In several experiments of survival analysis, the cause of death or failure of any subject may be characterized by more than one cause. Since the cause of failure may be dependent or independent, in this work, we discuss the competing risk lifetime model under progressive type-II censored where the removal follows a binomial distribution. We consider the Akshaya lifetime failure model under independent causes and the number of subjects removed at every failure time when the removal follows (...) the binomial distribution with known parameters. The classical and Bayesian approaches are used to account for the point and interval estimation procedures for parameters and parametric functions. The Bayes estimate is obtained by using the Markov Chain Monte Carlo method under symmetric and asymmetric loss functions. We apply the Metropolis–Hasting algorithm to generate MCMC samples from the posterior density function. A simulated data set is applied to diagnose the performance of the two techniques applied here. The data represented the survival times of mice kept in a conventional germ-free environment, all of which were exposed to a fixed dose of radiation at the age of 5 to 6 weeks, which was used as a practice for the model discussed. There are 3 causes of death. In group 1, we considered thymic lymphoma to be the first cause and other causes to be the second. On the base of mice data, the survival mean time of mice of the second cause is higher than the first cause. (shrink)

In reliability engineering and lifetime analysis, many units of the product fail with different causes of failure, and some tests require stress higher than normal stress. Also, we need to design the life experiments which present methodology for formulating scientific and engineering problems using statistical models. So, in this paper, we adopted a partially constant stress accelerated life test model to present times to failure in a small period of time for Gompertz life products. Also, considering that, units are (...) failing with the only two independent causes of failure and tested under type-I generalized hybrid censoring scheme the data built. Obtained data are analyzed with two methods of estimations, maximum likelihood and Bayes methods. These two methods are used to construct the point and interval estimators with the help of the MCMC method. The developed results are measured and compared under Monte Carlo studying. Also, a data set is analyzed for illustration purposes. Finally, some comments are presented to describe the numerical results. (shrink)

Decision-making competence reflects individual differences in the susceptibility to decision-making errors, measured using tasks common from behavioral decision research (e.g., framing effects, under/overconfidence, following decision rules). Prior research demonstrates that those with higher decision-making competence report lower incidence of health-risking and antisocial behaviors, but there has been less focus on intermediate mechanisms that may impact real-world decisions, and, in particular, those implicated by normative models. Here we test the associations between measures of youth decision-making competence (Y-DMC) and one such mechanism, (...) the degree to which individuals make choices consistent with maximizing expected value (EV). Using a task involving hypothetical gambles, we find that greater EV sensitivity is associated with greater Y-DMC. Higher Y-DMC scores are associated with (a) choosing risky options when expected value favors those options and (b) avoiding risky options when expected value favors a certain option. This relationship is stronger for gambles that involved potential losses. The results suggest that Y-DMC captures decision processes consistent with standard normative evaluations of risky decisions. (shrink)

“At-own-risk discharges” or “self-discharges” evidences an irretrievable breakdown in the patient–clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician’s duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and competent to invoke an (...) at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care’s use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient’s decision-making capacity and raises questions as to the patient’s decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient’s welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient’s specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis. (shrink)

In this paper, I address a question in social epistemology about the unity of a scientic community to- wards its inner groups (teams, labs...). I investigate the reasons why these groups might want to \go it alone", working among themselves and hiding their discoveries from other groups. I concentrate on the intermediate results of a longer project, where the first steps can help to achieve a more advanced result. I study to what extent the isolation of research groups might be (...) damaging to the epistemic progress of the whole community. In order to get an idea of the reason why scientists might not share their intermediate results with others, consider for example Schawlow and Townes in the summer of 1958 (the historical material is drawn from Broberg, 1991, chap. 3): together they had just designed the principle of functioning of what would be known as the laser, with the intention of constructing the rst laser, relying on their theoretical ideas. Should they have published their theoretical discovery, or rather taken advantage of their advance on possible oppo- nents and start the experimental work? They chose to publish their theoretical ideas in a scientic journal, and they also led a patent application. On the one hand, it was a valuable choice: the patent was granted and their paper was published, making them soon famous. Further- more, another scientist called Gould was to le a simi- lar patent application a few months later, in March 1959; it was refused, because of the priority of Schawlow and Townes. If the latter had not submitted their idea in 1958, the patent would certainly have been acknowl- edged to Gould. In this sense, publishing their intermediate result was a worthy strategy. On the other hand, history showed that their publication had also some drawbacks for them. Schawlow and Townes' publication triggered a race among many American laboratories for the rst experimental construction of the laser. In addition to bringing them competitors, their publication helped these competitors in crucial ways; so much so that it was another scientist, Maiman, and not Schawlow and Townes, who was able to build the rst working laser, in May 1960, and to publish the result. If Schawlow and Townes had not published their theoretical idea, there are chances that they would have been the first ones to build a laser. Their publication of the first theoretical result certainly prevented them from getting the second experimental one. In short, the best publishing strategy about an intermediate result is no easy question for a scientist. Consider now the whole community, concerned with the results available to all and with the pace of the epistemic progress. Schawlow and Townes' publication enabled the rst laser to be built quicker, as other teams could rely on their theoretical work. More generally, being able to reuse other's works seems to be a rm basis of scientic progress. Thus, for the whole community, it seems that there are only benets if intermediate results are published. As this is not necessarily the best strategy for those who reach these intermediate results, there might be a conflict between the interests of individuals and those of the whole community. The question Schawlow and Townes faced was whether they should make their discovery publicly known, or keep it for themselves to progress alone. This alternative can also arise for an entire lab, when competing with other labs on some long-run project: should it make its discoveries known to its opponents, or only share them internally among its members? At a higher level still, this question arises for what can be called scientic schools, which are groups of labs sharing some particular approach|methodological, experimental or interpre- tational, for example. At each level within the scientic community, there are competitive groups of scientists which may decide to go it alone and to prevent their results from being accessible to others. If they had good reasons for doing so, there would be dramatic consequences for the whole community: other groups would not be able to reuse their results, labour force would be wasted in achieving them again, and the progress of the eld would be slowered. 9 The aim of this paper is to investigate this risk of division: to assess the conditions under which it may oc- cur, its damage for the community, and to draw the limit of an acceptable pluralism. The reasoning with benets and drawbacks which has been sketched for Schawlow and Townes seems to be implicitly an informal economic argument. In order to clarify and to rene such an argument, I will investigate it in a rational decision framework, supposing some utility or preferences for the groups of scientists, and I will propose a formal model, in game theory. In social epistemology of science, formal models have been proposed for various questions (for example, Kitcher 1990, 1993, Goldman 2009, Strevens 2003, 2006, Weisberg and Muldoon, forthcoming, Zollman 2007, 2008, 2009, 2010), but not for the question of the division of the scientic community. I will concentrate on the normative aspect of the question, ignoring the descriptive and historical question of whether groups do go it alone or not. The model I propose is sequential: two groups are competing on a research program, which consists of several results which have to be obtained in order. The groups always carry out some research for the next result, which they reach with some probability per unit of time. When a group, say A, reaches a result, it can either make it public for the other group, or continue its research. After a result is made public, the competitor B can start from it so as to continue its own research. Thus, when A publishes it loses its lead, and its competitor will be able to compete with it in the near future. But it is also recognized as the rst to reach this step. I consider two dierent cases, one in which the number of steps is limited, another where the limit concerns the number of temporal intervals. In both cases, assuming that all steps are equally dicult and equally rewarding, it turns out that the best strategy for a group concerned with its own reward is to make public every step it takes. Thus, there is no risk that groups might separate: a scientist, whatever its group, will publish for all. Finally, I turn to more complex situations, where results have varying size or diculty: there, groups can indeed be better o going it alone. (shrink)

