Psychotherapists in mental health institutions as a professional group are part of the medical system, and from this perspective, as representing an occupation that serves the public health interests, as well as those of the individual seeking help. Despite the different existing therapeutic approaches and diverse forms of therapy deriving from these approaches critical theories, however, consider psychotherapy as a profession with a specific jurisdictional claim and own highly specific interests. In contrast to most of the recent discussion around therapy (...) culture, in this article, I argue that sociology and social theory could benefit from an understanding of psychotherapy as a profession with a separate logic and claim for jurisdiction for mental health. Moreover, I present some general trends showing that, regarding psychotherapy, we face a concurrence of a professionalisation, and simultaneously, an already ongoing deprofessionalisation. To develop my argument, I first discuss the perspectives of sociology of the psychotherapy professions. Second, I present the potential lack of professionalism in four dimensions. Third, I discuss possible tendencies of deprofessionalisation. Finally, I conclude by pointing out the importance of theorising the psychotherapy professions for medical sociology. (shrink)

Strategies for improving the explainability of artificial agents are a key approach to support the understandability of artificial agents’ decision-making processes and their trustworthiness. However, since explanations are not inclined to standardization, finding solutions that fit the algorithmic-based decision-making processes of artificial agents poses a compelling challenge. This paper addresses the concept of trust in relation to complementary aspects that play a role in interpersonal and human–agent relationships, such as users’ confidence and their perception of artificial agents’ reliability. Particularly, this (...) paper focuses on non-expert users’ perspectives, since users with little technical knowledge are likely to benefit the most from “post-hoc”, everyday explanations. Drawing upon the explainable AI and social sciences literature, this paper investigates how artificial agent’s explainability and trust are interrelated at different stages of an interaction. Specifically, the possibility of implementing explainability as a trust building, trust maintenance and restoration strategy is investigated. To this extent, the paper identifies and discusses the intrinsic limits and fundamental features of explanations, such as structural qualities and communication strategies. Accordingly, this paper contributes to the debate by providing recommendations on how to maximize the effectiveness of explanations for supporting non-expert users’ understanding and trust. (shrink)

Ethical issues of information and communication technologies (ICTs) are important because they can have significant effects on human liberty, happiness, and people’s ability to lead a good life. They are also of functional interest because they can determine whether technologies are used and whether their positive potential can unfold. For these reasons, policy makers are interested in finding out what these issues are and how they can be addressed. The best way of creating ICT policy that is sensitive to ethical (...) issues pertain to being proactive in addressing such issues at an early stage of the technology life cycle. The present paper uses this position as a starting point and discusses how knowledge of ethical aspects of emerging ICTs can be gained. It develops a methodology that goes beyond established futures methodologies to cater for the difficult nature of ethical issues. The authors outline how the description of emerging ICTs can be used for an ethical analysis. (shrink)

BackgroundInaccurate, false or incomplete research publications may mislead readers including researchers and decision-makers. It is therefore important that such problems are identified and rectified promptly. This usually involves collaboration between the research institutions and academic journals involved, but these interactions can be problematic.MethodsThese recommendations were developed following discussions at World Conferences on Research Integrity in 2013 and 2017, and at a specially convened 3-day workshop in 2016 involving participants from 7 countries with expertise in publication ethics and research integrity. The (...) recommendations aim to address issues surrounding cooperation and liaison between institutions and journals about possible and actual problems with the integrity of reported research arising before and after publication.ResultsThe main recommendations are that research institutions should: develop mechanisms for assessing the integrity of reported research that are distinct from processes to determine whether individual researchers have committed misconduct;release relevant sections of reports of research integrity or misconduct investigations to all journals that have published research that was investigated;take responsibility for research performed under their auspices regardless of whether the researcher still works at that institution or how long ago the work was done;work with funders to ensure essential research data is retained for at least 10 years.Journals should: respond to institutions about research integrity cases in a timely manner;have criteria for determining whether, and what type of, information and evidence relating to the integrity of research reports should be passed on to institutions;pass on research integrity concerns to institutions, regardless of whether they intend to accept the work for publication;retain peer review records for at least 10 years to enable the investigation of peer review manipulation or other inappropriate behaviour by authors or reviewers.ConclusionsVarious difficulties can prevent effective cooperation between academic journals and research institutions about research integrity concerns and hinder the correction of the research record if problems are discovered. While the issues and their solutions may vary across different settings, we encourage research institutions, journals and funders to consider how they might improve future collaboration and cooperation on research integrity cases. (shrink)

