The relationship between metacognition and mindreading was investigated by comparing the monitoring of one’s own learning and another person’s learning . Previous studies indicated that in self-paced study judgments of learning for oneself are inversely related to the amount of study time invested in each item. This suggested reliance on the memorizing-effort heuristic that shorter ST is diagnostic of better recall. In this study although an inverse ST–JOL relationship was observed for Self, it was found for Other only when the (...) Other condition followed the Self condition. The results were interpreted in terms of the proposal that the processes underlying experience-based metacognitive judgments are largely unconscious. However, participants can derive insight from observing themselves as they monitor their own learning, and transfer that insight to Other, thus exhibiting a shift from experience-based to theory-based judgments. Although different processes mediate metacognition and mindreading, metacognition can inform mindreading. (shrink)

Metacognitive research is dominated by meta-memory studies; meta-reasoning research is nascent. Accessibility – the number of associations for a stimulus – is a reliable heuristic cue for Feeling of Knowing when answering knowledge questions. We used a similar cue, subjective accessibility, for exposing commonalities and differences between meta-reasoning and meta-memory. In Experiment 1, participants faced solvable Compound Remote Associate problems mixed with unsolvable random word triads. We collected initial Judgement of Solvability, final JOS and confidence. Experiment 2 focused on confidence, (...) controlling for potential interactions among judgements. In Experiment 3, the participants memorised the same triads and rated Ease of Learning and Judgement of Learning. sAccessibility was associated with all judgements. Notably, it reliably predicted memory judgements and confidence in the provided solutions. However, it was unreliable for judging solvability. The findings highlight the importance of studying meta-reasoning for exposing the biasing factors in reasoning processes and for getting a broad perspective on metacognitive processes. (shrink)

The relationship between affect and metacognitive processes has been largely overlooked in both the affect and the metacognition literatures. While at the core of many affect-cognition theories is the notion that positive affective states lead people to be more confident, few studies systematically investigated how positive affect influences confidence and strategic behaviour. In two experiments, when participants were free to control answer interval to general knowledge questions, participants induced with positive affect outperformed participants in a neutral affect condition. However, in (...) Experiment 1 positive affect participants showed larger overconfidence than neutral affect participants. In Experiment 2, enhanced salience of social cues eliminated this overconfidence disadvantage of positive affect relative to neutral affect participants, without compromising their enhanced performance. Notably, in both experiments, positive affect led to compromised social norms regarding the answers’ informativeness. Implications for both affect and metacognition are discussed. (shrink)

Understanding time investment while solving problems is central to metacognitive research. By the Diminishing Criterion Model (DCM), time regulation is guided by two stopping rules: a confidence criterion that drops as time is invested in each problem and the maximum time to be invested. This combination generates curved confidence–time associations. We compared the belief that intelligence is malleable, a growth mindset, to the belief that intelligence is fixed, and to neutral control groups. We hypothesized that a growth mindset leads people (...) to selectively invest time in problems carrying the hope of improvement. This extra time makes the curved DCM pattern curvier. In two experiments, participants primed with growth, fixed, or control mindsets solved analogies (Experiment 1) and compound remote associates (Experiment 2). As expected, in both experiments a growth mindset exhibited a curvier confidence–time pattern, while the fixed mindset and control groups replicated previous confidence–time associations. Most additional time was invested in problems with intermediate difficulty levels, suggesting strategic time allocation. The study offers useful measures for delving into factors that affect thinking time allocation. (shrink)

Initial Judgment of Solvability (iJOS) is a metacognitive judgment that reflects solvers’ first impression as to whether a problem is solvable. We hypothesized that iJOS is inferred by combining prior expectations about the entire task with heuristic cues derived from each problem’s elements. In two experiments participants first provided quick iJOSs for all problems, then attempted to solve them. We manipulated expectations by changing the proportion of solvable problems conveyed to participants, 33%, 50%, or 66%, while the true proportion was (...) the 50% for all. In Experiment 1 we used the non-verbal Raven’s matrices and examined nameability as the element-based heuristic cue. Unsolvable matrices were generated by switching locations of elements in original Raven’s matrices. In Experiment 2 we used the verbal Compound Remote Associate (CRA) problems and examined word’s frequency in the language as the element-based heuristic cue. Unsolvable CRAs were random word triads from the same word pool. The results were consistent in suggesting that quick iJOS integrates prior expectations and experience-based heuristic cues. Notably, iJOS was predictive for the subsequent solving attempt only for Raven’s matrices. (shrink)