The “participatory turn” cutting across technical approaches for appraising environment, risk, science, and technology has been accompanied by intense debates over the desired nature, extent, and quality of public engagement in science. Burgeoning work evaluating the effectiveness of such processes and the social study of science in society more generally is notable, however, for lacking systematic understanding of the very actors shaping these new forms science-society interaction. This paper addresses this lacuna by drawing on United Kingdom based in-depth empirical research (...) that made space for participatory appraisal experts to reflect on effective practice and novel questions of competence, expertise, and citizen-specialist relations within analytic-deliberative processes. Emerging practitioner principles warn that existing participatory models have not sufficiently considered constructivist perspectives on knowledge, analysis, and deliberation. Effective participatory appraisal under uncertainty needs to guard against the “technocracy of participation” by opening up to diversity, difference, antagonism, and uncertainties/indeterminacies. (shrink)

Developmentally, adolescence sits in transition between childhood and adulthood. Involving adolescents in their medical decision-making prompts important and complex ethical questions. Originating in the UK, the concept of Gillick competence is a dominant framework for navigating adolescent medical decision-making from legal, ethical and clinical perspectives and is commonly treated as comprehensive. In this paper, we argue that its utility is far more limited, and hence over-reliance on Gillick risks undermining rather than promoting ethically appropriate adolescent involvement. We demonstrate that (...) Gillick only provides guidance in the limited range of cases where legal decisional authority needs to be clarified. The range of cases where use of Gillick actually promotes adolescent involvement is narrower still, because several features must be present for Gillick to be enacted. Each of these features can, and do, act as barriers to adolescent involvement. Within these limited situations, we argue that Gillick is not specific or strong enough and is reliant on ethically contestable principles. Moreover, in most situations in adolescent healthcare, Gillick is silent on the ethical questions around involving adolescents. This is because it focuses on decisional authority—having the final say in decision-making—which is one small subset of the many ways adolescents could be involved in decision-making. The implication of our analysis is that use of Gillick competence tends to limit or undermine adolescent involvement opportunities. We propose that those working with adolescents should be judicious in seeking Gillick’s guidance, instead drawing on and developing alternative frameworks that provide a comprehensive model for adolescent involvement. (shrink)

Academics working on military ethics and serving military personnel rarely have opportunities to talk to each other in ways that can inform and illuminate their respective experiences and approaches to the ethics of war. The workshop from which this paper evolved was a rare opportunity to remedy this problem. Our conversations about First Lieutenant (1LT) Portis’s experiences in combat provided a unique chance to explore questions about the relationship between oversight, accountability, and the idea of moral risk in military operations. (...) In this paper, we outline a particular experience of 1LT Portis’s that formed the basis of our discussions, before elucidating the ethical issues this experience raised. In particular, we see 1LT Portis’s experience as, first, illustrative of the problem of moral risk – when military personnel are placed in situations of moral temptation. The problem of moral risk, we propose, is best understood through the framework of the military’s duty of care. Second, we see his experience as highlighting tensions within the dominant moralized warrior model of the military profession. What we call a toxic warrior identity — a distorted form of the moralized warrior identity — can negatively affect the attitudes of military personnel toward rules, policies, procedures, and accountability mechanisms, particularly in relation to non-combat related roles and duties and when leaders must choose between competing bureaucratic demands. We see 1LT Portis’s experience as illustrative of these tensions, yet his experiences also highlight important concerns about the impact of increasing bureaucratic demands on military functioning. In the conclusion, we address the need to balance concerns about toxic warrior identity with legitimate criticisms of overly demanding bureaucracy and suggest avenues for further research on this issue. (shrink)

The fact that most of us are ignorant on politically relevant matters presents a problem for democracy. In light of this, some have suggested that we should impose epistemic constraints on democratic participation, and specifically that the franchise be restricted along competency lines – a suggestion that in turn runs the risk of violating a long-standing condition on political legitimacy to the effect that legitimate political arrangements cannot be open to reasonable objections. The present paper therefore outlines a way to (...) solve the problem of public ignorance without restricting the franchise. The proposal involves filtering the electoral input of a universal franchise through a statistical model that simulates what the public's political preferences would have been, had they been informed on politically relevant matters. The result is modelled democracy. A case is made that such democracy both solves the problem of public ignorance and satisfies the aforementioned condition on legitimacy. (shrink)

Emerging research has highlighted the utility of measuring individual differences in decision-making competence (DMC), showing that consistently following normatively rational principles is associated with positive psychosocial and health behaviors. From another level of analysis, functional theories of personality suggest that broad trait dimensions represent variation in underlying self-regulatory systems, providing a mechanistic account for robust associations between traits and similar life outcomes. Yet, the degree to which broad dispositional personality dimensions predict global tendencies to respond rationally is less understood. In (...) a large online community sample (N = 804), we tested the associations between HEXACO personality dimensions, a 6-factor structural trait model, and a subset of DMC indicators (Applying Decision Rules, Resistance to Framing, Recognizing Social Norms, and Consistency in Risk Perception). Additionally, we examined gender differences across the DMC, first considering the potential for measurement non-invariance across groups for the DMC. We observed partial measurement invariance between men and women; only the Applying Decision Rules scale showed evidence of differential functioning across groups. Controlling for these differences, analyses revealed that higher Conscientiousness, Honesty/Humility, and Openness were associated with higher DMC scores. In contrast, Emotionality and Extraversion demonstrated gender-specific associations. Speci... (shrink)

