Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call ‘value-impregnation,’ may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers’ decision making is sometimes affected (...) by value-impregnated factual claims or assumptions. If such claims influence e.g. doctor–patient encounters, this will likely have a negative impact on the provision of correct information to patients and on patients’ influence on decision making regarding their own care. In this paper, we explore the idea that value-impregnated factual claims influence healthcare decisions through a series of medical examples. We suggest that more research is needed to further examine whether healthcare staff’s personal values influence clinical decision-making. (shrink)

In this paper it is argued that physicians’ restrictive attitudes in offering abortions during 1946–1965 in Sweden were due to their private values. The values, however, were rarely presented openly. Instead physicians’ values influenced their assessment of the facts presented—that is, the women's’ trustworthiness. In this manner the physicians were able to conceal their private values and impede the women from getting what they wanted and needed. The practice was concealed from both patients and physicians and never publicly discussed. It (...) is also argued that a similar tacit practice could currently be applied by palliative care physicians. Such practice might allow palliative care physicians to be restrictive when offering sedation therapy without appearing paternalistic or declaring conscientious objections. However, the practice runs counter to patients’ right to participate in making decisions. The women seeking abortion began to oppose the situation and eventually a new abortion law was introduced 1975. Patients at the end of life will never be able to protest against palliative care physicians’ restrictive attitudes. This is a vulnerable and weak group, unable to lodge complaints after the treatment. In order to respect patients’ autonomy, even suffering patients at the end of their lives, it is suggested that physicians should openly declare their values when it comes to providing treatments that might shorten life. Such transparency might facilitate more genuine shared decision-making and accordingly less suboptimal end-of-life care. (shrink)

A scientific paradigm typically embraces research norms and values, such as truth-seeking, critical thinking, disinterestedness, and good scientific practice. These values should prevent a paradigm from introducing defective assumptions. But sometimes, scientists who are also physicians develop clinical norms that are in conflict with the scientific enterprise. As an example of such a conflict, we have analyzed the genesis and development of the shaken baby syndrome paradigm. The point of departure of the analysis is a recently conducted systematic literature review, (...) which concluded that there is very low scientific evidence for the basic assumption held by Child Protection Teams: when certain signs are present the infant has been violently shaken. We suggest that such teams have developed more value-based than scientific-based criteria when classifying SBS cases. Further, we suggest that the teams are victims of “groupthink,” aggravating the difficulties in considering critics’ questioning the criteria established by the teams. (shrink)

Aims The aim of this study was to examine if it is plausible to interpret the appearance of shame in a Swedish healthcare setting as a reaction to having one's honour wronged. Methods Using a questionnaire, we studied answers from a sample of long-term sick-listed patients who had experienced negative encounters (n=1628) and of these 64% also felt wronged. We used feeling wronged to examine emotional reactions such as feeling ashamed and made the assumption that feeling shame could be associated (...) with having one's honour wronged. In statistical analyses relative risks (RRs) were computed, adjusting for age, sex, disease-labelling, educational levels, as well as their 95% CI. Results Approximately half of those who had been wronged stated that they also felt shame and of those who felt shame, 93% (CI 91 to 95) felt that they had been wronged. The RR was 4.5 (CI 3.0 to 6.8) for shame when wronged. This can be compared with the other emotional reactions where the RRs were between 1.1 (CI 0.9 to 1.3)–1.4 (CI 1.2 to 1.7). We found no association between country of birth and feeling shame after having experienced negative encounters. Conclusions We found that the RR of feeling shame when wronged was significantly higher compared with other feelings. Along with theoretical considerations, and the specific types of negative encounters associated with shame, the results indicate that our research hypothesis might be plausible. We think that the results deserve to be used as point of departure for future research. (shrink)

During spring 2009 a Swedish senior paediatric intensivist and associate professor was detained and later prosecuted for mercy-killing a child with severe brain damage. The intensivist was accused of having used high doses of thiopental after having withdrawn life-sustaining treatment when the child was imminently dying. After more than 2.5 years of investigation the physician was acquitted by the Stockholm City Court. The court additionally stated that the physician had provided good end-of-life care. Since the trial it has become evident (...) that the accusation was based on a problematic medicolegal report. Nevertheless, the event has had severe negative consequences for the physician personally and professionally, and probably also, in general, for patients in the final stage of life. This case illustrates, together with other cases, that there is a lack of correspondence between ethical soft law/healthcare law and the Penal Code. To optimise medical practice we suggest that the criminal law be carefully examined and if possible changed. Furthermore, we suggest a peer-review system for assessing medicolegal reports in cases of suspected homicide. (shrink)