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician’s lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts ‘at the margins of professionalism’ as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps (...) with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard’s account offers a framework for interpreting different types of moral conflicts ‘at the margins of professionalism’ to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas. (shrink)

• Aggregates of previously isolated cells of Hydra are capable, under suitable solvant conditions, of regeneration forming complete animals. In a first stage, ecto- and endodermal cells sort out, producing the bilayered hollow structure characteristic of Hydra tissue; thereafter, heads are formed (even if the original cell preparation contained no head cells), eventually leading to the separation of normal animals with head, body column and foot. Hydra appears to be the highest type of organism that allows for regeneration of the (...) entire structure from random cell aggregates. The system is particularly useful for studying cell interactions, tissue polarity, pattern formation, and cell differentiation. (shrink)

Background: In order to fully understand nurses’ ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified. Research questions: What is the influence of context on nurses’ decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint? Research design: A qualitative descriptive study inspired by the Grounded Theory approach was carried out. (...) Participants and research context: In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium. Ethical considerations: The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven. Findings: Relationships with nursing colleagues and the patient’s family form an inter-personal network. Nurses also point to the importance of the procedural–legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses’ decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint. Discussion: The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making. Conclusion: An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions. (shrink)

Sexual exploitation and abuse (SEA) by United Nations (UN) peacekeepers causes severe physical and psychological consequences. Where SEA leads to pregnancy and childbirth, peacekeepers typically absolve themselves of their paternal responsibilities and paternity suits are largely unsuccessful. The lack of support for peacekeeper-fathered children (PKFC) tarnishes the image of the UN who fails to implement a victim-centred approach to SEA. Analysing shortcomings in the provision of support, this article presents an evaluation of the UN’s accountability system from the perspective of (...) PKFC families. In-depth interviews with thirty-five PKFC and sixty mothers demonstrate local barriers to child support and paternity claims in eastern Democratic Republic of Congo. We discuss PKFC’s need for assistance and their mothers’ attempts to navigate an opaque international legal system. The findings cast light on their limited access to UN subsidies and offer recommendations to better implement existing UN goals of justice and victim-oriented policies. (shrink)

Language’s intentional nature has been highlighted as a crucial feature distinguishing it from other communication systems. Specifically, language is often thought to depend on highly structured intentional action and mutual mindreading by a communicator and recipient. Whilst similar abilities in animals can shed light on the evolution of intentionality, they remain challenging to detect unambiguously. We revisit animal intentional communication and suggest that progress in identifying analogous capacities has been complicated by (i) the assumption that intentional (that is, voluntary) production (...) of communicative acts requires mental-state attribution, and (ii) variation in approaches investigating communication across sensory modalities. To move forward, we argue that a framework fusing research across modalities and species is required. We structure intentional communication into a series of requirements, each of which can be operationalised, investigated empirically, and must be met for purposive, intentionally communicative acts to be demonstrated. Our unified approach helps elucidate the distribution of animal intentional communication and subsequently serves to clarify what is meant by attributions of intentional communication in animals and humans. (shrink)

Acoustic signals serving intraspecific communication by predators are perceived by potential prey as warning signals. We analysed the acoustic characteristics of howling of wolves and found a striking similarity to the warning sounds of technical sirens. We hypothesize that the effectivity of sirens as warning signals has been enhanced by natural sensory predisposition of humans to get alerted by howling of wolves, with which they have a long history of coexistence. Psychoacoustic similarity of both stimuli seems to be supported by (...) the fact that wolves and dogs perceive the sound of technical sirens as a relevant releasing supernormal stimulus and reply to it with howling. Inspiration by naturally occurring acoustic aposematic signals might become an interesting example of biomimetics in designing new warning sound systems. (shrink)

Causation is a core feature of human cognition and language. How children learn about intricate causal meanings is yet unresolved. Here, we focus on how children learn verbs that express causation. Such verbs, known as lexical causatives (e.g., break and raise), lack explicit morphosyntactic markers indicating causation, thus requiring that the child generalizes the causal meaning from the context. The language addressed to children presumably plays a crucial role in this learning process. Hence, we tested whether adults adapt their use (...) of lexical causatives to children when talking to them in day-to-day interactions. We analyzed naturalistic longitudinal data from 12 children in the Manchester corpus (spanning from 20 to 36 months of age). To detect semantic generalization, we employed a network approach with semantics learned from cross-situational contexts. Our results show an increasing trend in the expansion of causative semantics, observable in both child speech and child-directed speech. Adults consistently maintain somewhat more intricate causative semantic networks compared to children. However, both groups display evolving patterns. Around 28–30 months of age, children undergo a reduction in the degree of causative generalization, followed by a slightly time-lagged adjustment by adults in their speech directed to children. These findings substantiate adults' adaptation in child-directed speech, extending to semantics. They highlight child-directed speech as a highly adaptive and subconscious teaching tool that facilitates the dynamic processes of language acquisition. (shrink)

