A hypothetical scenario is presented in which a female patient is admitted to a private hospital to undergo a mastectomy and breast reconstruction. The surgeons and anaesthetists conducting the different procedures charge three times the medical aid rates. When the patient asks what the co-payments are likely to be, she is informed by the doctors’ accounts section that they can only provide this information after each procedure. The patient’s medical scheme also advises her that it cannot determine the likely co-payments (...) unless she completes the assessment form sent to her. The form requires her to include the costs reflected against the relevant ICD10 codes. The patient cannot complete the form because the doctors’ accounts sections have not informed her about the proposed procedures and the likely costs of each. This article builds on a previous article discussing doctors’ overarching responsibility to disclose medical treatment costs in advance. The present article outlines the legal requirements in the South African Constitution, the National Health Act and the Health Professions Act, and refers to the Promotion of Access to Information Act and Consumer Protection Act. Similar to the earlier article, this article addresses the ethical requirements of the Health Professions Council of South Africa and the internationally recognised biomedical ethical principles. Furthermore, it also refers to the National Patients Charter, the government’s policy document on health care services. (shrink)

Consider the following hypothetical scenario: A patient suffering constant abdominal pain is referred to State Hospital A from her local clinic after not responding to simple analgesics for chronic pelvic pain associated with irregular menstruation. The doctors at State Hospital A discover that she has a suspicion of adenomyosis. She gives written informed consent for a hysterectomy. During routine postoperative check-ups she reports no alleviation of the pelvic pain, urinary frequency along with burning on micturition and a persistent vaginal discharge. (...) Preoperatively, she was not told that the surgeons had inserted a surgical mesh to prevent vault prolapse. She is given antibiotics and further simple analgesia. As her symptoms do not improve she self-refers to State Hospital B. She is informed that she needs a CAT scan. However, the hospital’s scanner has been out of order for three years. She is advised to go to State Hospital C, where the scanner works, but is not given a referral note. She is told by Hospital C that the doctors are too busy to see her, and as she does not have an appointment, and is not an emergency case she should go back to Hospital A. She does not want to go back to Hospital A, as during her last visit there, nursing staff accused her of being a nuisance and escorted her off the premises. She approaches Private Hospital D, where her abdomen and pelvis are scanned. The scan shows the surgical mesh inside her pelvis which had disintegrated. She is told that it is too risky to remove all the fragments, but that some could be removed at a cost - which she could not afford. The surgeon refers her back to State Hospital A with a referral note and copy of the CAT scan report. (shrink)

Reinforcement learning (RL) models of decision-making cannot account for human decisions in the absence of prior reward or punishment. We propose a mechanism for choosing among available options based on goal-option association strengths, where association strengths between objects represent previously experienced object proximity. The proposed mechanism, Goal-Proximity Decision-making (GPD), is implemented within the ACT-R cognitive framework. GPD is found to be more efficient than RL in three maze-navigation simulations. GPD advantages over RL seem to grow as task difficulty is increased. (...) An experiment is presented where participants are asked to make choices in the absence of prior reward. GPD captures human performance in this experiment better than RL. (shrink)

Far more than the dialectic philosophy of Socrates, the rhetorical humanist tradition avoids objectivist epistemology, charts a traversable path to practical wisdom, and aptly highlights the importance of aesthetic style. In those and other ways, we argue, it offers a preferable historical basis for today’s philosophical counseling. Advocates of that contemporary practice tend to cite Socrates as its historical progenitor and favor the narrow propositional logic that is ascribed to him. Some practitioners, though, have also grown more attuned to metaphorical (...) and narrative elements in a client’s worldview. We aim to supplement their claims by drawing from principles of classical rhetorical theory, showing a way to rethink the practice of philosophical counseling today. (shrink)

Current debates about “Darwinizing culture” have typically focused on the validity of memetics. In this article we argue that meme-like inheritance is not a necessary requirement for descent with modification. We suggest that an alternative and more productive way of Darwinizing culture can be found in the application of phylogenetic methods. We review recent work on cultural phylogenetics and outline six fundamental questions that can be answered using the power and precision of quantitative phylogenetic methods. However, cultural evolution, like biological (...) evolution, is often far from treelike. We discuss the problems reticulate evolution can cause for phylogenetic analyses and suggest ways in which these problems can be overcome. Our solutions involve a combination of new methods for the study of cultural evolution , and the triangulation of different lines of historical evidence. Throughout we emphasize that most debates about cultural phylogenies can only be settled by empirical research rather than armchair speculation. (shrink)

We use the Newell Test as a basis for evaluating ACT-R as an effective architecture for cognitive engineering. Of the 12 functional criteria discussed by Anderson & Lebiere (A&L), we discuss the strengths and weaknesses of ACT-R on the six that we postulate are the most relevant to cognitive engineering.