Genetic knowledge is a civil right and a civil obligation. New genetic knowledge in individual health risk prediction and prevention and new pharmacogenetic opportunities for developing more efficacious individualized drugs broaden human and civil rights for better health and health care. Public health policy has yet to develop and provide programs in genetic information and consultation together with other health risk information and health literacy education. Data availability and genetic knowledge will make citizens more competent partners in health risk management. (...) As with all information, abuse and manipulation of genetic information cannot be excluded; but health education as an essential part of public health services will empower citizens to better care for their own and their families health. Existing cultural and ethical principles, laws and regulations need to be reviewed and modified in order to prevent and fight illegal or immoral use of genetic information. The promotion of genetic knowledge allows for a new model of social contract as health care contract between citizens, health care experts, and society. (shrink)

Adverse developmental exposures and pathologies of the social environment make vastly greater contributions to the leading health burdens in society than currently known genotypic information. Yet, while patients now commonly bring information on single alleles to the attention of their healthcare team, the former conditions are only rarely considered with respect to future health outcomes. This manuscript aims to integrate social environmental influences in genetic predictive models of disease risk. Healthcare providers must be educated to better understand genetic risks (...) for complex diseases and the specific health consequences of societal adversities, to facilitate patient education, disease prevention, and the optimal care in order to achieve positive health outcomes for those with early trauma or other social disadvantage. (shrink)

Nietzsche offers us an account of how different drives interact with one another; it is rich but also appears to risk the homunculus fallacy. Competing attempts to deflect this charge on his behalf share an implicit consensus about the ‘epistemic ends’ of the account: they assume Nietzsche is trying to provide true explanations of psychological phenomena. I argue against this consensus. I claim that Nietzsche's characterisations of drive interaction are to be taken as fictive and are not intended to (...) have explanatory value. They nevertheless facilitate genuine epistemic achievement. Drawing on Catherine Elgin's account of the epistemic role of idealised models in science, I argue that Nietzsche's account of drive interaction is a ‘model of the mind’ that, despite relying on falsehoods, can exemplify features of our psychology that aid us in making novel predictions. We then see that Nietzsche neatly sidesteps the homunculus fallacy; we can further understand more fully what Nietzsche hopes his drive psychology will teach us. We can now resolve, for example, outstanding interpretative puzzles about the relationship between psychic integration and Nietzsche’s distinctive notion of spiritual health. (shrink)

Our beliefs and opinions are shaped by others, making our social networks crucial in determining what we believe to be true. Sometimes this is for the good because our peers help us form a more accurate opinion. Sometimes it is for the worse because we are led astray. In this context, we address via agent-based computer simulations the extent to which patterns of connectivity within our social networks affect the likelihood that initially undecided agents in a network converge on a (...) true opinion following group deliberation. The model incorporates a fine-grained and realistic representation of belief and trust, and it allows agents to consult outside information sources. We study a wide range of network structures and provide a detailed statistical analysis concerning the exact contribution of various network metrics to collective competence. Our results highlight and explain the collective risks involved in an overly networked or partitioned society. Specifically, we find that 96% of the variation in collective competence across networks can be attributed to differences in amount of connectivity and clustering, which are negatively correlated with collective competence. A study of bandwagon or “group think” effects indicates that both connectivity and clustering increase the probability that the network, wholly or partly, locks into a false opinion. Our work is interestingly related to Gerhard Schurz’s work on meta-induction and can be seen as broadly addressing a practical limitation of his approach. (shrink)

The concept of the national is often perceived, both in public and academic discourse as the central obstacle for the realization of cosmopolitan orientations. Consequently, debates about the nation tend to revolve around its persistence or its demise. We depart from this either-or perspective by investigating the formation of the ‘cosmopolitan nation’ as a facet of world risk society. Modern collectivities are increasingly preoccupied with debating, preventing and managing risks. However, unlike earlier manifestations of risk characterized by daring actions (...) or predictability models, global risks can no longer be calculated or forecast. Accordingly, more influence accrues to the perception of risk, largely constructed by media representations. Cosmopolitanized risk collectivities are engendered through the anticipation of endangered futures which are, for the most part, communicated through an increasingly global media scape. While global media events produce shared exposure, risk conceptions retain distinctive political-cultural features as their respective meanings are prefigured by path-dependent pasts. Nevertheless, the promulgation of risk societies, we argue, results in a reimagination of nationhood which takes place in the context of: global norms (e.g. human rights); globalized markets; transnational migrations; global generations and their embeddedness in civil society movements; and the local interpenetration of world religions to name but a few of the global backdrops shaping new associational intersections. We develop our argument in four interrelated steps. Contrary to essentialized notions of nationalism or universal versions of cosmopolitanism, we address the cosmopolitan reconfiguration of nationhood by differentiating between presumptions of thick belonging and the actual proliferation of cosmopolitan affiliations. In a second step we overcome the territorial fixation of the social sciences by shifting our attention to temporal dimensions, with a particular focus on competing conceptions of the future. In a third step we demonstrate how these cosmopolitan transformations of nationhood are taking place in the context of a world risk society regime that marshals a set of cosmopolitan imperatives situating the global other in our midst. In a fourth step we illustrate these developments by exploring how the mediatization of risk, and concomitant notions of the future, contribute to the reimagination of cosmopolitan risk collectivities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Anorexia and the MacCAT-T Test for Mental Competence:Validity, Value, and EmotionLouis C. Charland (bio)Keywordsmental competence, decisional capacity, anorexia, value, emotionValidity of the MacCAT-THow does one scientifically verify a psychometric instrument designed to assess the mental competence of medical patients who are asked to consent to medical treatment? Aside from satisfying technical requirements like statistical reliability, results yielded by such a test must conform to at least some accepted pretheoretical (...) desiderata; for example, determinations of competence, as measured by the test, must capture a minimal core of accepted basic intuitions about what competence means and what a theory of competence is supposed to do. The concepts of "face validity" and "content validity" are both important here. Face validity "indicates that an instrument appears to test what it is supposed to and that it is a plausible method for doing so" (Portney and Watkins 2000, 82). Content validity "means that the test contains all the elements that reflect the variable being studied" (Portney and Watkins 2000, 83). An adequate instrument for measuring mental competence must at minimum satisfy both of these requirements.What Tan and her colleagues (2006) have shown is that the MacArthur Competence Assessment Tool—Treatment (MacCAT-T) test for mental competence may not be an empirically valid measure of mental competence for some cases of anorexia. The data they report show that "competence," as measured by the MacCAT-T, does not conform sufficiently well with what is wanted of a clinical medical theory of competence. More specifically, the MacCAT-T is deficient in both face and content validity. This result is extremely significant; previous challenges to the validity of the MacCAT-T have often been largely theoretical in nature. My own objection that the MacCAT is inadequate because it omits the influence of emotion is based on a combination of empirical theory (Charland 1998a) and philosophical argument (Charland 1998b). However, it is entirely theoretical in nature. So is my argument that in ignoring emotion the MacCAT misses a crucial contributing ingredient in competence, namely, value (Charland 2001, see especially 136 note 2). Tan's study provides valuable empirical evidence for the second of these challenges, which deals more specifically with value. On the one hand, the study clearly demonstrates that patients sometimes do [End Page 283] base their treatment decisions on reasons derived from values. And on the other hand, it also nicely illustrates the centrality of values—"utilities" or "preferences"—in the decision-making process generally; a basic assumption of standard decision theory for which, paradoxically, there appears to be no satisfactory counterpart in the MacCAT-T model of reasoning and decision making.Thus, values figure among the reasons that patients actually use in reasoning when they weigh the risks and benefits of proposed treatment options. The MacCAT-T must be amended to incorporate this fact if it is to be a satisfactory clinical medical tool. Without such a correction, the concept of mental competence it measures is empirically invalid. At the root of the problem is a clash of intuitions. Tan's data provide convincing evidence that some of the patients who are deemed to be mentally competent by MacCAT-T standards should not in fact be considered competent. Note that the language in which this clash is expressed—"should not in fact"—involves a combination of descriptive and prescriptive elements, reminding us that the concept of competence is dual in nature: it is both prescriptive and descriptive (Freedman 1981). These problems underscore the need for greater clarity about what pretheoretically we want a clinical theory and test of competence to capture. It is of course reasonable to say that such a test must be consistent with major tenets of the relevant case law (Appelbaum 1998). But a legally valid concept of competence of this sort is too thin and arbitrary a foundation on which to build a clinical medical theory of competence. An empirically valid theory and test of the latter sort must incorporate the role of values if it is be truly helpful in medical practice.Value and the MacCAT-TI agree with Tan and her colleagues that some notion of "pathological value" needs to be... (shrink)