We have examined healthcare staff attitudes of toward a blogging cancer patient who publishes critical posts about her treatment and their possible effect on patient-staff relationships and treatment decisions. We used two versions of a questionnaire containing a vignette based on a modified real case involving a 39-year-old cancer patient who complained on her blog about how she was encountered and the treatment she received. Initially she was not offered a new, and expensive treatment, which might have influenced her perception (...) of further encounters. In one version of the vignette, the team decides to put extra effort into both encounters and offers the expensive new cancer treatment. In the other version, the team decides to follow the clinic’s routine to the letter. Subsequently, blog postings became either positive or negative in tone. We also divided participants into value-neutral and value-influenced groups by asking how their trust in healthcare would be affected if the team’s suggestion were followed. A total of 56 % of the respondents faced with a team decision to ‘do something-extra’ in encounters would act in accordance with this ambition. Concerning treatment, 32 % would follow the team’s decision to offer a new and expensive treatment. A large majority of those who received the “follow-routine” version agreed to do so in encountering [94 % ]. Similar proportions were found regarding treatment [86 % ]. A total of 83 % of the value-neutral participants who received the “do-something-extra” version stated that they would act as the team suggested regarding encounters, while 57 % would do so in regard to treatment. Among the value-influenced participants who received the “do-something-extra” version, 45 % stated that they would make an extra effort to accommodate the patient and her needs, while the proportion for treatment was 22 %. Among those who had received the “follow-routine” version, a large majority agreed, and no difference was indicated between the value-neutral and the value-influenced participants. The present study indicates that healthcare staff is indeed influenced by reading a patient’s critical blog entries, largely regarding encounters, but also concerning treatment is concerned. Value-neutral healthcare personnel seem to exhibit a pragmatic attitude and be more inclined to heed and respond to a patient whose criticism may well be warranted. The study also indicates that healthcare staff is partly positive or negative to future blogging patients depending on how the issue has been framed. For future research we suggest as a bold hypothesis that the phrase “clinical routine” might conceal power aspects masquerading as adopted ethical principles. (shrink)

Epidemiological studies indicate that the incidence of shaken baby cases is overestimated and that this is due to biased classifications, based on ethical rather than scientific considerations. In...

One problem, as we see it, is that in Sweden we do not know for sure whether or not certain soft laws ….

BackgroundThe ability of healthcare to protect sensitive personal data in medical records and registers might influence public trust, which in turn might influence willingness to allow healthcare to use such data. The aim of this study was to examine how the general public’s trust relates to their attitudes towards uses of health data.MethodsA stratified sample from the general Swedish population received a questionnaire about their willingness to share health data. Respondents were also asked about their trust in the management and (...) protection of electronic health data.ResultsA large majority (81.9%) of respondents revealed high levels of trust in the ability of healthcare to protect electronic patient data. Good health was associated with significantly higher levels of trust compared to bad health. Respondents with low levels of trust were significantly less willing to allow personal data to be used for different purposes and were more inclined to insist on being asked for permission beforehand. Those with low levels of trust also perceived risks of unauthorized access to personal data to be higher and the likely damage of such unauthorized access worse, compared to those with high levels of trust.ConclusionsTrust in the ability of healthcare to protect electronic health is generally high in Sweden. Those with higher levels of trust are more willing to let their data be used, including without informed consent. It thus seems crucial to promote trust in order to be able to reap the benefits that digitalization makes possible through increased access and use of data in healthcare. (shrink)

