent with the principle of double effect and showed little variation across differences in gender, age, educational level, ethnicity, religion or national affiliation and a majority of subjects failed to provide justifications that could account for their judgments. These results indicate that the principle of the double effect may be operative in our moral judgments but not open to conscious introspection. We discuss these results in light of current psychological theories of moral cognition, emphasizing the need to consider the unconscious appraisal system that mentally represents the causal and intentional properties of human action. (shrink)

Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained of (...) their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)

When we evaluate moral agents, we consider many factors, including whether the agent acted freely, or under duress or coercion. In turn, moral evaluations have been shown to influence our (non-moral) evaluations of these same factors. For example, when we judge an agent to have acted immorally, we are subsequently more likely to judge the agent to have acted freely, not under force. Here, we investigate the cognitive signatures of this effect in interpersonal situations, in which one agent (“forcer”) forces (...) another agent (“forcee”) to act either immorally or morally. The structure of this relationship allowed us to ask questions about both the “forcer” and the “forcee.” Paradoxically, participants judged that the “forcer” forced the “forcee” to act immorally (i.e. X forced Y), but that the “forcee” was not forced to act immorally (i.e. Y was not forced by X). This pattern obtained only for human agents who acted intentionally. Directly changing participants’ focus from one agent to another (forcer vs. forcee) also changed the target of moral evaluation and therefore force attributions. The full pattern of judgments may provide a window into motivated moral reasoning and focusing bias more generally; participants may have been motivated to attribute greater force to the immoral forcer and greater freedom to the immoral forcee. (shrink)

Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained of (...) their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)

Moral judgments, whether delivered in ordinary experience or in the courtroom, depend on our ability to infer intentions. We forgive unintentional or accidental harms and condemn failed attempts to harm. Prior work demonstrates that patients with damage to the ventromedial prefrontal cortex deliver abnormal judgments in response to moral dilemmas and that these patients are especially impaired in triggering emotional responses to inferred or abstract events, as opposed to real or actual outcomes. We therefore predicted that VMPC patients would deliver (...) abnormal moral judgments of harmful intentions in the absence of harmful outcomes, as in failed attempts to harm. This prediction was confirmed in the current study: VMPC patients judged attempted harms, including attempted murder, as more morally permissible relative to controls. These results highlight the critical role of the VMPC in processing harmful intent for moral judgment. (shrink)

The issues of climate change and environmental degradation elicit diverse responses. This paper explores how an understanding of human moral psychology might be used to motivate conservation efforts. Moral concerns for the environment can relate to issues of harm or impurity . Aversions to harm are linked to concern for current or future generations, non-human animals, and anthropomorphized aspects of the environment. Concerns for purity are linked to viewing the environment as imbued with sacred value and therefore worthy of being (...) protected at all costs. While both harm-based and purity-based framings of environmental issues can sometimes backfire, we argue that making these moral concerns salient can nevertheless bring about moral responses to environmental issues. In sum, scientists' emerging knowledge about the moral mind can be used to facilitate the sustainable conservation of the planet. (shrink)

This paper considers what it is about violent video games that leads one reasonably minded person to declare “That is immoral” while another denies it. Three interpretations of video game content are discussed: reductionist, narrow, and broad. It is argued that a broad interpretation is required for a moral objection to be justified. It is further argued that understanding the meaning of moral utterances—like “x is immoral”—is important to an understanding of why there is a lack of moral consensus when (...) it comes to the content of violent video games. Constructive ecumenical expressivism is presented as a means of explaining what it is that we are doing when we make moral pronouncements and why, when it comes to video game content, differing moral attitudes abound. Constructive ecumenical expressivism is also presented as a means of illuminating what would be required for moral consensus to be achieved. (shrink)

Detailed studies of people who have experienced the Capgras delusion (the delusion that certain other people, usually close relatives, have been replaced by impostors) have led to advances in constructing an account which can deal with the basic symptomatology, testing alternative possibilities, generating and testing non‐trivial predictions, and broadening the scope of the basic account to encompass other delusions. This paper outlines these developments. It uses them to explore implications for understanding the formation and maintenance of beliefs, and to discuss (...) basic principles of what has come to be known as cognitive neuropsychiatry. (shrink)

Emotion regulation choices are known to be profoundly consequential across affective, cognitive, and social domains. Prior studies have identified two important external factors of emotion regulati...