Indigenous populations in New World nations share the common experience of culture contact with outsiders and a prolonged history of prejudice and discrimination. This historical reality continues to have profound effects on their well-being, as demonstrated by their relative disadvantages in socioeconomic status on the one hand, and in their delayed demographic and epidemiological transitions on the other. In this study one aspect of aboriginals’ epidemiological situation is examined: their mortality experience between the early 1980s and early 1990s. The groups (...) studied are the Canadian Indians, the American Indians and the New Zealand Maori (data for Australian Aboriginals could not be obtained). Cause-specific death rates of these three minority groups are compared with those of their respective non-indigenous populations using multivariate log-linear competing risks models. The empirical results are consistent with the proposition that the contemporary mortality conditions of these three minorities reflect, in varying degrees, problems associated with poverty, marginalization and social disorganization. Of the three minority groups, the Canadian Indians appear to suffer more from these types of conditions, and the Maori the least. (shrink)

Competent risk management is central to the ethical conduct and profitability of organisations including universities. Recent UK research highlights the risks of physical and psychological harm and emotional distress for researchers and the importance of developing strategies to deal with these issues prior to data being collected. Actual numbers of incidents of researcher harm in Australian universities are unavailable; however anecdotal evidence and Bloor et al.’s ( 2010 ) case studies suggest that this is a significant issue. They recommended (...) risk management practices such as training about researcher safety, pre-trip security briefings, established call-back systems, working in pairs, and compulsory de-briefings are recommended. Yet Australian universities do little to protect the safety of field researchers when they collect data in private locations, such as participants’ homes and when dealing with emotionally challenging content. This is at odds with the duty of care requirements on employers in current state based occupational health and safety (OHS) laws where breaches attract considerable penalties. The failure to adequately address the potential safety hazards and manage the risks associated with data collection places Australian universities in a vulnerable position, and possibly at risk of litigation, in their duty to adequately protect researchers. The paper presents a review of the international literature and draws on the UK research. Conceptual modelling is provided to illustrate the risk to universities if researchers are harmed in the field. Finally, the paper concludes with a call for further research to develop robust policy and practice that protects the field researcher. (shrink)

Human infection challenge studies (HCS) have been proposed as a means to accelerate SARS-CoV2 vaccine development and thereby help to mitigate a prolonged global public health crisis. A key criterion for the ethical acceptability of SARS-CoV2 HCS is that potential benefits outweigh risks. Although the assessment of risks and benefits is meant to be a standard part of research ethics review, systematic comparisons are particularly important in the context of SARS-CoV2 HCS in light of the significant potential benefits (...) and harms at stake as well as the need to preserve public trust in research and vaccines. In this paper we explore several considerations that should inform systematic assessment of SARS-CoV-2 HCS. First, we detail key potential benefits of SARS-CoV-2 HCS including, but not limited to, those related to the acceleration of vaccine development. Second, we identify where modelling is needed to inform risk-benefit (and thus ethical) assessments. Modelling will be particularly useful in (i) comparing potential benefits and risks of HCS with those of vaccine field trials under different epidemiological conditions and (ii) estimating marginal risks to HCS participants in light of the background probabilities of infection in their local community. We highlight interactions between public health policy and research priorities, including situations in which research ethics assessments may need to strike a balance between competing considerations. (shrink)

Could the employment of large language models (LLMs) in place of human advisors improve the problem-solving ability of democratic assemblies? LLMs represent the most significant recent incarnation of artificial intelligence and could change the future of democratic governance. This paper assesses their potential to serve as expert advisors to democratic representatives. While LLMs promise enhanced expertise availability and accessibility, they also present specific challenges. These include hallucinations, misalignment and value imposition. After weighing LLMs’ benefits and drawbacks against human advisors, I (...) argue that time-tested democratic procedures, such as deliberation and aggregation by voting, provide safeguards that are effective against human and machine advisor shortcomings alike. Additional protective measures may include custom training for advisor LLMs or boosting representatives’ competencies in query formulation. Implementation of adversarial proceedings in which LLM advisors would debate each other and provide dissenting opinions is likely to yield further epistemic benefits. Overall, promising interventions that would mitigate the LLM risks appear feasible. Machine advisors could thus empower human decision-makers to make more autonomous, higher-quality decisions. On this basis, I defend the hypothesis that LLMs’ careful integration into policymaking could augment democracy’s ability to address today’s complex social problems. (shrink)

Doctors are regularly confronted with requests for sterilisation of mentally handicapped people who cannot give consent for themselves. They ought to act in a medical vacuum because there doesn't exist a consensus about a model for decision making on this matter. In this article a model for decision making is proposed, based on a review of the literature and our own research data. We have attempted to select and classify certain factors which could enable us to arrive at (...) an ethically justifiable method of making a medical decision. In doing so we distinguish two major criteria: heredity and parenting competence, and six minor criteria: conception risk, IQ, age, personality, medical aspects and prognosis and finally support and guidance for the mentally handicapped person. The major criteria give rise to a "situation of necessity". In this situation the physician is confronted with a conflict of values and interests. The minor criteria are of an entirely different ethical order. They can only be considered once the major criteria have created a "situation of necessity". Ultimately it comes down to deciding whether the benefits of sterilisation outweigh the drawbacks and whether the means are appropriate to the end, where efficient contraception is the end and irreversible sterilisation is the means. (shrink)