Background Physician-assisted suicide is a controversial issue and has sometimes raised emotion-laden reactions. Against this backdrop, we have analyzed how Swedish physicians are reasoning about physician-assisted suicide if it were to be legalized. Methods and participants We conducted a cross-sectional study and analyzed 819 randomly selected physicians’ responses from general practitioners, geriatricians, internists, oncologists, psychiatrists, surgeons, and all palliativists. Apart from the main questions about their attitude toward physician-assisted suicide, we also asked what would happen with the respondents’ own trust (...) in healthcare if physician-assisted suicide were legalized. Response options were that trust would decrease, not be influenced, or would increase. Results We identified a strong statistical association between on the one hand those whose own trust would increase and who were pro physician-assisted suicide, and on the other hand those who were against physician-assisted suicide and whose own trust would decrease [relative risk: 16.7 (95% confidence interval: 10.2–27.2)]. Among those whose own trust would not be influenced (n = 456), 60% were pro pysician-assisted suicide, 16% were against, and 24% were undecided. Of those whose trust would increase or not be influenced, a large majority supported autonomy-based arguments, whereas those whose trust would decrease supported non-maleficence-based arguments. Conclusion Analyzing the answers after having divided respondents into those whose own trust in healthcare would decrease or increase and not be influenced brings about interesting results such as how the three groups prioritize arguments for and against physician-assisted suicide. This way of analyzing the data seems to be a promising strategy when identifying value-impregnated factual claims. (shrink)

This textbook introduces the reader to basic problems in the philosophy of science and ethics, mainly by means of examples from medicine. It is based on the conviction that philosophy, medical science, medical informatics, and medical ethics are overlapping disciplines. It claims that the philosophical lessons to learn from the twentieth century are not that nature is a 'social construction' and that 'anything goes' with respect to methodological and moral rules. Instead, it claims that there is scientific knowledge, but that (...) it is never completely secure; that there are norms, but that they are situation-bound; and that, therefore, it makes good sense to search for scientific truths and try to act in a morally decent way. Using philosophical catchwords, the authors advocate 'fallibilism' and 'particularism'; a combination that might be called 'pragmatic realism'. (shrink)

To investigate whether Swedish physicians, contrary to Swedish health care policy, employ considerations of patient responsibility for illness when rationing expensive treatments.

Slippery-slope arguments typically question a course of action by estimating that it will end in misery once the first unfortunate step is taken. Previous studies indicate that estimations of the long-term consequences of certain debated actions, such as legalizing physician-assisted suicide, may be strongly influenced by tacit personal values. In this paper, we suggest that to the extent that slippery-slope arguments rest on estimations of future events, they may be mere rationalizations of personal values. This might explain why there are (...) proponents even for strikingly poor slippery-slope arguments. (shrink)

In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well (...) as the reasons provided for this. A random sample of general practitioners and orthopaedic surgeons as well as members of the general public received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”. (shrink)

Relational reasoning is a hallmark of human higher cognition and creativity, yet it is notoriously difficult to encourage in abstract tasks, even in adults. Generally, young children initially focus more on objects, but with age become more focused on relations. While prerequisite knowledge and cognitive resource maturation partially explains this pattern, here we propose a new facet important for children's relational reasoning development: a general orientation to relational information, or a relational mindset. We demonstrate that a relational mindset can be (...) elicited, even in 4‐year‐old children, yielding greater than expected spontaneous attention to relations. Children either generated or listened to an experimenter state the relationships between objects in a set of formal analogy problems, and then in a second task, selected object or relational matches according to their preference. Children tended to make object mappings, but those who generated relations on the first task selected relational matches more often on the second task, signaling that relational attention is malleable even in young children. (shrink)

Hymen reconstruction is a controversial measure performed to help young females under threat of honour-related violence. Official guidelines often reject offering hymen reconstructions. On the other hand, extraordinary measures in order to enable operations of Jehovah’s Witnesses who want a bloodless operation in order to avoid religiously related sanctions are often considered praiseworthy. The aim is thus to examine whether or not there are relevant differences between these two measures.

