BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced (...) philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

Due to the ongoing advancements in technology, socio-technical collaboration has become increasingly prevalent. This poses challenges in terms of governance and accountability, as well as issues in various other fields. Therefore, it is crucial to familiarize decision-makers and researchers with the core of human–machine collaboration. This study introduces a taxonomy that enables identification of the very nature of human–machine interaction. A literature review has revealed that automation and technical autonomy are main parameters for describing and understanding such interaction. Both aspects (...) must be carefully evaluated, as their increase has potentially far-reaching consequences. Hence, these two concepts comprise the taxonomy’s axes. Five levels of automation and five levels of technical autonomy are introduced below, based on the assumption that both automation and autonomy are gradual. The levels of automation were developed from existing approaches; those of autonomy were carefully derived from a review of the literature. The taxonomy’s use is also explained, as are its limitations and avenues for further research. (shrink)

The challenges of adapting to this new world require universities to establish new actions that strengthen the preparation of their students. The objective of the research is to identify the degree of burnout that students of the Bachelor of Public Accounting (BPA) and Bachelor of Economics and Finance (BEF) programs of the Technological Institute of Sonora are experiencing. The research methodology is quantitative, non-experimental, with a cross-sectional design and descriptive scope. To collect the information, the Burnout Inventory-Student Survey (MBISS) was (...) used, developed by Schaufeli, Martínez, Salanova, GonzálezRomá and Bakker in 2002 in its Colombian adaptation and validation developed by Hederich and Caballero in 2016. The contribution is to determine the situation of the students of these academic programs in three major aspects: Exhaustion, Cynicism and Academic Efficiency, in such a way that interventions are established that support the academic transition of the student. (shrink)

The COVID-19 pandemic has led governments worldwide to make ethically controversial decisions. As a result, healthcare professionals are facing several ethical dilemmas, especially in terms of healthcare services provided to senior citizens. Thus, the aim of this review is to identify and categorize ethical dilemmas as well as propose solutions regarding health care services for elderly individuals. A qualitative systematic review of the literature was undertaken in the first tier of the pandemic. All identified scientific and editorial articles published in (...) English or French between December 2019 and October 2021 were included. An article was excluded if it was commercial, did not address an issue in the care of the elderly or present any qualitative data. Article eligibility was determined through a process of triangulation among three independent reviewers. Initially, 69 articles met our inclusion criteria and were selected for this review. These studies can be divided into 2 distinct categories: scientific articles (17 studies) and expert opinion articles (52 articles). However, due to the large quantity of qualitative data that was extracted, only the results from the scientific literature are presented here. The analysis of the data of 17 studies has allowed the emergence of 2 main themes of ethical dilemmas: 1) access to care (3 subthemes: A) triage decisions for admission, B) access to the intensive care unit and C) vaccine allocation) and 2) infection control decisions (2 subthemes: (D) isolation and E) autonomy). Our results also revealed 4 categories of potential solutions to the encountered ethical dilemmas, namely, optimal protocols, enhanced communication, caregiver support and technological assistance (virtual team-based, AI). The ethical dilemmas that emerged from our results highlight the interest of a serious international discussion around the phenomena of ageism and its potential ethical implications for health care workers (be it under normal circumstances or exceptional circumstances such as those of a pandemic). We highly recommend that future research be undertaken to test the efficacy of the proposed solutions in providing age-friendly, dilemma-free health care and environments. (shrink)

Oregon is the only state in the United States where a physician may legally prescribe a lethal dose of barbiturate for a patient intending suicide. The Oregon Death with Dignity Act was passed by voters in 1994 and came into effect after much legal wrangling in October of 1997. At the same time, a cabinetmaker named Pat Matheny was struggling with progressive weakness from amyotrophic lateral sclerosis, or ALS. I met with Pat and his family for a lengthy interview in (...) October 1998 in Coos Bay, Oregon, for a television news report on his decision to get a lethal prescription. Below is an extract from that interview. On the day this introduction was written, 10 March 1999, Pat took the prescribed lethal overdose of barbiturates and died at home. His illness was taking his voice, he could not move his hands or legs, and breathing was becoming very difficult. His mother told me he knew that was for him. (shrink)