Motivation has been the subject of much research in the sport psychology literature, whereas athlete mental health has received limited attention. Motivational complexities in elite sport are somewhat reflected in the mental health literature, where there is evidence for both protective and risk factors for athletes. Notably, few studies have linked motivation to mental health. Therefore, the key objective of this study was to test four mental health outcomes in the motivational sequence posited by the Hierarchical Model of Intrinsic (...) and Extrinsic Motivation: motivational climate  basic psychological needs  motivation  mental health outcomes. Elite team-sport athletes (140 females, 75 males) completed seven psychometric inventories of motivation-related and mental health variables. Overall, the athletes reported positive motivational patterns, with autonomous motivation and task climate being more prevalent than their less adaptive counterparts. Elevated depressive symptoms and poor sleep quality affected nearly half of the cohort. Structural equation modelling supported pathways between motivational climate, basic needs, motivation, and mood, depressive symptoms, sleep quality, and trait anxiety. Specifically, a task climate was positively associated with the three basic psychological needs, and an ego climate was positively associated with competence. Autonomy and relatedness had positive and negative associations with autonomous and controlled forms of motivation, respectively. Controlled motivation regulations were positively associated with the four mental health outcomes. Integrated regulation had a negative association with anxiety, and intrinsic regulation had a positive association with depressive symptoms. These findings highlight the complexities of and interrelations between motivation and mental health among athletes, and support the importance of considering mental health as an outcome of motivation. (shrink)

The advent of ChatGPT by OpenAI has prompted extensive discourse on its potential implications for science and higher education. While the impact on education has been a primary focus, there is limited empirical research on the effects of large language models (LLMs) and LLM-based chatbots on science and scientific practice. To investigate this further, we conducted a Delphi study involving 72 researchers specializing in AI and digitization. The study focused on applications and limitations of LLMs, their effects on the science (...) system, ethical and legal considerations, and the required competencies for their effective use. Our findings highlight the transformative potential of LLMs in science, particularly in administrative, creative, and analytical tasks. However, risks related to bias, misinformation, and quality assurance need to be addressed through proactive regulation and science education. This research contributes to informed discussions on the impact of generative AI in science and helps identify areas for future action. (shrink)

An issue of ongoing concern to clinical investigators, medical ethicists, and institutional review board members is the problem of obtaining informed consent in research that involves people with mental illness as research participants. Although the presence of a mental disorder per se does not render a person incapable of giving informed consent, some individuals afflicted with significant cognitive impairment, formal thought disorder, substantial anxiety or depression, or a variety of other symptoms may be impaired in their capacity to comprehend consent (...) disclosures and therefore to exercise consent to research participation in a competent manner.The stakes surrounding this informed consent issue are significant. On the one hand, the inclusion in research of participants who are not capable of giving informed consent may result in their exposure to unwarranted risks and significant harm. These concerns may be exacerbated in certain clinical trials in which patients are required to discontinue their medications during “washout periods” at the onset of a study, or are randomly assigned to a placebo treatment and remain off medication for extended periods. (shrink)

Objective The objective of this article is to provide an ethical analysis of a high-risk, advanced treatment case where the patient received transcatheter aortic valve insertion (TAVI), for aortic valve stenosis. Particular emphasis will be placed upon the significance of evidence and the implications for priority setting. Method One paradigmatic case involving a TAVI patient from a large university hospital in Norway is described and analysed. The method used was ethical case analysis modified after Kymlicka by Miljeteig et al. Perioperative (...) mortality risk was estimated using the Euroscore risk-logarithm and the Society of Thoracic Surgeons’ risk model, STS. These predict the risk of operative mortality and morbidity associated with adult cardiac surgery. GRADE, the Grading of Recommendations Assessment, Development and Evaluation, was used to evaluate the evidence. Results In the case analysis, we found that it would be ethically justifiable not to recommend TAVI treatment for this patient. Although the patient had a severe condition in need of treatment, the expected improvement was marginal, the quality of evidence was low and the opportunity costs for other patients and society were higher than usually deemed appropriate. Conclusions Decision-making in the absence of high quality evidence from randomized trials is a complex process involving difficult ethical judgments. Novel high-risk devices often enter the European market with limited clinical evidence. Transparency and improved clinical evaluation are required so patient safety is not jeopardized. We argue that implementation of high risk, high cost interventions should be better regulated at a national level. Background All clinical decisions imply priority setting and therefore indirectly affect other patients and other patient groups. The use of expensive, innovative health technologies has an affect on individual patients as well as on other patient groups competing for the same resources. (shrink)

Moving from the paradigms of “mentalization” and “reflective function”, this article develops the concept of “mentalizing” in organizations, understood as a process of construction of shared meaning in the work contexts, and whose absence or deterioration produces suffering in organizational experience, exposing individuals to significant psychosocial risks. This model converges in outlining a framework in which the absence of a reflective competence and the lack of symbolization of the experience of work fall on the perception of one's own (...) job, and on the relationship with colleagues and management, producing unsustainability of the work experience. The availability of reflective spaces that are inscribed in the ordinary dimension of work thus appears as a solution capable of promoting organizational well-being. (shrink)

It has been convincingly argued that computer simulation modeling differs from traditional science. If we understand simulation modeling as a new way of doing science, the manner in which scientists learn about the world through models must also be considered differently. This article examines how researchers learn about environmental processes through computer simulation modeling. Suggesting a conceptual framework anchored in a performative philosophical approach, we examine two modeling projects undertaken by research teams in England, both aiming to inform flood risk (...) management. One of the modeling teams operated in the research wing of a consultancy firm, the other were university scientists taking part in an interdisciplinary project experimenting with public engagement. We found that in the first context the use of standardized software was critical to the process of improvisation, the obstacles emerging in the process concerned data and were resolved through exploiting affordances for generating, organizing, and combining scientific information in new ways. In the second context, an environmental competency group, obstacles were related to the computer program and affordances emerged in the combination of experience-based knowledge with the scientists’ skill enabling a reconfiguration of the mathematical structure of the model, allowing the group to learn about local flooding. (shrink)