BackgroundWe aim to further develop an index for detecting disguised paternalism, which might influence physicians’ evaluations of whether or not a patient is decision-competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by questioning the patient’s decision-making competence. MethodsA previously presented index, based on a cross-sectional study, was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using the average index of the whole (...) sample. We recalculated the results from a 2007 study for comparison to a new study conducted in 2020. Both studies are about physicians’ attitudes towards, and arguments for or against, physician-assisted suicide. ResultsThe 2020 study showed that geriatricians, palliativists, and middle-aged physicians (46–60 years old) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs and surgeons) had indices indicating high degrees of disguised paternalism.ConclusionsThe proposed index for identifying disguised paternalism reflects the attitude of a group towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice. Methods for improving measures of disguised paternalism are worthy of further development. (shrink)

AimsTo examine attitudes towards physician-assisted suicide (PAS) among physicians in Sweden and compare these with the results from a similar cross-sectional study performed in 2007.ParticipantsA random selection of 250 physicians from each of six specialties (general practice, geriatrics, internal medicine, oncology, surgery and psychiatry) and all 127 palliative care physicians in Sweden were invited to participate in this study.SettingA postal questionnaire commissioned by the Swedish Medical Society in collaboration with Karolinska Institute in Stockholm. ResultsThe total response rate was 59.2%. Slightly (...) fewer than half [47.1% (95% CI 43.7–50.5)] of the respondents from the six specialties accepted PAS, which is significantly more than accepted PAS in the 2007 study [34.9% (95% CI 31.5–38.3)]. Thirty-three percent of respondents were prepared to prescribe the needed drugs. When asked what would happen to the respondent’s own trust in healthcare, a majority [67.1% (95% CI 63.9–70.3)] stated that legalizing PAS would either not influence their own trust in healthcare, or that their trust would increase. This number is an increase compared to the 2007 survey, when just over half [51.9% (95% CI 48.0–55.2)] indicated that their own trust would either not be influenced, or would increase.ConclusionsThe study reveals a shift towards a more accepting attitude concerning PAS among physicians in Sweden. Only a minority of the respondents stated that they were against PAS, and a considerable proportion reported being prepared to prescribe the needed drugs for patient self-administration if PAS were legalized. (shrink)

The aim of the present study was to corroborate or undermine a previously presented conjecture that physicians’ estimations of others’ opinions are influenced by their own opinions. We used questionnaire based cross-sectional design and described a situation where an imminently dying patient was provided with alleviating drugs which also shortened life and, additionally, were intended to do so. We asked what would happen to physicians’ own trust if they took the action described, and also what the physician estimated would happen (...) to the general publics’ trust in health services. Decrease of trust was used as surrogate for an undesirable action. The results are presented as proportions with a 95 % Confidence Interval. Statistical analysis was based on inter-rater agreement -test as well as χ2 test and Odds Ratio with 95 % CI. We found a moderate inter-rater agreement between what would happen with the physicians’ own trust in healthcare and their estimations of what would happen with the general population’s trust. We identified a significant difference between being pro et contra the treatment with double intentions and the estimation of the general population’s trust. Focusing on either decreasing or increasing own trust and being pro or contra the action we identified a strong association [OR 79 ]. Although the inter-rater agreement in the present study was somewhat weaker compared to a study about the explicit use of the term ‘physicians assisted suicide’ we found that our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making. We suggest that Merton’s ideal of disinterestedness should be highlighted. (shrink)

Ethical dilemmas are common in the neonatal intensive care setting. The aim of the present study was to investigate the opinions of Swedish physicians and the general public on treatment decisions regarding a newborn with severe brain damage. We used a vignette-based questionnaire which was sent to a random sample of physicians (n = 628) and the general population (n = 585). Respondents were asked to provide answers as to whether it is acceptable to discontinue ventilator treatment, and when it (...) actually is discontinued whether or not it was acceptable to use drugs which hasten death unintentionally or intentionally. The response rate was 67 % of physicians and 46 % of the general population. A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. The study indicated that physicians and the general population have similar opinions regarding discontinuing life-sustaining treatment and providing effective drugs which might unintentionally hasten death but seem to have different views on intentions. The results might be helpful to physicians wanting to examine their own intentions when providing adequate treatment at the end of life. (shrink)

Background This study was designed to investigate how patient-reported shared decision-making relates to other aspects of patient centredness and satisfaction. Methods Questionnaire study with patients. Consecutive patients in primary care responding post visit. Associations are presented as proportions, positive predictive values, with 95% confidence intervals. Results 223 patient questionnaires were included. 62% : 55–69) of the patients indicated the highest possible rating of being involved in the decisions about their ongoing care. Self-reported SDM had a positive predictive value of between (...) 85% and 95% for five other patient-centred aspects and satisfaction. Conclusion The results suggest that shared decision making is the patient-centred aspect hardest to achieve and that a patient-centred process leading up to the decision-making increases the chance of the patient being involved in the decision-making. (shrink)

