BackgroundConsent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and (...) health-related data for observational research.MethodsWe conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues.ResultsSudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients’ data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives.ConclusionsSudden cardiac arrest patients’ donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants’ data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well. (shrink)

Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within (...) a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research—among researchers and with data subjects—is grounded in trust, which should be more explicitly recognised in the governance of health data research. (shrink)

BackgroundThe emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD).AimExplore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD).MethodsSemi-structured, future scenario-based (...) interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission’s Ethics Guidelines for Trustworthy AI to structure the interviews.ResultsSix themes arose from the interviews: the ability of AI to rectify human doctors’ limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the ‘human touch’; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the ‘human touch’ in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients’ individual contexts and values, in consultation with the patient.ConclusionThe ‘human touch’ patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the ‘right to a human doctor’ is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward. (shrink)

ObjectiveWhile nudges are increasingly utilized in public policy settings, their potential threat to autonomous choice is the topic of heated debate. Regardless of the actual effects of nudges on autonomy, the mere perception of nudges as autonomy threatening by the general public or policy makers could negatively influence nudge acceptability. The present online studies examined how people expect nudges to affect their perception of autonomy.MethodsIn the first study, participants were presented with a hypothetical choice that employed either a default nudge, (...) direct persuasion, or no persuasion, to steer to the desired choice. The presented influence technique was explained before participants reported their expected autonomy, as well as their expected choice satisfaction. Study 2 involved a replication of Study 1 with an additional social norm nudge condition. In Study 3, the explanation of how choice had been influenced was omitted.ResultsWhile participants expected the default nudge to violate autonomy, they had no such expectations for social norm nudges. Omitting the explanation that most people are unaware of nudges influencing their choice, reduced the negative impact of nudges on expected autonomy.ConclusionEffects of nudges on expectations of autonomy differ by type of nudge. Negative expectations are primarily driven by the explanation that decision makers are often unaware of nudges. (shrink)

PurposeTo explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction training.MethodA qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was (...) reached after 16 interviews.ResultsMost interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an “unchanged lifestyle.” Three main themes came forward; “focused attention and open awareness” during daily activities as core elements of long-term mindfulness practice; “changes in behavior and coping” that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; “integration in personal and professional life” by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were understanding and intention as “pre-conditions”; practical, personal, and professional factors of students in maintaining practice.ConclusionTwo years after participation in a MBSR training, many interviewees were still engaged in mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals. (shrink)

It is widely recognized that police performance may be hindered by psychophysiological state changes during acute stress. To address the need for awareness and control of these physiological changes, police academies in many countries have implemented Heart-Rate Variability biofeedback training. Despite these trainings now being widely delivered in classroom setups, they typically lack the arousing action context needed for successful transfer to the operational field, where officers must apply learned skills, particularly when stress levels rise. The study presented here aimed (...) to address this gap by training physiological control skills in an arousing decision-making context. We developed a Virtual-Reality breathing-based biofeedback training in which police officers perform deep and slow diaphragmatic breathing in an engaging game-like action context. This VR game consisted of a selective shoot/don’t shoot game designed to assess response inhibition, an impaired capacity in high arousal situations. Biofeedback was provided based on adherence to a slow breathing pace: the slower and deeper the breathing, the less constrained peripheral vision became, facilitating accurate responses to the in-game demands. A total of nine male police trainers completed 10 sessions over a 4-week period as part of a single-case experimental ABAB study-design. Results showed that eight out of nine participants showed improved breathing control in action, with a positive effect on breathing-induced low frequency HRV, while also improving their in-game behavioral performance. Critically, the breathing-based skill learning transferred to subsequent sessions in which biofeedback was not presented. Importantly, all participants remained highly engaged throughout the training. Altogether, our study showed that our VR environment can be used to train breathing regulation in an arousing and active decision-making context. (shrink)