United States Atomic Energy Commission (USAEC) and UN agencies utilized techniques of power and negotiation to implement radiation exposure regulations. USAEC affiliated scientists’ expertise was cultivated while establishing a radiation protection regime based on classified experiments. World Health Organization (WHO) leadership sought to manifest a human right to health, including a right to protection from radiation contamination. The careers of a few technical experts and interagency UN correspondence shows how American risk models of radiation regulation traveled and ultimately inhibited WHO (...) attempts to frame radiation as a public health threat. The USAEC and the International Atomic Energy Agency (IAEA) navigated WHO’s way of perceiving radiation with technical experts and bureaucratic and legislative means. This paper shows the underpinning at the UN of competing models of radiation regulation, one state centric and the other, an individual right to health. This narrative provides insights into the nature of the UN’s current conceptualization of radiation regulation and argues for further research into UN, radiation, and human rights history. (shrink)

Within thirty years of first appearing, the networked digital economy has spread its tentacles into the lives of half the population of the world, and transformed the balance of power in the commercial economy. Social theory has been slow to recognize the significance and scale of these developments, and this special issue is a contribution to redressing the balance. It is organized around the concept of moral economies: the values and norms that underpin and shape our participation in larger economic (...) structures. The digital economy today is the site of a range of competing economic models, and this is reflected in clashes between a corresponding range of moral economies. The contributors to this special issue map these tensions in examples of both gift and commodity models of economy, analyse the implications for global risk, and re-evaluate classic analytic schemes to represent these tensions. Because the economy is built on moral economies, the process of economic change is already inherently a process of debate and contestation between different moral economies, with the consequence that academic work on the ethics of the economy can influence these processes of change. (shrink)

The financial crisis that began in the US real-estate market in 2007 and culminated in a global economic slump showed bluntly how wrong financial risk models can be. This state of affairs has triggered a number of reactions and observations at the level of the specification and use of models and at a more conceptual/fundamental level. This article focuses on the epistemic features of such models – namely the nature, source, conditions of validity, structure and limits of the knowledge that (...) ‘well-specified’ models generate – so as to assess models in a balanced way, giving due weight to the fundamental determinants of their output and warning against overestimation of their possibilities; clarify the conditions under which models can be validly applied to economic and social relationships; render intelligible why the degree of accuracy that successful models would require is intrinsically unattainable; better understand models’ failure as evidenced by the crisis; and comment on the policy steps being undertaken to prevent similar financial crisis in the future. The analysis applies the principal tenets of critical realism to the daily preoccupations of risk management professionals and financial regulators alike. It is not intended as an intervention into critical realism. It draws on the works of Tony Lawson and Roy Bhaskar, and revisits relevant aspects of John Maynard Keynes’s work, connecting dots amongst them and marrying economic and philosophical analysis with day-to-day financial risk management and regulatory issues. Content Type Journal Article Category Article Pages 462-486 DOI 10.1558/jcr.v11i4.462 Authors Mattia L. Rattaggi, UBS/Cambridge Social Ontology Group Journal Journal of Critical Realism Online ISSN 1572-5138 Print ISSN 1476-7430 Journal Volume Volume 11 Journal Issue Volume 11, Number 4 / 2012. (shrink)

The analysis of survival data often aims at the prediction of failure time distribution. In cases of competing risk events, the time distributions of more than one failure are under investigation. In this paper, the comparison of two approaches to analyzing survival data with competing risks is presented. The analyses are performed by use of an ensemble of dipolar trees with and without adjustment to competing risks.

Underscoring the economic significance of the Knightian distinction between risk and uncertainty, Don Katzner forcefully challenges the continued dominance of the expected utility model based on subjective probability in macroeconomic analysis and offers in its place a simple yet elegant model of decision making inspired by the pioneering work of G.L.S. Shackle. In doing so, Katzner lends support to a research program to identify a more coherent and empirically grounded theory of decision making under uncertainty. Our paper makes (...) three contributions to this program. First, we argue that the appropriate choice of a model of individual behavior under uncertainty cannot be adjudicated merely on logical, a priori grounds, but must ultimately be based on consistency with observed behavior. There are many internally consistent models and their external conditions of validity hardly ever rely on inconceivable scenarios. Second, while Katzner’s model certainly provides a plausible foundation for understanding choice under uncertainty, we suggest that it is somewhat underdetermined. It requires further theoretical articulation to yield testable predictions which differentiate it from competing approaches. Third, we discuss recent experimental findings that may need to be addressed by any satisfactory theoretical account of decision making under uncertainty. (shrink)

Values are numerous, interrelated and hard to discern in professional practice. This article reports on key findings from research into locating professional values within health social work practice in Aotearoa New Zealand. The research explores how 15 health social workers experience and negotiate value demands when working with newborn infants. A staged methodology underpinned by constructivist grounded theory was utilised to generate theoretical knowledge through two phases of semi-structured individual interviews. The research firmly located health social workers practice in the (...) middle ground of a complex, tension-ridden practice environment with health social workers courageously striving to balance competing requirements. Within a health model influenced by neoliberal policy, key tensions related to challenges faced due to professionals oversimplifying social circumstances in risk-laden situations. This resulted in issues of judgements, bias and racism being a central concern for the participants’ social work practice. Despite these tensions, the place of social justice as a primary organising value was affirmed by the research. A stronger focus on the profession’s values would strengthen the collective voice of health social workers and their identity, in order to better address the systemic drivers of health inequities. (shrink)

What is the epistemological structure of situations where many small risks amount to a large one? Lottery and preface paradoxes and puzzles about quantum-mechanical blips threaten the idea that competent deduction is a way of extending our knowledge. Seemingly, everyday knowledge involves small risks, and competently deducing the conjunction of many such truths from them yields a conclusion too risky to constitute knowledge. But the dilemma between scepticism and abandoning MPC is false. In extreme cases, objectively improbable truths (...) are known. Safety is modal, not probabilistic, in structure, with closure and factiveness conditions. It is modelled using closeness of worlds. Safety is analogous to knowledge. It suggests an interpretation of possible worlds semantics for epistemic logic. To avoid logical omniscience, a relation of epistemic counterparthood between formulas is introduced. This supports a safety conception of knowledge and formalizes how extending knowledge by deduction depends on logical competence. (shrink)

The generative AI boom is unleashing its minions. Enterprise software vendors have rolled out legions of automated assistants that use large language model (LLM) technology, such as ChatGPT, to offer users helpful suggestions or to execute simple tasks. These so-called copilots and chatbots can increase productivity and automate tedious manual work. In this article, we explain how that leads to the risk that users' ethical competence may degrade over time — and what to do about it.