Este estudo objetivou refletir sobre o contexto da pós-graduação à luz dos argumentos que compõem a obra sociedade do cansaço, de Byung-Chul Han. Nas duas categorias de análise desenvolvidas, que relacionaram as vivências e as reflexões dos autores no âmbito da pós-graduação com os pressupostos de Han, ponderou-se que diversos aspectos inerentes desse cenário contribuem para ocasionar prejuízos à saúde biopsicossocial daqueles que o constituem. São exemplos a violência neuronal, o excesso de positividade, e o status, que confluem para transformar (...) os discentes em animal laborans e configurar sua habitação no território da pós-graduação como em uma sociedade do cansaço, em que não há espaço para uma vida contemplativa. Dessa forma, sinaliza-se a necessidade de reflexões que almejem preservar a saúde mental desses sujeitos como prioridade no planejamento de ensino, pesquisa e gestão, de maneira transversal. (shrink)

Cet ouvrage est né d'une réalité et d'un besoin. La petite Maëlle, enfant autiste, est devenue adolescente, alors il fallait la suivre pour mieux l'accompagner dans cette nouvelle étape de sa vie. Comme cela arrive chez les autres enfants qui entrent dans l'adolescence, tout est remis en question : les idéaux, l'identité, l'amitié, l'amour. Entre-temps, il y a eu la publication de la cinquième version du Manuel diagnostique et statistique des troubles mentaux (DSM-5). Il fallait donc étudier cette entrée dans (...) l'adolescence à partir des données diagnostiques les plus récentes. Autisme et adolescence est la suite de L'autisme, un jour à la fois et d'Accompagner un enfant autiste. Encore ici, la mère Catherine Kozminski et la psychologue Nathalie Poirier entrent en dialogue afin de se mettre à l'écoute des besoins de l'adolescente et d'élaborer les meilleures formes d'accompagnement. Il en résulte un ouvrage plein de sensibilité et rempli de solutions pratiques. (shrink)

In Older Adults (OAs), Electroencephalogram (EEG) slowing in frontal lobes and a diminished muscle atonia during Rapid Eye Movement sleep (REM) have each been effective tracers of Mild Cognitive Impairment (MCI), but this relationship remains to be explored by non-linear analysis. Likewise, data provided by EEG, EMG (Electromyogram) and EOG (Electrooculogram)—the three required sleep indicators—during the transition from REM to Non-REM (NREM) sleep have not been related jointly to MCI. Therefore, the main aim of the study was to explore, with (...) results for Detrended Fluctuation Analysis (DFA) and multichannel DFA (mDFA), the Color of Noise (CN) at the NREM to REM transition in OAs with MCI vs. subjects with good performances. The comparisons for the transition from NREM to REM were made for each group at each cerebral area, taking bilateral derivations to evaluate interhemispheric coupling and anteroposterior and posterior networks. In addition, stationarity analysis was carried out to explore if the three markers distinguished between the groups. Neuropsi and the Mini-Mental State Examination (MMSE) were administered, as well as other geriatric tests. One night polysomnography was applied to 6 OAs with MCI (68.1 ± 3) and to 7 subjects without it (CTRL) (64.5 ± 9), and pre-REM and REM epochs were analyzed for each subject. Lower scores for attention, memory and executive funcions and a greater index of arousals during sleep were found for the MCI group. Results confirmed that EOGs constituted significant markers of MCI, increasing the CN for the MCI group in REM sleep. The CN of the EEG from the pre-REM to REM was higher for the MCI group vs. the opposite for the CTRL group at frontotemporal areas. Frontopolar interhemispheric scaling values also followed this trend as well as right anteroposterior networks. EMG Hurst values for both groups were lower than those for EEG and EOG. Stationarity analyses showed differences between stages in frontal areas and right and left EOGs for both groups. These results may demonstrate the breakdown of fractality of areas especially involved in executive functioning and the way weak stationarity analyses may help to distinguish between sleep stages in OAs. (shrink)

How should one react when one has a belief, but knows that other people—who have roughly the same evidence as one has, and seem roughly as likely to react to it correctly—disagree? This paper argues that the disagreement of other competent inquirers often requires one to be much less confident in one’s opinions than one would otherwise be.

What role, if any, does formal logic play in characterizing epistemically rational belief? Traditionally, belief is seen in a binary way - either one believes a proposition, or one doesn't. Given this picture, it is attractive to impose certain deductive constraints on rational belief: that one's beliefs be logically consistent, and that one believe the logical consequences of one's beliefs. A less popular picture sees belief as a graded phenomenon.

Sometimes we get evidence of our own epistemic malfunction. This can come from finding out we’re fatigued, or have been drugged, or that other competent and well-informed thinkers disagree with our beliefs. This sort of evidence seems to seems to behave differently from ordinary evidence about the world. In particular, getting such evidence can put agents in a position where the most rational response involves violating some epistemic ideal.