In this paper, we present and defend the theoretical framework of an empirical model to describe people’s fundamental moral attitudes (FMAs) to animals, the stratification of FMAs in society and the role of FMAs in judgment on the culling of healthy animals in an animal disease epidemic. We used philosophical animal ethics theories to understand the moral basis of FMA convictions. Moreover, these theories provide us with a moral language for communication between animal ethics, FMAs, and public debates. We defend (...) that FMA is a two-layered concept. The first layer consists of deeply felt convictions about animals. The second layer consists of convictions derived from the first layer to serve as arguments in a debate on animal issues. In a debate, the latter convictions are variable, depending on the animal issue in a specific context, time, and place. This variability facilitates finding common ground in an animal issue between actors with opposing convictions. (shrink)

Tempuutn Senarikng is one Indonesian mythical folklore telling the origins of humans in the Dayak Benuaq and Tunjung tribal communities. This research aims to represent the cultural values in Tempuutn Senarikng. This study is qualitative research using an ethnographic approach and interactive model data analysis techniques. The results show that Tempuutn Senarikng contains cultural values of the Dayak Benuaq and Tunjung tribal communities explaining that (1) the nature of the Dayak Benuaq and Tunjung people’s life is to try to avoid (...) being cursed by praying and performing ceremonial rituals. (2) The nature of the work of the Dayak Benuaq and Tunjung tribes is oriented to being a living. The work commonly carried out by the Dayak Benuaq and Tunjung people is farming. (3) Human nature in space and time is oriented to the future so what they do now will also have an impact on the future. However, they do not forget the past as part of life lessons. Therefore, they always make offerings in the form of sacrificial animal blood and cooked food in every ceremony to be grateful for what they have obtained in life, to avoid disaster, and to facilitate all hopes. (4) The nature of human relations with nature is by always maintaining harmony. They always conduct various ceremonial activities to get rid of disturbing spirits from human life, and vice versa, they are always accompanied by good spirits. In other words, the folklore of Tempuutn Senarikng is the forerunner of the traditions and culture of the Dayak Benuaq and Tunjung tribal communities continuing to be undertaken to this day.Contribution: The article results can be used in scientific research in verbal literature, folklore, and ethnology fields. (shrink)

The paper is concerned with the psychological relevance of a logical model for deductive reasoning. We propose a new way to analyze logical reasoning in a deductive version of the Mastermind game implemented within a popular Dutch online educational learning system (Math Garden). Our main goal is to derive predictions about the difficulty of Deductive Mastermind tasks. By means of a logical analysis we derive the number of steps needed for solving these tasks (a proxy for working memory load). Our (...) model is based on the analytic tableaux method, known from proof theory. We associate the difficulty of Deductive Mastermind game-items with the size of the corresponding logical trees obtained by the tableaux method. We derive empirical hypotheses from this model. A large group of students (over 37 thousand children, 5–12 years of age) played the Deductive Mastermind game, which gave empirical difficulty ratings of all 321 game-items. The results show that our logical approach predicts these item ratings well, which supports the psychological relevance of our model. (shrink)

In 2004 a survey was conducted in the member states of the European Union designed to gain greater insight into the views on control strategies for foot and mouth disease, classical swine fever, and avian influenza with respect to the epidemiological, economic and social-ethical consequences of each of these animal diseases. This article presents the results of the social-ethical survey. A selection of stakeholders from each member state was asked to prioritize issues for the prevention and control of these diseases. (...) A majority of stakeholders chose preventive measures as the preferred issue. An analysis was done to determine whether there were differences in views expressed by stakeholders from member states with a history of recent epidemics and ones without such a history, and whether there were regional differences. There were no differences between member states with or without a history of recent epidemics. There were indeed regional differences between the priority orders from Northern and Southern Europe on the one hand, and from Eastern Europe on the other. (shrink)