Controlled Human Infection Model (CHIM) research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: reimbursement, (...) wage payment and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways (value of statistical life or consistency with risk in other employment) by which payment for risk could be calculated. (shrink)

Managers often ask why their firm should have an ethics program, especially if no one has complained about unethical behavior. The pursuit of business ethics can cost money, they say. It can lose sales to less scrupulous competitors and can drain management time and energy. But as Harvard business professor Francis Aguilar points out, ethics scandals (such as over Beech-Nut's erzatz "apple juice" or Sears's padded car repair bills) can severely damage a firm, with punishing legal penalties, bad publicity, and (...) irreparably injured customer relations. Equally important if less obvious, unethical behavior can undermine a firm's organizational spirit. On the other hand, Aguilar argues, in a well run firm, ethical programs can actually enhance corporate performance, strengthening the company at every level and supercharging employee risk taking and innovation. In Managing Corporate Ethics, Aguilar shows managers how to create ethical programs within their organizations that not only discourage large-scale wrongdoing, but can contribute substantially to the achievement of corporate excellence. Aguilar's program is down-to-earth and comprehensive, and based on his extensive research on highly successful, ethical companies, both large and small. He recommends action on three fronts: first, get senior management to provide effective ethical leadership; second, set up an ethics program that promotes concern for the interests of people affected by the firm's operations and that provides safeguards against corrupting business pressures; and third, staff the company with ethical people and surround the organization with ethical advisors (including legal, financial, accounting, tax, and marketing consultants). To illuminate this three-step program, Aguilar incorporates the lessons learned in his in-depth study of ten prominent firms with proven successful ethics programs--among them Hewlett-Packard, Johnson & Johnson, Nucor Steel, Cray Research, ServiceMaster, and Texas Instruments. He examines Lincoln Electric's attention to compensation and job security to ensure quality products and to reduce the pressure or temptation to act unethically. He shows how General Mills, while pushing product line managers to compete aggressively, uses corporate staff units to guard against illegal or unacceptable claims (testing cake recipes, for example, to see if a product's quality fails under the less-than-perfect conditions of a normal kitchen). And he details how Armstrong World Industries uses pep talks, inspirational stories, role models, and ready access to management to promote ethical standards among employees. Throughout, Aguilar demonstrates convincingly that an ethical program pays dividends: that employees, suppliers, customers, and the community at large know when they are being treated in a positive and constructive manner, and are likely to respond in kind. Packed with real life examples of successful (and failed) ethical programs, Managing Corporate Ethics is a valuable roadmap to an often overlooked source of business success. (shrink)

In this paper, we explore the interests of non-shareholder stakeholders in the context of a shareholder risk model. We first differentiate shareholders and nonshareholders with regard to the nature of their risks, their awareness of risks, their abilities to avoid risk, and their abilities to ensure compensation for risk. We then develop a model of measuring the risks facing stakeholders that addresses human risk magnitude and environmental risk magnitude. We conclude with implications for theory and (...) practice. (shrink)

When people rely on the web to gather and distribute information, they can build a sense of trust in the websites with which they interact. Understanding the correlates of trust in most websites (general website trust) and trust in websites that one frequently visits (familiar website trust) is crucial for constructing better models of risk perception and online behavior. We conducted an online survey of active Internet users and examined the associations between the two types of web trust and several (...) independent factors: information technology competence, adverse online events, and general dispositions to be trusting or cautious of others. Using a series of nested ordered logistic regression models, we find positive associations between general trust, general caution, and the two types of web trust. The positive effect of information technology competence erases the effect of general caution for general website trust but not for familiar website trust, providing evidence that general trust and self-reported competence are stronger associates of general website trust than broad attitudes about prudence. Finally, the experience of an adverse online event has a strong, negative association with general website trust, but not with familiar website trust. We discuss several implications for online behavior and suggest website policies that can help users make informed decisions about interacting with potentially risky websites. (shrink)

Psychological safety is a shared belief among team members that it is safe to take interpersonal risks. It can enhance team learning, experimentation with new ideas, and team performance. Considerable research has examined the positive effects of PS in diverse organizational contexts and is now shifting its focus toward exploring the nature of PS itself. This study aims to enhance our understanding of PS antecedents and development over time. Based on the model of team faultlines and research on (...) team diversity, we examined the effects of demographic faultlines, team member personality, and member competencies on the development of PS. Over 5 months, 61 self-managed teams assessed their PS at the beginning, midpoint, and end of a research project. Results of a multilevel growth curve model show that PS decreased from project beginning to end. Initial levels of PS were especially low when teams had strong demographic faultlines and when team members differed in neuroticism. PS decreased more strongly over time when team members were diverse in agreeableness and assessed their task-related competencies to be relatively high. Our study identifies time and team composition attributes as meaningful predictors for the development of PS. We present ideas for future research and offer suggestions for how and when to intervene to help teams strengthen PS throughout their collaboration. (shrink)

In 2009, Greenpeace launched an aggressive campaign against Nestlé, accusing the organization of driving rainforest deforestation through its palm oil suppliers. The objective was to damage the brand image of Nestlé and, thereby, force the organization to make its supply chain more sustainable. Prominent cases such as these have led to the prevailing view that sustainable supply chain management is primarily reactive and propelled by external pressures. This research, in contrast, assumes that SSCM can contribute positively to the reputation of (...) an organization as a “good citizen” and, thereby, counter the impression that external stakeholder pressure is the only driver of SSCM. The study draws on Resource Dependence Theory in analyzing the three competing models of the potential stakeholder, SSCM and the corporate sustainability performance relationship. A dataset of 1,621 organizations allows the statistical comparison of these three models. Findings suggest that stakeholder pressure and SSCM both contribute to an organization’s sustainability performance. Thus, supply chain managers will perceive benefits from SSCM other than merely the reduction of risk from reputational damage through stakeholder activism. (shrink)

Load monitoring in basketball is fundamental to develop training programs, maximizing performance while reducing injury risk. However, information regarding the load associated with specific activity patterns during competition is limited. This study aimed at assessing the external load associated with high-intensity activities recorded during official basketball games, with respect to different activity patterns, playing positions, and activities performed with or without ball. Eleven male basketball players competing in the Lithuanian third division were recruited for this study. Three in-season games (...) were assessed via time-motion analysis and microsensors. Specifically, the high-intensity activities including sprints, high-intensity specific movements and jumps were identified and subsequently the external load [PlayerLoad™ and PlayerLoad™/min ] of each activity was determined. Linear mixed models were used to examine differences in PL, PL/min and mean duration between activity pattern, playing positions and activities performed with or without ball. Results revealed PL was lower in jumps compared to sprints [p < 0.001, effect size = 0.68] and HSMs, while PL/min was greater in sprints compared to jumps. Jumps displayed shorter duration compared to sprints and HSMs, with HSMs lasting longer than sprints. Jumps duration was longer in backcourt than frontcourt players. When considering activity patterns combined, PL and duration were greater without ball. Regarding HSMs, PL/min was higher with ball, while duration was longer without ball. The current findings suggest that external load differences in high-intensity activities exist among activity patterns and between activities performed with and without ball, while no differences were found between playing positions. Practitioners should consider these differences when designing training sessions. (shrink)

