BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

While social interaction and play in a VR environment are becoming ever more popular, little is known about how social VR games affect users. The purpose of this study was to elucidate the role of several contingent factors in social VR games by modeling the relationships between involvement, well-being, depression, self-esteem, and social connectedness. A conditional process-moderated mediation model of the measured variables was analyzed with 220 pieces of collected data. The result showed that: the direct effect of involvement on (...) well-being was significant, and the index of moderated mediation involving depression, self-esteem, and social connectedness was significant. We conclude that high levels of involvement in social VR games by socially isolated users with low self-esteem can negatively affect their well-being. The findings of this study contribute in several ways to our understanding of the effect of social VR games upon users and provide important practical implications. (shrink)

Virtual reality is a rapidly developing technology that simulates the real world. However, for some cybersickness-susceptible people, VR still has an unanswered problem—cybersickness—which becomes the main obstacle for users and content makers. Sensory conflict theory is a widely accepted theory for cybersickness. It proposes that conflict between afferent signals and internal models can cause cybersickness. This study analyzes the brain states that determine cybersickness occurrence and related uncomfortable feelings. Furthermore, we use the electroencephalogram microstates and functional connectivity approach based on (...) the sensory conflict theory. The microstate approach is a time–space analysis method that allows signals to be divided into several temporarily stable states, simultaneously allowing for the exploration of short- and long-range signals. These temporal dynamics can show the disturbances in mental processes associated with neurological and psychiatric conditions of cybersickness. Furthermore, the functional connectivity approach gives us in-depth insight and relationships between the sources related to cybersickness. We recruited 40 males, and they watched a VR video on a curved computer monitor for 10 min to experience cybersickness. We recorded the 5-min resting state EEG and 10-min EEG while watching the VR video. Then, we performed a microstate analysis, focusing on two temporal parameters: mean duration and global explained variance. Finally, we obtained the functional connectivity data using eLoreta and lagged phase synchronization. We discovered five sets of microstates, including four widely reported canonical microstates, during baseline and task conditions. The average duration increased in microstates A and B, which is related to the visual and auditory networks. The GEV and duration decreased in microstate C, whereas those in microstate D increased. Microstate C is related to the default mode network and D to the attention network. The temporal dynamics of the microstate parameters are from cybersickness disturbing the sensory, DMN, and attention networks. In the functional connectivity part, the LPS between the left and right parietal operculum significantly decreased compared with the baseline condition. Furthermore, the connectivity between the right OP and V5 significantly decreased. These results also support the disturbance of the sensory network because a conflict between the visual and vestibular system causes cybersickness. Changes in the microstates and functional connectivity support the sensory conflict theory. These results may provide additional information in understanding brain dynamics during cybersickness. (shrink)

The purpose of this study was to investigate the relationship between organizational ethical context and the individual ethical decision-making process. In addition, a new statistical approach combining cluster and discriminant analyses was developed to overcome violations of regression assumptions, which are commonly not identified and/or ignored in behavioral and psychological research. Using regressions and this new alternative method, the findings indicated that ethical context does indeed influence the various components of ethical reasoning. However, social desirability was the strongest predictor of (...) ethical decision making, which raises new concerns about how this bias can confound business ethics research. Finally, the findings showed that the alternative method provided more useful and interpretive results, indicating that it has the capacity to influence future empirical work in the field of business ethics, particularly when dealing with data that do not satisfy regression assumptions. The implications and limitations of the study are discussed, and several noteworthy suggestions for future research are provided. (shrink)

BackgroundExperience with open disclosure and its study are restricted to certain western countries. In addition, there are concerns that open disclosure may be less suitable in non-western countries. The present study explored and compared the in-depth perceptions of the general public and physicians regarding open disclosure in Korea.MethodsWe applied the COREQ checklist to this qualitative study. We conducted 20 in-depth interviews and four focus group discussions with 16 physicians and 18 members of the general public. In-depth interviews and focus group (...) discussions were performed according to semi-structured guidelines developed according to a systematic review of open disclosure. We conducted a directed content analysis by analyzing the verbatim transcripts and field notes in accordance with the predetermined guidelines.ResultsOpen disclosure perceptions were summarized in terms of the “five Ws and one H”. All physician and general public participants acknowledged the normative justifiability of open disclosure. The participants mostly agreed on the known effects of open disclosure, but the physicians had negative opinions on its expected effects, such as decreased intention of the general public to file lawsuits and increased credibility of medical professionals. Generally, the participants thought that open disclosure is required for medical errors causing major harm. However, the physicians and general public had conflicting opinions on the need for open disclosure of near misses. Most physicians did not know how to conduct open disclosure and some physicians had bad experiences due to inappropriate or incomplete open disclosure.ConclusionPhysicians and the general public in Korea acknowledge the need for open disclosure. Guidelines according to the type of patient safety incident are required to encourage physicians to more readily conduct open disclosure. Furthermore, hospitals need to consider organizing a dedicated team and hiring experts for open disclosure. (shrink)