How much should your confidence in your beliefs be shaken when you learn that others – perhaps 'epistemic peers' who seem as well-qualified as you are – hold beliefs contrary to yours? This article describes motivations that push different philosophers towards opposite answers to this question. It identifies a key theoretical principle that divides current writers on the epistemology of disagreement. It then examines arguments bearing on that principle, and on the wider issue. It ends by describing some outstanding questions (...) that thinking about this issue raises. (shrink)

Responding rationally to the information that others disagree with one’s beliefs requires assessing the epistemic credentials of the opposing beliefs. Conciliatory accounts of disagreement flow in part from holding that these assessments must be independent from one’s own initial reasoning on the disputed matter. I argue that this claim, properly understood, does not have the untoward consequences some have worried about. Moreover, some of the difficulties it does engender must be faced by many less conciliatory accounts of disagreement.

This is a collective study of the epistemic significance of disagreement: twelve contributors explore rival responses to the problems that it raises for philosophy. They develop our understanding of epistemic phenomena that are central to any thoughtful engagement with others' beliefs.

It has often been noticed that conciliatory views of disagreement are "self-undermining" in a certain way: advocates of such views cannot consistently maintain them when other philosophers disagree. This leads to apparent problems of instability and even inconsistency. Does self-undermining, then, show conciliationism untenable? If so, the untenablity would extend not only to almost all views of disagreement, but to a wide range of other views supporting what one might call epistemic modesty: roughly, the idea that getting evidence that one (...) has made an epistemic error in arriving at one’s opinion may require adjusting that opinion. This paper argues that the phenomenon of self-undermining does not disclose any defect in views mandating epistemic modesty. Instead, it highlights an uncomfortable but natural consequence of reflecting on one's own possible epistemic imperfections, a sort of reflection that tends to cause epistemic ideals to conflict. (shrink)

We present a synthetic theory of skilled action which proposes that cognitive processes make an important contribution to almost all skilled action, contrary to influential views that many skills are performed largely automatically. Cognitive control is focused on strategic aspects of performance, and plays a greater role as difficulty increases. We offer an analysis of various forms of skill experience and show that the theory provides a better explanation for the full set of these experiences than automatic theories. We further (...) show that the theory can explain experimental evidence for skill automaticity, including evidence that secondary tasks do not interfere with expert performance, and evidence that experts have reduced memory for performance of sensorimotor skills. (shrink)

Conciliationism holds that disagreement of apparent epistemic peers often substantially undermines rational confidence in our opinions. Uniqueness principles say that there is at most one maximally rational doxastic response to any given batch of total evidence. The two views are often thought to be tightly connected. This paper distinguishes two ways of motivating conciliationism, and two ways that conciliationism may be undermined by permissive accounts of rationality. It shows how conciliationism can flourish under certain strongly permissive accounts of rationality. This (...) occurs when the motivation for conciliationism does not come from taking disagreement as evidence of one's own rational failings. However, divorcing the motive for conciliating from worries about rationality does not remove a feature of conciliationism that some find troubling: that conciliationism can lead to cases of “rational toxicity,” in which the most rational response to one's evidence involves violating some rational ideal. (shrink)

A critical examination of the Reflection principle in Bayesian epistemology, and of the diachronic Dutch-book-style arguments that have been invoked to support Reflection and Conditionalization.

This paper explores an initially attractive principle connecting beliefs in general with beliefs about what beliefs are rational. The principle turns out to be violated by intuitively rational beliefs in some situations. The paper lays out some options for reacting to this fact.

Formally-inclined epistemologists often theorize about ideally rational agents--agents who exemplify rational ideals, such as probabilistic coherence, that human beings could never fully realize. This approach can be defended against the well-know worry that abstracting from human cognitive imperfections deprives the approach of interest. But a different worry arises when we ask what an ideal agent should believe about her own cognitive perfection (even an agent who is in fact cognitively perfect might, it would seem, be uncertain of this fact). Consideration (...) of this question reveals an interesting feature of the structure of our epistemic ideals: for agents with limited information, our epistemic ideals turn out to conflict with one another. (shrink)

The old evidence problem affects any probabilistic confirmation measure based on comparing pr(H/E) and pr(H). The article argues for the following points: (1) measures based on likelihood ratios also suffer old evidence difficulties; (2) the less-discussed synchronic old evidence problem is, in an important sense, the most acute; (3) prominent attempts to solve or dissolve the synchronic problem fail; (4) a little-discussed variant of the standard measure avoids the problem, in an appealing way; and (5) this measure nevertheless reveals a (...) different problem for probabilistic confirmation measures, a problem that is unlikely to lend itself to formal solution. (shrink)

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 1-2, Page 164-188, June 2022.