The aim of this paper is to present a version of the principle of alternate possibilities which is not susceptible to the Frankfurt-style counter-example. I argue that PAP does not need to be endorsed as a necessary condition for moral responsibility and, in fact, presenting PAP as a sufficient condition maintains its usefulness as a maxim for moral accountability whilst avoiding Frankfurt-style counter-examples. In addition, I provide a further sufficient condition for moral responsibility – the twin world condition – and (...) argue that this provides a means of justifying why the protagonist in Frankfurt-style scenarios is still felt to be morally responsible. I conclude with the claim that neither the amended PAP nor the twin world condition is necessary for the ascription of moral responsibility; rather, what is necessary is simply that one of these conditions is satisfied. (shrink)

This paper reports the results of a survey of 842 undergraduate business students in four nations - the United States of America, the Peoples' Republic of China, Japan, and the Republic of Korea. This survey asked students to respond to four scenarios with potentially unethical business behavior and a string of questions related to the importance of ethics in business strategy and in personal behaviors. Based on arguments related to differences in recent historical experiences, the authors suggest that student responses (...) may be as different within the East Asian environment as they are between this environment as a whole and the USA. Survey results indicate a greater perception of ethical problems and more importance placed on ethics per se in business practices, as well as less of an emphasis on social harmony on the part of USA students. At the same time, substantial national differences in response are also witnessed within the set of East Asian students. A priori expectations as to the manner in which these East Asian responses should vary based on differences in recent historical experiences are partially, but not fully, supported. The authors argue that the key value of the reported research rests on a demonstration that national differences within a common cultural area can be as great as differences across cultural areas and that practitioners of global business must fine-tune their expectations as to acceptable business and personal actions to accommodate specific national historical experiences to be effective. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)

To be successful, policy must anticipate a broad range of constituents. Yet, all too often, technology policy is written with primarily mainstream populations in mind. In this article, drawing on Value Sensitive Design and discount evaluation methods, we introduce a new method—Diverse Voices—for strengthening pre-publication technology policy documents from the perspective of underrepresented groups. Cost effective and high impact, the Diverse Voices method intervenes by soliciting input from “experiential” expert panels. We first describe the method. Then we report on two (...) case studies demonstrating its use: one with a white paper on augmented reality technology with expert panels on people with disabilities, people who were formerly or currently incarcerated, and women; and the other with a strategy document on automated driving vehicle technologies with expert panels on youth, non-car drivers, and extremely low-income people. In both case studies, panels identified significant shortcomings in the pre-publication documents which, if addressed, would mitigate some of the disparate impact of the proposed policy recommendations on these particular stakeholder groups. Our discussion includes reflection on the method, evidence for its success, its limitations, and future directions. (shrink)

ArgumentNeuroscience research has created multiple versions of the human brain. The “social brain” is one version and it is the subject of this paper. Most image-based research in the field of social neuroscience is task-driven: the brain is asked to respond to a cognitive (perceptual) stimulus. The tasks are derived from theories, operational models, and back-stories now circulating in social neuroscience. The social brain comes with a distinctive back-story, an evolutionary history organized around three, interconnected themes: mind-reading, empathy, and the (...) emergence of self-consciousness. This paper focuses on how empathy has been incorporated into the social brain and redefined via parallel research streams, employing a shared, imaging technology. The concluding section describes how these developments can be understood as signaling the emergence of a new version of human nature and the unconscious. My argument is not that empathy in the social brain is a myth, but rather that it is served by a myth consonant with the canons of science. (shrink)

Many of the errors that occur in children' subtraction are due to the use of incorrect strategies rather than to the incorrect recall of number facts. A production system is presented for performing written subtraction which is consistent with an earlier analysis of the nature of such a cognitive skill. Most of the incorrect strategies used by schoolchildren can be accounted for in a principled way by simple changes in the production system, such as the omission of individual rules or (...) the inclusion of rules appropriate to other arithmetical tasks. The production system model is evaluated against a corpus of over 1500 subtraction problems done by 10‐year olds and is shown to account for about two‐thirds of the (nonnumber fact) errors. It also provides an alternative, simpler interpretation of the subtraction errors analysed by Brown and Burton (1978). Some implications for teaching are discussed. (shrink)

Philosophy of science has traditionally focused on the epistemological dimensions of scientific practice at the expense of the ethical and political questions scientists encounter when addressing questions of policy in advisory contexts. In this article, I will explore how an exclusive focus on epistemology and theoretical reason can function to reinforce common, yet flawed assumptions concerning the role of scientific knowledge in policy decision making when reproduced in philosophy courses for science students. In order to address this concern, I will (...) argue that such courses should supplement the traditional focus on theoretical reason with an analysis of the practical reasoning employed by scientists in advisory contexts. Later sections of this paper outline a teaching strategy by which this can be achieved that consists of two steps: the first examines idealized examples of scientific advising in order to highlight the irreducible role played by moral reasoning in justifying policy recommendations. The second employs argument analysis to reveal implicit moral assumptions in actual advisory reports that form the basis for class discussion. This paper concludes by examining some of the wider benefits that can be expected from adopting such an approach. (shrink)

A bewildering array of accounts of the ontology of musical works is available. Philosophers have held that works of music are sets of performances, abstract, eternal sound-event types, initiated types, compositional action types, compositional action tokens, ideas in a composer’s mind and continuants that perdure. This paper maintains that questions in the ontology of music are, in Rudolf Carnap’s sense of the term, pseudo-problems. That is, there is no alethic basis for choosing between rival musical ontologies. While we have no (...) alethic basis for choosing any ontology of music, pragmatic reasons can be given for favoring certain ontologies of musical works over others. (shrink)

This chapter contains section titled: Art, Culture, and Appropriation Types of Cultural Appropriation What is a Culture? Objections to Cultural Appropriation In Praise of Cultural Appropriation.