Smartphone app-use patterns will predict professional golfers’ athletic performance, and the use time of serious apps would be associated with improved performance. This longitudinal 4-week observation of 79 professional golfers assessed golf handicaps and smartphone app-use patterns at the start of the Korean professional golf season and 2 and 4 weeks later. We classified use as social networking, entertainment, serious apps, and others. Use time of entertainment apps increased for non-improved golfers but did not change for improved golfers. Use time (...) of serious apps increased for improved golfers and decreased for non-improved ones. Changes in golf handicaps were positively correlated with changes in entertainment app use time and negatively correlated with changes in serious app use time. Professional golfers’ sports performance was not associated with smartphone use time but was with the smartphone app type. The management of smartphone app-use patterns is important for professional golfers’ performance. (shrink)

How can corporate social responsibility initiatives influence brand love? Based on the theory of social identity complexity, we examined whether greater complexity of a sport fan’s multiple identifications with sport leagues led to higher multicultural tolerance and more positive perceptions of leagues’ corporate social responsibility activities. Further, brand authenticity was tested as a variable intervening between perceived corporate social responsibility and brand love. We analyzed this serial mediation effect impacting sport fans’ brand love for their multiple, favored and less favored, (...) sport leagues. Participants answered the scale item questionnaire for model assessment. The hypothesized model was supported as the indirect effect through all mediators was significant. Our results suggest that when sport fans acknowledge a high overlap among league fan groups, their tolerance is more likely to be higher than those who have a low overlap. Such high levels of tolerance influence how fans perceive corporate social responsibility initiatives, and these effects build up for fans to perceive the brand to be more authentic. These antecedents affected brand love through a serial mediation. Sport league managers should consider the diverse aspects across leagues for harmonious coexistence with other leagues and maintain brand authenticity for their social initiatives to result in a greater brand love in the consumer’s mind. (shrink)

How can sport community involvement influence life satisfaction during a pandemic? Self-expansion theory posits that individuals seek to gain resources such as positive interpersonal relationships for growth and achievement. By considering psychological capital as a dispositional resource intervening between sport community involvement and life satisfaction, we examined an empirical model to test the chain of effects. Based on the stress process model, distress and generational group were tested as moderators. Participants responded to the scale item questionnaire for model assessment. Supporting (...) the hypothesized relationships, the model was supported with a significant moderated-moderated mediation. The mediation effect of PsyCap was stronger when distress level was lower and such interaction effect was amplified for Generation Z. Whereas the global sport communities and Gen Z were found to be more particularly vulnerable to COVID-19, our findings suggest that there are psychological pathways for fans to maintain their resilience. It is foremost imperative to lower the stress level of sport fans for their community involvement to positively affect life satisfaction. Gen Z were more stressed during the pandemic but individuals who managed to cope with stress were able to leverage community involvement to boost positive psychological resources. Acknowledgment of these effects brings implications for better management strategies and provides avenues for new research. (shrink)

The result of 2007’s presidential election in South Korea symbolizes the decline of the Left and the growth of the new Right. They say it goes with the global retrogression of democracy, or the consolidation of the hegemony of the rightist versions of democracy. According to Choi Jang-jip, the general public in Korea has thought that the Roh Moo-hyun’s administration had betrayed them, handing power over to the market, and seeking to form a coalition government with theconservatives. Similarly, Professor (...) Jang Ha-jun asserts that the democratic governments of Kim Dae-jung and Roh Moo-hyun have mistaken economic democratization for neo-liberalistic structural adjustment. (shrink)

This chapter introduces several distinctions relevant to what is called the “discounting problem”, since the issue is how (future) costs and benefits are discounted to make them comparable in present terms. The author defends the claim that there are good reasons to adopt Ramsey-style discounting in the context of climate change: the Ramsey rule is robust, flexible, and well-understood. An important distinction involved in discounting—“descriptivism” and “prescriptivism”—is discussed. It is argued that, even if we adopt prescriptivism, and accept that this (...) means there is need for moral experts in parameter assignments, there is a significant issue. The type of moral expertise required for the discounting problem will not involve knowledge of moral theory—thus making moral philosophy unhelpful in terms of making particular parameter assignments, despite these being substantive moral judgments. (shrink)