We often get evidence concerning the reliability of our own thinking about some particular matter. This “higher-order evidence” can come from the disagreement of others, or from information about our being subject to the effects of drugs, fatigue, emotional ties, implicit biases, etc. This paper examines some pros and cons of two fairly general models for accommodating higher-order evidence. The one that currently seems most promising also turns out to have the consequence that epistemic akrasia should occur more frequently than (...) is sometimes supposed. But it also helps us see why this might not be a bad thing. (shrink)

Abstract: Theories of epistemic rationality that take disagreement (or other higher-order evidence) seriously tend to be “modest” in a certain sense: they say that there are circumstances in which it is rational to doubt their correctness. Modest views have been criticized on the grounds that they undermine themselves—they’re self-defeating. The standard Self-Defeat Objections depend on principles forbidding epistemically akratic beliefs; but there are good reasons to doubt these principles—even New Rational Reflection, which was designed to allow for certain special cases (...) that are intuitively akratic. On the other hand, if we construct a Self-Defeat Objection without relying on anti-akratic principles, modest principles turn out not to undermine themselves. In the end, modesty should not be seen as a defect in a theory of rational belief. (shrink)

Outlines the etiological theory of normative functionality. Analysis of the autonomous system; Function of systems-oriented approaches; Specifications of system identity.

Anne-Marie Søndergaard Christensen presents a new account of the role of moral philosophy and its relationship to our ordinary moral lives. She challenges the idea that moral theories have an authoritative explanatory or action-guiding role, and develops instead a descriptive, pluralistic, and elucidatory conception of moral philosophy.

We often get evidence that bears on the reliability of some of our own first-order reasoning. The rational response to such “higher-order” evidence would seem to depend on a rational assessment of how reliable we can expect that reasoning to be, in light of the higher-order evidence. “Independence” principles are intended to constrain this reliability-assessment, so as to prevent question-begging reliance on the very reasoning being assessed. However, extant formulations of Independence principles tend to be vague or ambiguous, and coming (...) up with a tolerably precise formulation turns out to be tricky. This paper aims to make some progress toward developing a more precise Independence principle, and also to highlight some of the difficulties the project entails. The hope is to take a step toward understanding how rational belief is informed by evidence bearing on agents’ cognitive reliability. (shrink)

Many writers have recently urged that the epistemic rationality of beliefs can depend on broadly pragmatic (as opposed to truth-directed) factors. Taken to an extreme, this line of thought leads to a view on which there is no such thing as a distinctive epistemic form of rationality. A series of papers by Susanna Rinard develops the view that something like our traditional notion of pragmatic rationality is all that is needed to account for the rationality of beliefs. This approach has (...) undeniable attractions. But examining different versions of the approach uncovers problems. The problems help reveal why epistemic rationality is an indispensable part of understanding rationality—not only of beliefs, but of actions. We may or may not end up wanting to make a place, in our theories of epistemic rationality, for factors such as the practical or moral consequences of having beliefs. But a purely pragmatic notion of rationality—one that’s stripped of any component of distinctively epistemic evaluation—cannot do all the work that we need done. (shrink)

A wide range of prominent epistemological theories include a principle of conservatism. Such principles take the fact that an agent currently holds a certain belief to constitute at least some measure of epistemic justification for her to maintain that belief. I examine the main arguments that have been made in conservatism's behalf, and find them unsound. Most interestingly, conservatism does not fall out of confirmational holism (the view that the justification of each of our beliefs is in part determined by (...) our other beliefs). I argue that conservatism is a mild form of dogmatism, and should be abandoned. (shrink)

Wayne D. Christensen and Cliff A. Hooker.