We argue for a perspective on bilingual heritage speakers as native speakers of both their languages and present results from a large-scale, cross-linguistic study that took such a perspective and approached bilinguals and monolinguals on equal grounds. We targeted comparable language use in bilingual and monolingual speakers, crucially covering broader repertoires than just formal language. A main database was the open-access RUEG corpus, which covers comparable informal vs. formal and spoken vs. written productions by adolescent and adult bilinguals with heritage-Greek, (...) -Russian, and -Turkish in Germany and the United States and with heritage-German in the United States, and matching data from monolinguals in Germany, the United States, Greece, Russia, and Turkey. Our main results lie in three areas. We found non-canonical patterns not only in bilingual, but also in monolingual speakers, including patterns that have so far been considered absent from native grammars, in domains of morphology, syntax, intonation, and pragmatics. We found a degree of lexical and morphosyntactic inter-speaker variability in monolinguals that was sometimes higher than that of bilinguals, further challenging the model of the streamlined native speaker. In majority language use, non-canonical patterns were dominant in spoken and/or informal registers, and this was true for monolinguals and bilinguals. In some cases, bilingual speakers were leading quantitatively. In heritage settings where the language was not part of formal schooling, we found tendencies of register leveling, presumably due to the fact that speakers had limited access to formal registers of the heritage language. Our findings thus indicate possible quantitative differences and different register distributions rather than distinct grammatical patterns in bilingual and monolingual speakers. This supports the integration of heritage speakers into the native-speaker continuum. Approaching heritage speakers from this perspective helps us to better understand the empirical data and can shed light on language variation and change in native grammars. Furthermore, our findings for monolinguals lead us to reconsider the state-of-the art on majority languages, given recurring evidence for non-canonical patterns that deviate from what has been assumed in the literature so far, and might have been attributed to bilingualism had we not included informal and spoken registers in monolinguals and bilinguals alike. (shrink)

Previous research indicates positive effects of a person’s attractiveness on evaluations of opposite-sex persons, but less positive or even negative effects of attractiveness on same-sex evaluations. These biases are consistent with social motives linked to mate search and intrasexual rivalry. In line with the hypothesis that such motives should not become operative until after puberty, 6- to 12-year-old participants (i.e., children) displayed no evidence for biased social evaluations based on other people’s attractiveness. In contrast, 13- to 19-year-old participants (i.e., adolescents) (...) displayed positive and negative attractiveness biases toward opposite- and same-sex targets, respectively. Moreover, these biases increased with the age—and thus the reproductive relevance—of the targets being evaluated. Findings corroborate the relevance of mating-related motives for social judgment and illustrate how such biases can grow during human development. At a broader conceptual level, this research demonstrates the utility of investigating proximate social judgment processes through the lens of adaptationist thinking. (shrink)

Teachers´ attitudes toward their students have been associated with differential teachers´ expectations and, in turn, with students´ educational pathways. Theories of social cognition can explain the link between attitudes and behavior. In this regard, the distinction between implicit and explicit attitudes is worth to be considered, whereby implicit attitudes are automatically activated when the attitude object is present and guide automatic behavior. In contrast, explicit attitudes infer deliberation and reflection, hence affecting controlled behavior. As teachers often are required to act (...) immediately in situations that do not allow for thoughtful reflection due to time restraints, teachers´ implicit attitudes concerning different student groups with shared characteristics, such as gender or ethnicity, may be especially important when considering teachers´ behavior in relation to students´ educational pathways. This notion is reflected by an increased interest in adopting implicit methodology in the educational domain. Over the last 10 years, several studies have been conducted in different countries, involving in- and preservice teachers and investigating their attitudes toward different student groups. Estimates of effects have varied and may be affected by sampling bias. To systematically review and integrate data from different studies, this meta-analysis focuses on teachers´ implicit attitudes. Following the systematic search of the database and initial screening, 43 articles were identified from which 22, describing 34 studies, were retained for the meta-analysis after further inspection. First analyses revealed an estimated average effect size of 0.56 for implicit attitudes in favor of non-marginalized groups. As there was a large extent of heterogeneity between studies, several moderator variables, were investigated. Results showed that the employed implicit measure and stimulus materials as well as the student target group affected the effect sizes. Low or non-significant relationships were reported between implicit and explicit attitudes. Findings are discussed in terms of theory and future research. (shrink)