While mitigation and adaptation will help to protect us from climate change, there are harms that are beyond our ability to adapt. Some of these harms, which may have been instigated from historical emissions, plausibly give rise to duties of compensation. This chapter discusses several principles that have been discussed about how to divide climate duties—the polluter pays principle, the beneficiary pays principle, the ability to pay principle, and a new one, the polluter pays, then receives principle. The chapter introduces (...) several challenges to these principles from the literature, before discussing which policies and institutions might be relevant to compensation, whether internationally (e.g. the Green Climate Fund) or intergenerationally (e.g. Broome and Foley’s World Climate Bank). It also describes some recent successful climate cases which require both the Dutch government and a private firm to act in accordance with climate targets to avoid potential rights-violations. Finally, it discusses one of the most important international concepts with respect to compensation: the Loss & Damage pillar of climate policy. (shrink)

The two mythical tales from the Samguk yusa, “Lady Suro” and “Monk Hyet’ong Defeats the Dragon” reveal the little-known evil character of the Korean dragons. The second story presents a particular scene of a confrontation between a hero and a malicious dragon; this story leads us to reflect on the question of the symbolism of evil embodied by the Dragon who has a vengeful character. The dragon symbol and its semantic variations were constructed specifically within the singular Korean context and (...) cannot be limited to Chinese Buddhist heritage. (shrink)

The so-called Baldwin Effect generally says how learning, as a form of ontogenetic adaptation, can influence the process of phylogenetic adaptation, or evolution. This idea has also been taken into computation in which evolution and learning are used as computational metaphors, including evolving neural networks. This paper presents a technique called evolving self-taught neural networks – neural networks that can teach themselves without external supervision or reward. The self-taught neural network is intrinsically motivated. Moreover, the self-taught neural network is the (...) product of the interplay between evolution and learning. We simulate a multi-agent system in which neural networks are used to control autonomous agents. These agents have to forage for resources and compete for their own survival. Experimental results show that the interaction between evolution and the ability to teach oneself in self-taught neural networks outperform evolution and self-teaching alone. More specifically, the emergence of an intelligent foraging strategy is also demonstrated through that interaction. Indications for future work on evolving neural networks are also presented. (shrink)

It is a hallmark of a good model to make accurate a priori predictions to new conditions (Busemeyer & Wang, 2000). This study compared 8 decision learning models with respect to their generalizability. Participants performed 2 tasks (the Iowa Gambling Task and the Soochow Gambling Task), and each model made a priori predictions by estimating the parameters for each participant from 1 task and using those same parameters to predict on the other task. Three methods were used to evaluate the (...) models at the individual level of analysis. The first method used a post hoc fit criterion, the second method used a generalization criterion for short‐term predictions, and the third method again used a generalization criterion for long‐term predictions. The results suggest that the models with the prospect utility function can make generalizable predictions to new conditions, and different learning models are needed for making short‐versus long‐term predictions on simple gambling tasks. (shrink)

In the first half, I suggest that Kant’s conception of our moral life goes through a significant shift after 1793, with reverberations in his eschatology. The earlier account, based on the postulate of immortality, describes our moral life as an endless pursuit of the highest good, but all this changes in the later account, and I point out three possible reasons for this change of heart. In the second half, I explore how the considerations Kant brings up to argue for (...) his accounts can inform our process of formulating positions with respect to the afterlife. I argue that, in the absence of a convincing theoretical proof for or against the afterlife as well as apodictically certain knowledge of how demanding the moral law is, the Kantian strategy would be to ask which account of our moral life delivers the kind of contentment that can sustain our moral resolve. I also point out a way theists might be able to find contentment despite their moral failures by imagining God’s moral kenosis. (shrink)

The current consensus is that most natural categories are not organized around strict definitions (a list of singly necessary and jointly sufficient features) but rather according to a family resemblance (FR) principle: Objects belong to the same category because they are similar to each other and dissimilar to objects in contrast categories. A number of computational models of category construction have been developed to provide an account of how and why people create FR categories (Anderson, 1990; Fisher, 1987). Surprisingly, however, (...) only a few experiments on category construction or free sorting have been run and they suggest that people do not sort examples by the FR principle. We report several new experiments and a two‐stage model for category construction. This model is contrasted with a variety of other models with respect to their ability to account for when FR sorting will and will not occur. The experiments serve to identify one basis for FR sorting and to support the two‐stage model. The distinctive property of the two‐stage model is that it assumes that people impose more structure than the examples support in the first stage and that the second stage adjusts for this difference between preferred and perceived structure. We speculate that people do not simply assimilate probabilistic structures but rather organize them in terms of discrete structures plus noise. (shrink)