Artificial Intelligence is supposed to perform tasks autonomously, make competent decisions, and interact socially with people. From a psychological perspective, AI can thus be expected to impact users’ three Basic Psychological Needs, namely autonomy, competence, and relatedness to others. While research highlights the fulfillment of these needs as central to human motivation and well-being, their role in the acceptance of AI applications has hitherto received little consideration. Addressing this research gap, our study examined the influence of BPN Satisfaction on Intention (...) to Use an AI assistant for personal banking. In a 2×2 factorial online experiment, 282 participants watched a video of an AI finance coach with a female or male synthetic voice that exhibited either high or low agency. In combination, these factors resulted either in AI assistants conforming to traditional gender stereotypes or in non-conforming conditions. Although the experimental manipulations had no significant influence on participants’ relatedness and competence satisfaction, a strong effect on autonomy satisfaction was found. As further analyses revealed, this effect was attributable only to male participants, who felt their autonomy need significantly more satisfied by the low-agency female assistant, consistent with stereotypical images of women, than by the high-agency female assistant. A significant indirect effects model showed that the greater autonomy satisfaction that men, unlike women, experienced from the low-agency female assistant led to higher ITU. The findings are discussed in terms of their practical relevance and the risk of reproducing traditional gender stereotypes through technology design. (shrink)

Initiating and maintaining sports and exercise behaviour are usually discussed in terms of strategies for promoting health. In the present study, we analysed a sample of extreme endurance sport athletes and set out to predict exercise addiction, which is a facet of a sport-related health risk. We therefore draw on self-determination theory (Deci & Ryan, 1985, 2000), according to which low basic psychological need satisfaction can lead to excessive compensatory behaviour. We aim to disentangle the effects of need satisfaction in (...) the activity itself (exercising) and outside the activity (work/leisure) on exercise addiction. Furthermore, we propose anxious self-motivation as a mediator and tested whether it links low basic need satisfaction with exercise dependence. A correlational study with 323 multi-triathlon athletes confirmed our hypothesis that need satisfaction in work/leisure (but not in sports) is negatively related to exercise addiction. Furthermore, only need for competence in both domains (sport, work/leisure) is associated with anxious self-motivation. Mediation models showed that low competence satisfaction leads to anxious self-motivation that in turn predicts exercise addiction. The results are discussed critically in terms of their practical and theoretical implications for promoting health through sport and exercise. (shrink)

We live in the era of Facebook, Fitbit, and Skype. As such, it would be unreasonable to expect that the healthcare industry would not see the same kind of globalization as do our social spheres and consumer activities. Indeed, the explosion of information technology, the ease of transcontinental travel, and the emergence of a more globally aware citizenry allows for scientific collaboration that has had many positive effects on global health. However, the economic and structural disparities between systems of healthcare (...) delivery in the industrialized world and parts of the developing world have created a monster in the form of an international medical tourism industry that endangers the health and safety of citizens of the host country as well as visiting patients. Not only does the practice of medical tourism pose a practical danger to those in direct contact with the industry, but it brings up troubling philosophical problems centering on national responsibility and the commodification of healthcare, among other important issues. In the United States, the driving force behind international medical tourism is the exorbitant cost of healthcare, particularly for the uninsured but also for the underinsured and those who experience catastrophic medical expenses from chronic illness or sudden health crises. Not only have individuals begun to look outside the U.S. for surgical procedures and other expensive therapies, but employers have begun to toy with the idea of outsourcing the medical care of the employees they insure in order to cut costs. In other industrialized nations, the issues that underpin international medical tourism are related to healthcare rationing and reflect different shortcomings in the delivery of healthcare in those nations, such as the United Kingdom and Canada, that have single-payer systems. Yet the regulatory and philosophical implications for both patients and hosts of international healthcare are largely the same. The challenge of regulating international trade in medical care is obvious and becomes particularly acute when there are insurers and employers involved. Complicating matters further, medical care that takes place outside the country of origin of the patient is often brokered by “medical concierge services,” which, though quick to claim indemnity from any harm arising from substandard or inappropriate medical care, cannot be divorced from responsibility for the health outcomes of their clients. Agreements hashed out between concierge services and patients specify that any remedy for harm stemming from their medical care must be pursued within the confines of the law of the host country, but the practical implications of this are troublesome. How can a foreign patient—often without either linguistic or cultural competency in the host country—be expected to navigate the complexity of a foreign legal system, particularly one that may be far less developed than his home country? Furthermore, if insurance companies and employers are involved with such care, who pays for an adverse result or determines responsibility for harm that may befall the patient? Under which countries’ laws? If a patient travels to Singapore for sexual reassignment surgery or a cardiac valve repair, returns to the States and suffers complications, who pays for the restoration of her health? Beyond legal standards and judicial remedies for harm to patients seeking care on the international market, there is the question of what ethical standards and norms apply to such patients. What effect does it have on American patients, for example, to receive care within a system that does not emphasize autonomy and informed consent the way they are used to? Why should foreign physicians care about the cultural mores of their patients’ country of origin? Can they be expected to grasp cultural differences between American, Canadian, and British patients? The medical concierge might respond, “Well, buyer beware!” This is unreasonable: It is nearly impossible for any patient to accurately assess the various options, risks and benefits that go with a particular medical treatment, much less the patient who is attempting to do so on the international market. And the crass invocation of the doctrine of caveat emptor betrays a view of healthcare as a commodity that is naive and inappropriate. Paramount in my mind, however, are the practical implications for the care of the citizens of developing nations that host international patients and the broader philosophical issue of what the goals of the medical profession as a whole and each country’s individual healthcare system should be. While I understand the argument that international medical tourism creates great economic gains for developing nations, which can then be channeled toward the care of their citizenry as a whole, there is much reason to doubt that this “trickle-down” model of economics provides real benefits for underserved, whether in healthcare or other arenas. What is more likely is that, while lucrative international “medi-cities” may keep bright doctors in their home countries, it is also likely to lure them away from the institutions that serve the lion’s share of their countrymen. With the concentration of talented native doctors in private hospitals that serve citizens of the developed world, the population at large is left to obtain care at institutions that suffer “brain drain” from the flight of talented local staff to more prestigious, often “brand name,” institutions that give them more Western-like salaries while allowing them to practice in their countries of origin. The very fact that citizens of the wealthiest nations in the world are forced to go abroad for life-saving care speaks to an abdication of national responsibility on the part of their home countries. The provision of health care is one of the principal responsibilities of any nation and it is unacceptable that a nation with the strength and wealth of the United States would take advantage of the weaker political and economic situations of developing nations in order to shirk its responsibility to its fellow citizens. If we take care of our countrymen and take pride in an equitable system of healthcare delivery, there will be no need to shrug our shoulders and say “Buyer beware” to the patient who heads to the Philippines for heart surgery. (shrink)