This study takes a systemic functional multimodal social semiotic approach to the analysis and discussion of image and text relations in two sets of data. First, patterns of contextualisation of images and text in the online magazines Dabiq and Rumiyah produced by the Islamic extremist organisation which refers to itself as Islamic State are examined. The second data set consists of a sample of texts from Western online news and blog sites which include recontextualisations of images found in the first (...) data set. A sample of examples of the use and re-use of images is discussed in order to identify patterns of similarity and difference when images and text are recontextualised. It is argued that the ISIS material tends to foreground the interpersonal metafunction in combination with the textual metafunction, while the other data set tends to foreground the ideational metafunction. These inferences indicate that further exploration of a larger data set is worth pursuing. Such studies would provide deeper insights helping to distinguish between online material which supports terrorism and that which opposes it, as well as facilitating the further development of multimodal social semiotic approaches to image and text relations. (shrink)

BackgroundBiobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people’s (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed consent can be obtained and improve current consent procedures.MethodsWe designed a survey, in co-production with CYP, collecting demographic data, views on biobanking, and consent using three scenarios: 1) prospective consent, 2) deferred consent, and 3) reconsent and assent at age of capacity. The survey was disseminated (...) via the Young Person’s Advisory Group North England (YPAGne) and participating CYP’s secondary schools. Data were analysed using a qualitative thematic approach by three independent reviewers (including CYP) to identify common themes. Data triangulation occurred independently by a fourth reviewer.ResultsOne hundred two CYP completed the survey. Most were between 16–18 years (63.7%, N = 65) and female (66.7%, N = 68). 72.3% had no prior knowledge of biobanking (N = 73).Acceptability of prospective consent for biobanking was high (91.2%, N = 93) with common themes: ‘altruism’, ‘potential benefits outweigh individual risk’, 'frugality', and ‘(in)convenience’.Deferred consent was also deemed acceptable in the large majority (84.3%, N = 86), with common themes: ‘altruism’, ‘body integrity’ and ‘sample frugality’. 76.5% preferred to reconsent when cognitively mature enough to give assent (N = 78), even if parental consent was previously in place. 79.2% wanted to be informed if their biobanked biospecimen is reused (N = 80).ConclusionProspective and deferred consent acceptability for biobanking is high among CYP in the UK. Altruism, frugality, body integrity, and privacy are the most important themes. Clear communication and justification are paramount to obtain consent. Any CYP with capacity should be part of the consenting procedure, if possible. (shrink)

Primary progressive multiple sclerosis (PPMS) shows a highly variable disease progression with poor prognosis and a characteristic accumulation of disabilities in patients. These hallmarks of PPMS make it difficult to diagnose and currently impossible to efficiently treat. This study aimed to identify plasma metabolite profiles that allow diagnosis of PPMS and its differentiation from the relapsing-remitting subtype (RRMS), primary neurodegenerative disease (Parkinson’s disease, PD), and healthy controls (HCs) and that significantly change during the disease course and could serve as surrogate (...) markers of multiple sclerosis (MS)-associated neurodegeneration over time. We applied untargeted high-resolution metabolomics to plasma samples to identify PPMS-specific signatures, validated our findings in independent sex- and age-matched PPMS and HC cohorts and built discriminatory models by partial least square discriminant analysis (PLS-DA). This signature was compared to sex- and age-matched RRMS patients, to patients with PD and HC. Finally, we investigated these metabolites in a longitudinal cohort of PPMS patients over a 24-month period. PLS-DA yielded predictive models for classification along with a set of 20 PPMS-specific informative metabolite markers. These metabolites suggest disease-specific alterations in glycerophospholipid and linoleic acid pathways. Notably, the glycerophospholipid LysoPC(20:0) significantly decreased during the observation period. These findings show potential for diagnosis and disease course monitoring, and might serve as biomarkers to assess treatment efficacy in future clinical trials for neuroprotective MS therapies. (shrink)