The chapter reviews key foundations and principles of the burgeoning discipline of executive or leadership coaching and explores how these relate to the practice, profession, and philosophy of engineering. In exploring and comparing objectives, approaches, cognitive preferences and future challenges of coaches and engineers, the authors identify a number of kindred properties between the two disciplines. This common ground would invite us to believe that engineering would naturally draw upon coaching for the development of its students, educators, and practitioners, but (...) evidence shows that this is not the case. Although many late-stage engineers get coached upon reaching the C-suite or other high positions in the public or private sectors, early and mid-career engineers do not have ready access to the coaching support seen elsewhere. Equally, very few initiatives to integrate and tap into this resource are seen in the global engineering education system for academic leaders, educators, or engineering students in ways that would benefit future generations of engineers. This chapter aims at providing a possible explanation for this gap, whilst suggesting why and how coaching could possibly be the untapped resource that engineers may need to successfully meet the challenges and demands of today and tomorrow. The authors call on philosophers to join in the efforts, drawing out some key paths for collaboration and helpful future investigative questions. (shrink)

Phylogenies are increasingly prominent across all of biology, especially as DNA sequencing makes more and more trees available. However, their utility is compromised by widespread misconceptions about what phylogenies can tell us, and improved tree thinking is crucial. The most-serious problem comes from reading trees as ladders from left to right - many biologists assume that species-poor lineages that appear early branching or basal are ancestral - we call this the primitive lineage fallacy. This mistake causes misleading inferences about changes (...) in individual characteristics and leads to misrepresentation of the evolutionary process. The problem can be rectified by considering that modern phylogenies of present-day species and genes show relationships among evolutionary cousins. Emphasizing that these are extant entities in the 21st century will help correct inferences about ancestral characteristics, and will enable us to leave behind 19th century notions about the ladder of progress driving evolution. (shrink)

In 2004 a survey was conducted in the member states of the European Union designed to gain greater insight into the views on control strategies for foot and mouth disease, classical swine fever, and avian influenza with respect to the epidemiological, economic and social-ethical consequences of each of these animal diseases. This article presents the results of the social-ethical survey. A selection of stakeholders from each member state was asked to prioritize issues for the prevention and control of these diseases. (...) A majority of stakeholders chose preventive measures as the preferred issue. An analysis was done to determine whether there were differences in views expressed by stakeholders from member states with a history of recent epidemics and ones without such a history, and whether there were regional differences. There were no differences between member states with or without a history of recent epidemics. There were indeed regional differences between the priority orders from Northern and Southern Europe on the one hand, and from Eastern Europe on the other. (shrink)

This article seeks to shed light on civil commitment in the context of the opioid crisis, to sketch the existing legal landscape surrounding civil commitment, and to illustrate the relevant medical, ethical, and legal concerns that policymakers must take into account as they struggle to find appropriate responses to the crisis.

We approach the issue of holophrasis versus compositionality in the emergence of protolanguage by analyzing the earliest combinatorial constructions in child, bonobo, and chimpanzee: messages consisting of one symbol combined with one gesture. Based on evidence from apes learning an interspecies visual communication system and children acquiring a first language, we conclude that the potential to combine two different kinds of semiotic element — deictic and representational — was fundamental to the protolanguage forming the foundation for the earliest human language. (...) This is a form of compositionality, in that each communicative element stands for a single semantic element. The conclusion that human protolanguage was exclusively holophrastic — containing a proposition in a single word — emerges only if one considers the symbol alone, without taking into account the gesture as a second element comprising the total message. (shrink)

Little attention has focused on the reporting of ethical research practices in journal articles. In Study 1, published articles in 2 psychopathology journals were reviewed to ascertain the types of ethical research information that were reported. In Study 2, a survey was sent to authors in Study 1 to determine which ethical practices they engaged in, if they reported this information, and reasons for not including this information in their article. In general, there is a great variability regarding the types (...) of ethical research practices reported in journal articles. Commonly cited reasons for not including ethical research practice information in the articles included the need for brevity, belief that it was common practice, and lack of relevance for the project. These results suggest that there is no standard practice for reporting research practices in journal articles and great variability in the implementation of procedures that are generally considered standard. (shrink)

The authors of the target article discuss the expansion of the scope of noninvasive prenatal testing (NIPT) that is likely to occur in the near future, including its possible extension to “non-medi...