Constraints and dependencies among the elements of embodied cognition form patterns or microstrategies of interactive behavior. Hard constraints determine which microstrategies are possible. Soft constraints determine which of the possible microstrategies are most likely to be selected. When selection is non-deliberate or automatic the least effort microstrategy is chosen. In calculating the effort required to execute a microstrategy each of the three types of operations, memory retrieval, perception, and action, are given equal weight; that is, perceptual-motor activity does not have (...) a privileged status with respect to memory. Soft constraints can work contrary to the designer's intentions by making the access of perfect knowledge in-the-world more effortful than the access of imperfect knowledge in-the-head. These implications of soft constraints are tested in two experiments. In experiment 1 we varied the perceptual-motor effort of accessing knowledge in-the-world as well as the effort of retrieving items from memory. In experiment 2 we replicated one of the experiment 1 conditions to collect eye movement data. The results suggest that milliseconds matter. Soft constraints lead to a reliance on knowledge in-the-head even when the absolute difference in perceptual-motor versus memory retrieval effort is small, and even when relying on memory leads to a higher error rate and lower performance. We discuss the implications of soft constraints for routine interactive behavior, accounts of embodied cognition, and tool and interface design. (shrink)

The framework of plateaus, dips, and leaps shines light on periods when individuals may be inventing new methods of skilled performance. We begin with a review of the role performance plateaus have played in experimental psychology, human–computer interaction, and cognitive science. We then reanalyze two classic studies of individual performance to show plateaus and dips which resulted in performance leaps. For a third study, we show how the statistical methods of Changepoint Analysis plus a few simple heuristics may direct our (...) focus to periods of performance change for individuals. For the researcher, dips become the marker of exploration where performance suffers as new methods are invented and tested. Leaps mark the implementation of a successful new method and an incremental jump above the path plotted by smooth and steady log–log performance increments. The methods developed during these dips and leaps are the key to surpassing one's teachers and acquiring extreme expertise. (shrink)

This paper traces the development of parental rights to accept or to refuse treatment for a defective newborn infant in the United Kingdom and in the United States of America; its main purpose is to explore the common trends from which an acceptable policy may be derived. It is probable that the British law on parental decision-making in respect of infants suffering from Down's syndrome is to be found in the civil case of In Re B rather than in the (...) criminal case of R v Arthur. United States court decisions are strongly influenced by constitutional law and reflect the right to personal privacy. The position on each side of the Atlantic seems very similar but this similarity includes a sense of uncertainty as to legal responsibility. There is a case for agreed guidelines and a suggested format is offered for consideration. (shrink)

Acquiring expertise in a task is often thought of as an automatic process that follows inevitably with practice according to the log‐log law (aka: power law) of learning. However, as Ericsson, Chase, and Faloon (1980) showed, this is not true for digit‐span experts and, as we show, it is certainly not true for Tetris players at any level of expertise. Although some people may simply “twitch” faster than others, the limit to Tetris expertise is not raw keypress time but the (...) techniques acquired by players that allow them to use the tools provided by the hardware and software to compensate for the game's relentlessly increasing drop speed. Unfortunately, these increases in drop speed between Tetris levels make performance plateaus very short and quickly followed by game death. Hence, a player's success at discovering, exploring, and practicing new techniques for the tasks of board preparation, board maintenance, optimal placement discovery, zoid rotation, lateral movement of zoids, and other tasks important to expertise in Tetris is limited. In this paper, we analyze data collected from 492 Tetris players to reveal the challenges they confronted while constructing expertise via the discovery of new techniques for gameplay at increasingly difficult levels of Tetris. (shrink)

Tasks, tools, and techniques that we perform, use, and acquire, define the elements of expertise which we value as the hallmarks of goal-driven behavior. Somehow, the creation of tools enables us to define new tasks, or is it that the envisioning of new tasks drives us to invent new tools? Or maybe it is that new tools engender new techniques which then result in new tasks? This jumble of issues will be explored and discussed in this diverse collection of papers. (...) Individually, few of the papers are related to each other by topic or by techniques of analysis. Collectively, all focus on tasks performed using tools and discuss the techniques of tool use which enable differences in performance and expertise across individuals, societies, and (even) species. -/- . (shrink)

Why games? How could anyone consider action games an experimental paradigm for Cognitive Science? In 1973, as one of three strategies he proposed for advancing Cognitive Science, Allen Newell exhorted us to “accept a single complex task and do all of it.” More specifically, he told us that rather than taking an “experimental psychology as usual approach,” we should “focus on a series of experimental and theoretical studies around a single complex task” so as to demonstrate that our theories of (...) human cognition were powerful enough to explain “a genuine slab of human behavior” with the studies fitting into a detailed theoretical picture. Action games represent the type of experimental paradigm that Newell was advocating and the current state of programming expertise and laboratory equipment, along with the emergence of Big Data and naturally occurring datasets, provide the technologies and data needed to realize his vision. Action games enable us to escape from our field's regrettable focus on novice performance to develop theories that account for the full range of expertise through a twin focus on expertise sampling and longitudinal studies of simple and complex tasks. (shrink)

Understanding the nature of errors in a simple, rule‐based task—programming a VCR—required analyzing the interactions among human cognition, the artifact, and the task. This analysis was guided by least‐effort principles and yielded a control structure that combined a rule hierarchy task‐to‐device with display‐based difference‐reduction. A model based on this analysis was used to trace action protocols collected from participants as they programmed a simulated VCR. Trials that ended without success (the show was not correctly programmed) were interrogated to yield insights (...) regarding problems in acquiring the control structure. For successful trials (the show was correctly programmed), steps that the model would make were categorized as matches to the model; steps that the model would not make were violations of the model. The model was able to trace the vast majority of correct keystrokes and yielded a business‐as‐usual account of the detection and correction of errors. Violations of the model fell into one of two fundamental categories. The model provided insights into certain subcategories of errors; whereas, regularities within other subcategories of error suggested limitations to the model. Although errors were rare when compared to the total number of correct actions, they were important. Errors were made on 4% of the keypresses that, if not detected, would have prevented two‐thirds of the shows from being successfully recorded. A misprogrammed show is a minor annoyance to the user. However, devices with the approximate complexity of a VCR are ubiquitous and have found their way into emergency rooms, airplane cockpits, power plants, and so on. Errors of ignorance may be reduced by training; however, errors in the routine performance of skilled users can only be reduced by design. (shrink)