Within current debates about the future impact of Artificial Intelligence on human society, roughly three different perspectives can be recognised: the technology-centric perspective, claiming that AI will soon outperform humankind in all areas, and that the primary threat for humankind is superintelligence; the human-centric perspective, claiming that humans will always remain superior to AI when it comes to social and societal aspects, and that the main threat of AI is that humankind’s social nature is overlooked in technological designs; and the (...) collective intelligence-centric perspective, claiming that true intelligence lies in the collective of intelligent agents, both human and artificial, and that the main threat for humankind is that technological designs create problems at the collective, systemic level that are hard to oversee and control. The current paper offers the following contributions: a clear description for each of the three perspectives, along with their history and background; an analysis and interpretation of current applications of AI in human society according to each of the three perspectives, thereby disentangling miscommunication in the debate concerning threats of AI; and a new integrated and comprehensive research design framework that addresses all aspects of the above three perspectives, and includes principles that support developers to reflect and anticipate upon potential effects of AI in society. (shrink)

Rumination is a process of uncontrolled, narrowly focused negative thinking that is often self-referential, and that is a hallmark of depression. Despite its importance, little is known about its cognitive mechanisms. Rumination can be thought of as a specific, constrained form of mind-wandering. Here, we introduce a cognitive model of rumination that we developed on the basis of our existing model of mind-wandering. The rumination model implements the hypothesis that rumination is caused by maladaptive habits of thought. These habits of (...) thought are modeled by adjusting the number of memory chunks and their associative structure, which changes the sequence of memories that are retrieved during mind-wandering, such that during rumination the same set of negative memories is retrieved repeatedly. The implementation of habits of thought was guided by empirical data from an experience sampling study in healthy and depressed participants. On the basis of this empirically derived memory structure, our model naturally predicts the declines in cognitive task performance that are typically observed in depressed patients. This study demonstrates how we can use cognitive models to better understand the cognitive mechanisms underlying rumination and depression. (shrink)

The complex emotional work of nurses calls for more recognition of emotional labour and the incorporation of emotional labour in nursing education. Based on participant observation and semistructured interviews, we describe the experiences of student nurses in two nursing homes for elderly people with dementia in the Netherlands. We analyse their interactions using Goffman's dramaturgical view on the front and backstage behaviour and the distinction between surface acting and deep acting. The study reveals the complexity of emotional labour, as nurses (...) swiftly adapt their communication styles and behavioural strategies between settings, patients, and even between moments within one interaction sequence, which shows that the theoretical binaries fail to fully capture their skills. Although student nurses take pride in their emotionally taxing work, the societal undervaluation of the nursing profession negatively impacts their self‐image and ambitions. More explicit recognition of these complexities would enhance their self‐appreciation. This calls for a professional ‘backstage area’ that allows nurses to articulate and strengthen their emotional labour skills. Educational institutions should provide this backstage for nurses‐in‐training to strengthen these skills as part of the professional skill set. (shrink)

The focus of this article is the analysis of generative mechanisms, a basic concept and phenomenon within the metatheoretical perspective of critical realism. It is emphasized that research questions and methods, as well as the knowledge it is possible to attain, depend on the basic view – ontologically and epistemologically – regarding the phenomenon under scrutiny. A generative mechanism is described as a trans empirical but real existing entity, explaining why observable events occur. Mechanisms are mostly possible to grasp only (...) indirectly by analytical work, based however on empirical observations. In order to achieve such an explanatory analysis, five methodological steps are suggested and discussed, among them abduction and retroduction. These steps are illustrated throughout by examples drawn from empirical research regarding social work practice. The article is concluded with a discussion of the need for knowledge of generative mechanisms. (shrink)

The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors’ manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients’ participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, relatives and caregivers acted (...) differed in the respective variations; this seemed either to promote or to impede the patients’ opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient’s personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process. (shrink)

Several evolutionary accounts of human social cognition posit that language has co-evolved with the sophisticated mindreading abilities of modern humans. It has also been argued that these mindreading abilities are the product of cultural, rather than biological, evolution. Taken together, these claims suggest that the evolution of language has played an important role in the cultural evolution of human social cognition. Here we present a new computational model which formalises the assumptions that underlie this hypothesis, in order to explore how (...) language and mindreading interact through cultural evolution. This model treats communicative behaviour as an interplay between the context in which communication occurs, an agent’s individual perspective on the world, and the agent’s lexicon. However, each agent’s perspective and lexicon are private mental representations, not directly observable to other agents. Learners are therefore confronted with the task of jointly inferring the lexicon and perspective of their cultural parent, based on their utterances in context. Simulation results show that given these assumptions, an informative lexicon evolves not just under a pressure to be successful at communicating, but also under a pressure for accurate perspective-inference. When such a lexicon evolves, agents become better at inferring others’ perspectives; not because their innate ability to learn about perspectives changes, but because sharing a language with others helps them to do so. (shrink)

(2013). ‘A Sense of the World’: Hannah Arendt’s Hermeneutic Phenomenology of Common Sense. International Journal of Philosophical Studies. ???aop.label???. doi: 10.1080/09672559.2012.743156.