Die Notwendigkeit guter Arzt-Patienten-Kommunikation für eine angemessene Behandlung und für die Ausübung der Patientenselbstbestimmung ist bekannt. In interkulturell-mehrsprachigen Situationen, in denen ein kommunikationsintensiver Aushandlungsprozess besonders notwendig ist, erhält die Qualität der Verständigung besondere Bedeutung, so dass der Einsatz qualifizierter Dolmetschender hier ethisch geboten ist. Er stellt Ärzte und Ärztinnen, aber auch die Dolmetschenden vor besondere, ethisch zu reflektierende Herausforderungen. Sind zudem keine qualifizierten Dolmetschenden einsetzbar, müssen Ärzte und Ärztinnen in schwierigen ethischen Abwägungsprozessen eine Entscheidung über das weitere Vorgehen treffen. Diese (...) beiden Themen finden in der medizinethischen Literatur bisher wenig Beachtung. Anhand von Erkenntnissen aus der Forschung u. a. zum Gesprächsdolmetschen werden im Folgenden zentrale ethische Herausforderungen eines Dolmetschereinsatzes herausgearbeitet. Diskutiert werden der Bedarf sprachlicher Unterstützung, der drohende Ausschluss von Patientinnen und Patienten in gedolmetschten Gesprächen, die Beachtung der für das Dolmetschen geltenden berufsethischen Prinzipien, die Gewährleistung der Vertraulichkeit sowie die Konsequenzen interkulturellen Vermittelns. Des Weiteren wird für Ärzte und Ärztinnen, die unter nicht-idealen Bedingungen ohne qualifizierte Dolmetschende agieren müssen, erstmals ein strukturierter argumentativer Rahmen vorgestellt. Es werden neun Bewertungskriterien vorgeschlagen, anhand derer in einem Abwägungsprozess über die Eignung einer Person zum (spontanen) Dolmetschen entschieden werden kann. (shrink)

Shared leadership is not only about individual team members engaging in leadership, but also about team members adopting the complementary follower role. However, the question of what enables team members to fill in each of these roles and the corresponding influence of formal leaders have remained largely unexplored. Using a social network perspective allows us to predict both leadership and followership ties between team members based on considerations of implicit leadership and followership theories. From this social information processing perspective, we (...) identify individual team members’ political skill and the formal leaders’ empowering leadership as important qualities that facilitate the adoption of each the leader and the follower role. Results from a social network analysis in a R&D department with 305 realized leadership ties support most of our hypotheses. (shrink)

Ce texte constitue l'introduction de C. Brüstle et al. (Hrsg.), Rhythmus im Prozess, Berlin, 2004. On le trouvera en ligne également ici. Il nous a été signalé par Andres Leon-Geyer que nous remercions de cette attention. Wenn von Rhythmus die Rede ist und wenn man nach einer Definition von Rhythmus fragt, so trifft man in der Regel auf Erklärungen wie die folgende : Rhythmus ist eine »unbedingt schematische Abfolge von betonten und nichtbetonten Zeitelementen, deren gesamte Einheit überschaubar (...) - Sur (...) le concept de rythme – Nouvel article. (shrink)

Free games that are monetized by selling virtual items, such as cosmetic microtransactions for one’s avatar, seem to offer a better gaming experience to paying players. To experimentally explore this phenomenon, the effects of character customization with cosmetic microtransactions on objective and self-estimated player performance, subjective identification with the avatar, fun and the players’ perceived competence were examined in the game League of Legends. This study introduces a new laboratory-based, experimental task to objectively measure within-game player performance. Each participant performed (...) this game-based task in two different conditions: With a character that was customized using a provided set of cosmetic microtransactions and with a default character. Results showed that customization increased subjective identification with the player character. However, objective performance measures were unaffected by this manipulation although the novel experimental approach provided reliable performance results. Additionally, identification was positively related to perceived competence, fun, and self-estimated performance. Implications for the design of cosmetic microtransactions and their influence on competitive gaming are discussed. (shrink)

This study investigates the persuasiveness of different types of expert evidence. Following Wagemans, two types of experts were distinguished that can be used in expert evidence: experiential experts and professional experts. In a between-subjects experiment, these different types of experts were included in a news report on a political issue. Results indicate that the perceived expertise and persuasiveness of professional experts was higher than that of experiential experts. Perceived expertise completely mediated the effects of the different types of expert evidence (...) on persuasion. These results point towards a recommendation of using professional expert evidence over experiential expert evidence in reporting on political issues. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)