Stereotype threat—a situational context in which individuals are concerned about confirming a negative stereotype—is often shown to impact test performance, with one hypothesized mechanism being that cognitive resources are temporarily co-opted by intrusive thoughts and worries, leading individuals to underperform despite high content knowledge and ability. We test here whether stereotype threat may also impact initial student learning and knowledge formation when experienced prior to instruction. Predominantly African American fifth-grade students provided either their race or the date before a videotaped, (...) conceptually demanding mathematics lesson. Students who gave their race retained less learning over time, enjoyed the lesson less, reported a diminished desire to learn more, and were less likely to choose to engage in an optional math activity. The detrimental impact was greatest among students with high baseline cognitive resources. While stereotype threat has been well documented to harm test performance, the finding that effects extend to initial learning suggests that stereotype threat's contribution to achievement gaps may be greatly underestimated. (shrink)

Evidence‐based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, (...) PsychInfo, MEDLINE and the CDC compendium of evidence‐based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM. (shrink)

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on (...) these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: Address the role of history and experience on trust, engage concerns about potential group harm, address cultural values and communication barriers, and integrate patient values and expectations into oversight and governance structures. (shrink)

It has been widely theorized and empirically proven that self-regulated learning is related to more desired learning outcomes, e.g., higher performance in transfer tests. Research has shifted to understanding the role of SRL during learning, such as the strategies and learning activities, learners employ and engage in the different SRL phases, which contribute to learning achievement. From a methodological perspective, measuring SRL using think-aloud data has been shown to be more insightful than self-report surveys as it helps better in determining (...) the link between SRL activities and learning achievements. Educational process mining on the basis of think-aloud data enables a deeper understanding and more fine-grained analyses of SRL processes. Although students’ SRL is highly contextualized, there are consistent findings of the link between SRL activities and learning outcomes pointing to some consistency of the processes that support learning. However, past studies have utilized differing approaches which make generalization of findings between studies investigating the unfolding of SRL processes during learning a challenge. In the present study with 29 university students, we measured SRL via concurrent think-aloud protocols in a pre-post design using a similar approach from a previous study in an online learning environment during a 45-min learning session, where students learned about three topics and wrote an essay. Results revealed significant learning gain and replication of links between SRL activities and transfer performance, similar to past research. Additionally, temporal structures of successful and less successful students indicated meaningful differences associated with both theoretical assumptions and past research findings. In conclusion, extending prior research by exploring SRL patterns in an online learning setting provides insights to the replicability of previous findings from online learning settings and new findings show that it is important not only to focus on the repertoire of SRL strategies but also on how and when they are used. (shrink)

Stigma can influence the prevention and identification of fetal alcohol spectrum disorder, a leading cause of developmental delay in North America. Understanding the effects of public health practices and policies on stigma is imperative. We reviewed social science and biomedical literatures to understand the nature of stigma in FASD and its relevance from an ethics standpoint in matters of health practices and policies. We propose a descriptive model of stigma in FASD and note current knowledge gaps; discuss the ethical implications (...) of stigma based on two distinct criteria ; and describe two cases and the concerns associated with inadvertent stigmatization by public health initiatives for FASD. We recommend further empirical and ethical analyses to examine whether public health policies and practices inadvertently stigmatize and impact the success of public health initiatives and programs for FASD. (shrink)

This paper discusses the possibility of modelling inductive inference (Gold 1967) in dynamic epistemic logic (see e.g. van Ditmarsch et al. 2007). The general purpose is to propose a semantic basis for designing a modal logic for learning in the limit. First, we analyze a variety of epistemological notions involved in identification in the limit and match it with traditional epistemic and doxastic logic approaches. Then, we provide a comparison of learning by erasing (Lange et al. 1996) and iterated epistemic (...) update (Baltag and Moss 2004) as analyzed in dynamic epistemic logic. We show that finite identification can be modelled in dynamic epistemic logic, and that the elimination process of learning by erasing can be seen as iterated belief-revision modelled in dynamic doxastic logic. Finally, we propose viewing hypothesis spaces as temporal frames and discuss possible advantages of that perspective. (shrink)