In his The Symbolism of Evil Ricœur explores the dynamics of human consciousness of evil in different cultures and times. Consciousness of evil is examined by looking at the different prevailing symbols wherein human beings confess their experience with evil. Although appeared in 1960, this study is still cited in recent publications in psychology, cultural anthropology and religion. In this article I describe the context of The Symbolism of Evil as the last part of Ricœur’s study of the will and (...) give a summary of its relevant content. (shrink)

Natural languages make prolific use of conventional constituent‐ordering patterns to indicate “who did what to whom,” yet the mechanisms through which these regularities arise are not well understood. A series of recent experiments demonstrates that, when prompted to express meanings through silent gesture, people bypass native language conventions, revealing apparent biases underpinning word order usage, based on the semantic properties of the information to be conveyed. We extend the scope of these studies by focusing, experimentally and computationally, on the interpretation (...) of silent gesture. We show cross‐linguistic experimental evidence that people use variability in constituent order as a cue to obtain different interpretations. To illuminate the computational principles that govern interpretation of non‐conventional communication, we derive a Bayesian model of interpretation via biased inductive inference and estimate these biases from the experimental data. Our analyses suggest people's interpretations balance the ambiguity that is characteristic of emerging language systems, with ordering preferences that are skewed and asymmetric, but defeasible. (shrink)

Natural languages make prolific use of conventional constituent‐ordering patterns to indicate “who did what to whom,” yet the mechanisms through which these regularities arise are not well understood. A series of recent experiments demonstrates that, when prompted to express meanings through silent gesture, people bypass native language conventions, revealing apparent biases underpinning word order usage, based on the semantic properties of the information to be conveyed. We extend the scope of these studies by focusing, experimentally and computationally, on the interpretation (...) of silent gesture. We show cross‐linguistic experimental evidence that people use variability in constituent order as a cue to obtain different interpretations. To illuminate the computational principles that govern interpretation of non‐conventional communication, we derive a Bayesian model of interpretation via biased inductive inference and estimate these biases from the experimental data. Our analyses suggest people's interpretations balance the ambiguity that is characteristic of emerging language systems, with ordering preferences that are skewed and asymmetric, but defeasible. (shrink)

The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors’ manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients’ participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, relatives and caregivers acted (...) differed in the respective variations; this seemed either to promote or to impede the patients’ opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient’s personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process. (shrink)

In the 1980s extra-parliamentary social movements and critical theories of race, class, and gender added a new sociocultural understanding of justice—recognition—to the much older socioeconomic one. The best-known form of the struggle for recognition is the identity politics of disadvantaged groups. I argue that there is still another option to conceptualize their predicament, neglected in recent political philosophy, which understands exclusion not in terms of injustice, more particularly a lack of sociocultural recognition, but in terms of a lack of freedom. (...) I draw my inspiration from Hannah Arendt's model of political action. Arendt diagnoses exclusion not solely as a mode of injustice, but as a lack of participation and public freedom. Consequently, she advocates a struggle for participation, political equality, and freedom as a strategy for emancipation or empowerment. Arendt could help feminists see that collective empowerment is made possible not by a shared identity (the target of poststructuralist critics) but by common action in the service of a particular worldly issue or common end. In other words, feminists would do well to appreciate the revolutionary quality and heritage of the feminist movement better, that is, its character as a set of practices of freedom. (shrink)

Performative methods have been part of history of science research and education for at least three decades. Understood broadly, they cover every methodology in which a historian or philosopher of science engages in embodied interaction with sources, tools and materials that do not traditionally belong to historical research, with the aim of answering a historical research question. The question no longer appears to be whether performative methods have a place within history and philosophy of science research, but what their place (...) is, could, or should be; when and how they can and cannot be used. Because although performative methods are seen as an enrichment of the field by many, their growing popularity also raises questions: what new insights and challenges has the increased use of performative methods in the history of science brought us? How has it changed the field? Should performative research methods become a mandatory part of the training of new generations of historians of science? In this special issue, historians and philosophers of science for whom performative methods play an important role in their work reflect on these questions from their own research and teaching practices. (shrink)