Ideal carbon tax policy is internationally coordinated, fully internalizes externalities, redistributes revenues to those harmed, and is politically acceptable, generating predictable market signals. Since nonideal circumstances rarely allow all these conditions to be met, moral issues arise. This paper surveys some of the work in moral philosophy responding to several of these issues. First, it discusses the moral drivers for estimates of the social cost of carbon. Second, it explains how national self-interest can block climate action and suggests international policies—carbon (...) border tax adjustments and carbon clubs—that can help address these concerns. Third, it introduces some of the social science literature about the political acceptability of carbon taxes before addressing a couple common public concerns about carbon taxes. Finally, it introduces four carbon revenue usage options, arguing that redistributive and climate compensation measures are most morally justified. [Open access]. (shrink)

The three main types of policies for addressing climate change are command and control regulation, carbon taxes (or price instruments), and cap and trade (or quantity instruments). The first question in the ethics of carbon pricing is whether the latter two (price and quantity instruments) are preferable to command and control regulation. The second question is, if so, how should we evaluate the relative merits of price and quantity instruments. I canvass relevant arguments to explain different ways of addressing these (...) important policy questions, suggesting that carbon pricing is preferable to command and control regulation, and that price instruments have the theoretical edge over quantity instruments. [Open access]. (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what (...) they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (shrink)

Solar radiation management (SRM) may help to reduce the negative outcomes of climate change by minimising or reversing global warming. However, many express the worry that SRM may pose a moral hazard, i.e., that information about SRM may lead to a reduction in climate change mitigation efforts. In this paper, we report a large-scale preregistered, money-incentivised, online experiment with a representative US sample (N = 2284). We compare actual behaviour (donations to climate change charities and clicks on climate change petition (...) links) as well as stated preferences (support for a carbon tax and self-reported intentions to reduce emissions) between participants who receive information about SRM with two control groups (a salience control that includes information about climate change generally and a content control that includes information about a different topic). Behavioural choices are made with an earned real-money endowment, and stated preference responses are incentivised via the Bayesian Truth Serum. We fail to find a significant impact of receiving information about SRM and, based on equivalence tests, we provide evidence in favour of the absence of a meaningfully large effect. Our results thus provide evidence for the claim that there is no detectable moral hazard with respect to SRM. [Open access]. (shrink)

Climate ethics has been concerned with polluter pays, beneficiary pays and ability to pay principles, all of which consider climate change as a single negative externality. This paper considers it as a constellation of externalities, positive and negative, with different associated demands of justice. This is important because explicitly considering positive externalities has not to our knowledge been done in the climate ethics literature. Specifically, it is argued that those who enjoy passive gains from climate change owe gains not to (...) the net losers, but to the emitters, just as the emitters owe compensation to the net losers for the negative externality. This is defended by appeal to theoretical virtues and to the social benefits of generating positive externalities, even when those positive externalities are coupled with far greater negative externalities. We call this the Polluter Pays, Then Receives ('PPTR', or 'Peter') Principle. This principle is then applied at two levels in the context of Canada. [Open access]. (shrink)

The coronavirus disease 2019 (COVID-19) crisis ought to serve as a reminder about the costs of failure to consider another long-term risk, climate change. For this reason, it is imperative to consider the merits of policies that may help to limit climate damages. This essay rebuts three common objections to carbon taxes: (1) that they do not change behaviour, (2) that they generate unfair burdens and increase inequality, and (3) that fundamental, systemic change is needed instead of carbon taxes. The (...) responses are (1) that there is both theoretical and empirical reason to think that carbon taxes do change behaviour, with larger taxes changing it to a greater extent; (2) that undistributed carbon taxes are regressive but distributing the tax receipts can alleviate that regressivity (and, in many cases, make the overall effect progressive); and (3) that while small changes for increasing democratic decision-making may be helpful, (fundamental) change takes time and the climate crisis requires urgent action. [Open access] //// -/- La crise de lamaladie à coronavirus 2019 (COVID-19) devrait servir de rappel sur les coûts de la non-prise en compte d’un autre risque à long terme, les changements climatiques. Pour cette raison, il est impératif de considérer lesmérites des politiques susceptibles de contribuer à limiter les changements climatiques. Cet essai réfute trois objections courantes aux taxes sur le carbone : (1) qu’elles ne changent pas les comportements (2) qu’elles génèrent des charges injustes et augmentent les inégalités, et (3) qu’un changement fondamental et systémique est nécessaire au lieu de taxes sur le carbone. Les réponses sont (1) qu’il existe des raisons à la fois théoriques et empiriques de penser que les taxes sur le carbone modifient effectivement les comportements, et que des taxes plus élevées les modifient dans une plus grande mesure; (2) que les taxes sur le carbone non distribuées sont régressives,mais que la distribution des recettes fiscales peut atténuer cette régressivité (et, dans de nombreux cas, rendre l’effet global progressif); et (3) que, bien que de petits changements pour l’amélioration de la prise de décision démocratique peuvent être utiles, un changement (fondamental) prend du temps et la crise climatique exige une action urgente. (shrink)