An absolute decline in US life expectancy in low education whites has alarmed policy makers and attracted media attention. Depending on which studies are correct, low education white women have lost between 3 and 5 years of lifespan; men, between 6 months and 3 years. Although absolute declines in life expectancy are relatively rare, some commentators see the public alarm as reflecting a racist concern for white lives over black ones. How ought we ethically to evaluate this lifespan contraction in (...) low education whites? Should we care, or is it racist to care? Does it constitute an injustice or reflect justice being done? I argue that the lifespan contraction in low education whites violates key normative criteria used to make determinations of health justice, and that these judgments do not vitiate concerns about racism. I conclude with reflections on US population health policy and building an inclusive health equity movement. (shrink)

The most immediately appealing model for formal constraints on degrees of belief is provided by probability theory, which tells us, for instance, that the probability of P can never be greater than that of (P v Q). But while this model has much intuitive appeal, many have been concerned to provide arguments showing that ideally rational degrees of belief would conform to the calculus of probabilities. The arguments most frequently used to make this claim plausible are the so-called "Dutch Book" (...) arguments. (shrink)

Previous research has established that the success of strikes, and social movements more broadly, depends on their ability to garner support from the public. However, there is scant published research investigating the response of the public to strike action by healthcare workers. In this study, we address this gap through a study of public responses to UK nursing strikes in 2022–2023, using a data set drawn from Twitter of more than 2300 publicly available tweets. We focus on negative tweets, investigating (...) which societal discourses social media users draw on to oppose strike action by nurses. Using a combination of corpus‐based approaches and discourse analysis, we identified five categories of opposition: (i) discourse discrediting nurses; (ii) discourse discrediting strikes by nurses; (iii) discourse on the National Health System; (iv) discourse about the fairness of strikers' demands and (v) discourse about potential harmful impact. Our findings show how social media users operationalise wider societal discourses about the nursing profession (e.g., associations with care, gender, vocation and sacrifice) as well as recent crises such as the Covid‐19 pandemic to justify their opposition. The results also provide valuable insights into misconceptions about nursing, strike action and patient harm, which can inform strategies for public communication. (shrink)

ABSTRACTIn keeping with the dominant view that skills are largely automatic, the standard view of memory systems distinguishes between a representational declarative system associated with cognitive processes and a performance-based procedural system. The procedural system is thought to be largely responsible for the performance of well-learned skilled actions. Here we argue that most skills do not fully automate, which entails that the declarative system should make a substantial contribution to skilled performance. To support this view, we review evidence showing that (...) the declarative system does indeed play a number of roles in skilled action. (shrink)

Current advances in assisted reproductive technologies aim to promote the health and well-being of future children. They offer the possibility to select embryos with the greatest potential of being born healthy (eg, preimplantation genetic testing) and may someday correct faulty genes responsible for heritable diseases in the embryo (eg, human germline genome modification (HGGM)). Most laws and policy statements surrounding HGGM refer to the notion of ‘serious’ as a core criterion in determining what genetic diseases should be targeted by these (...) technologies. Yet, this notion remains vague and poorly defined, rendering its application challenging and decision making subjective and arbitrary. By way of background, we begin by briefly presenting two conceptual approaches to ‘health’ and ‘disease’: objectivism (ie, based on biological facts) and constructivism (ie, based on human values). The basic challenge under both is sorting out whether and to what extent social and environmental factors have a role in helping to define what qualifies as a ‘serious’ disease beyond the medical criteria. We then focus on how a human rights framework (eg, right to science and right to the highest attainable health) could integrate the concepts of objectivism and constructivism so as to provide guidance for a more actionable consideration of ‘serious’. Ultimately, it could be argued that a human rights framework, by way of its legally binding nature and its globally accepted norms and values, provides a more universal foundation for discussions of the ethical, legal and social implications of emerging or disruptive technologies. (shrink)

One of Mill’s main arguments for free speech springs from taking disagreement as an epistemically valuable resource for fallible thinkers. Contemporary conciliationist treatments of disagreement spring from the same motivation, but end up seeing the epistemic implications of disagreement quite differently. Conciliationism also encounters complexities when transposed from the 2-person toy examples featured in the literature to the public disagreements among groups that give the issue much of its urgency. Group disagreements turn out to be in some ways more powerful (...) defeaters of rational belief, even when opposing groups are comparable in size and epistemic credentials. And conciliationism also shows us why determining the rational response to these disagreements can in certain cases (e.g. politics) be a particularly difficult and nuanced matter. (shrink)

Existing whistle-blowing models rely on “cold” economic calculations and cost-benefit analyses to explain the judgments and actions of potential whistle-blowers. I argue that “hot” cognitions – value conflict and emotions – should be added to these models. I propose a model of the whistle-blowing decision process that highlights the reciprocal influence of “hot” and “cold” cognitions and advocate research that explores how value conflict and emotions inform reporting decisions. I draw on the cognitive appraisal approach to emotions and on the (...) social-functional value pluralism model to generate propositions. (shrink)