How do cognitive biases and mechanisms from learning and use interact when a system of language conventions emerges? We investigate this question by focusing on how transitive events are conveyed in silent gesture production and interaction. Silent gesture experiments have been used to investigate cognitive biases that shape utterances produced in the absence of a conventional language system. In this mode of communication, participants do not follow the dominant order of their native language, and instead condition the structure on the (...) semantic properties of the events they are conveying. An important source of variability in structure in silent gesture is the property of reversibility. Reversible events typically have two animate participants whose roles can be reversed. Without a syntactic/conventional means of conveying who does what to whom, there is inherent unclarity about the agent and patient roles in the event. In experiment 1 we test a novel, fine-grained analysis of reversibility. Presenting a silent gesture production experiment, we show that the variability in word order depends on two factors that together determine how reversible an event is. We relate our experimental results to principles from information theory, showing that our data support the “noisy channel” account of constituent order. In experiment 2, we focus on the influence of interaction on word order variability for reversible and non-reversible events. We show that when participants use silent gesture for communicative interaction, they become more consistent in their usage of word order over time, however, this pattern less pronounced for events that are classified as strongly non-reversible. We conclude that full consistency in word order is theoretically a good strategy, but word order use in practice is a more complex phenomenon. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

We study the effect of scarcity on decision making by low income Swedes. We exploit the random assignment of welfare payments to study their borrowing decisions within the pawn and mainstream credit market. We document that higher educated borrowers borrow less frequently and choose lower loan to value ratios when their budget constraints are exogenously tighter. In contrast, low-educated borrowers do not respond to temporary elevated levels of scarcity. This lack of response translates into a significantly higher probability to default (...) and an 11.6% increase in borrowing cost. We show that a difference in access to liquidity and/or buffer stocks cannot explain our results. Instead a framework, where the awareness of self-control problems is positively correlated with education can explain that high-educated consumers choose a lower LTV as a commitment device to increase their likelihood to repay. Analogously, low-educated with less awareness of their future self-control problems, do not tie themselves to the mast and thus ignore the consequences of their credit decisions when focusing on solving acute liquidity problems. Our findings highlight that increased levels of scarcity risk reinforcing the conditions of poverty through overborrowing. (shrink)

Sixteen essays discuss _De iure praedae_ – Hugo Grotius’s 1604-1605 commentary on booty –, its sources, circumstances and consequences, and explore how Grotius the humanist, the theologian, the jurist and the politician concur in this his first exercise in natural law and rights.

A fresh look at the importance of natural and international law in the religious politics at the heartlands of the Reformation, from the Low Countries, the German principalities up to Transylvania; from Niels Hemmingsen to Gian Battista Vico; from religious reasons for the universalist claims of natural law to political arguments for the sacred polity, their tension and creative potential.

Many human languages have complex grammatical machinery devoted to temporality, but very little is known about how this came about. This paper investigates how people convey temporal information when they cannot use any conventional languages they know. In a laboratory experiment, adult participants were asked to convey information about simple events taking place at a given time, in spoken language and in silent gesture. It was shown that in spoken language, participants formed utterances according to the rules of their native (...) language, but in silent gesture, the temporal information was presented initially, and structurally separately, from the other information in the utterance. The experimental results are consistent with findings from natural systems emerging in situations of communicative stress: unsupervised adult second language learning and homesign. This confirms that presenting temporal information separately and initially is a robust strategy to talk about past and future when only sparse communicative means are available. (shrink)

Compared to approach motivation, avoidance motivation evokes vigilance, attention to detail, systematic information processing, and the recruitment of cognitive resources. From a conservation of energy perspective it follows that people would be reluctant to engage in the kind of effortful cognitive processing evoked by avoidance motivation, unless the benefits of expending this energy outweigh the costs. We put forward three empirically testable propositions concerning approach and avoidance motivation, investment of energy, and the consequences of such investments. Specifically, we propose that (...) compared to approach-motivated people, avoidance-motivated people (a) carefully select situations in which they exert such cognitive effort, (b) only perform well in the absence of distracters that occupy cognitive resources, and (c) become depleted after exerting such cognitive effort. (shrink)