This commentary addresses omissions in De Neys's model of fast-and-slow thinking from a metacognitive perspective. We review well-established meta-reasoning monitoring (e.g., confidence) and control processes (e.g., rethinking) that explain mental effort regulation. Moreover, we point to individual, developmental, and task design considerations that affect this regulation. These core issues are completely ignored or mentioned in passing in the target article.

In this reply, we provide an analysis of Alter et al. response to our earlier paper. In that paper, we reported difficulty in replicating Alter, Oppenheimer, Epley, and Eyre’s main finding, namely that a sense of disfluency produced by making stimuli difficult to perceive, increased accuracy on a variety of reasoning tasks. Alter, Oppenheimer, and Epley argue that we misunderstood the meaning of accuracy on these tasks, a claim that we reject. We argue and provide evidence that the tasks were (...) not too difficult for our populations and point out that in many cases performance on our tasks was well above chance or on a par with Alter et al.’s participants. Finally, we reiterate our claim that the distinction between answer fluency and perceptual fluency is genuine, and argue that Thompson et al. provided evidence that these are distinct factors that have different downstream effects on cognitive processes. (shrink)

Although widely studied in other domains, relatively little is known about the metacognitive processes that monitor and control behaviour during reasoning and decision-making. In this paper, we examined the conditions under which two fluency cues are used to monitor initial reasoning: answer fluency, or the speed with which the initial, intuitive answer is produced, and perceptual fluency, or the ease with which problems can be read. The first two experiments demonstrated that answer fluency reliably predicted Feeling of Rightness judgments to (...) conditional inferences and base rate problems, which subsequently predicted the amount of deliberate processing as measured by thinking time and answer changes; answer fluency also predicted retrospective confidence judgments. Moreover, the effect of answer fluency on reasoning was independent from the effect of perceptual fluency, establishing that these are empirically independent constructs. In five experiments with a variety of reasoning problems similar to those of Alter et al., we found no effect of perceptual fluency on FOR, retrospective confidence or accuracy; however, we did observe that participants spent more time thinking about hard to read stimuli, although this additional time did not result in answer changes. In our final two experiments, we found that perceptual disfluency increased accuracy on the CRT, but only amongst participants of high cognitive ability. As Alter et al.’s samples were gathered from prestigious universities, collectively, the data to this point suggest that perceptual fluency prompts additional processing in general, but this processing may results in higher accuracy only for the most cognitively able. (shrink)

ArgumentTwo medical delegations, one from Palestine and one from the United States, were sent to detainment camps in Cyprus in the summer of 1947. The British Mandatory government had set up these camps in the summer of 1946 to stem the flow of Jewish immigrants into Palestine after World War II. The purpose of the medical delegations was to screen the camps' inhabitants and to propose a mental-health program for their life in Palestine. We examine the activities of these two (...) delegations within the context of their scientific interest in the psycho-pathology of displaced persons after World War II and as part of a broader project of mental hygiene. According to the delegations, the detainees would be a potential source of strength for building a new society if they adapted to life in Palestine. However, they would become a burden if they failed to be absorbed. At the same time, the medical delegations also saw the detainee camps as a potential “living laboratory” for scientific exploration. The case of the two medical delegations in Cyprus is also a story about constructing and transgressing medical borders. Apart from the obvious fact that this case study deals with movement of people, refugees as well as health-care workers, it is also about the transmission of knowledge and professions across the ocean. (shrink)

ArgumentThis paper focuses on the Jewish nursing profession in Poland during the interwar period. We argue that the integration of Jewish women in medical activity under the AJDC (American Jewish Distribution Committee) and TOZ (Towarzystwa Ochrony Zdrowia Ludności Żydowskiej [the Society for the Protection of the Health of the Jewish People]) emerged in Poland less from the adoption of gender equality and more out of necessity. On the one hand, JDC and TOZ needed Jewish nurses and public health nurses to (...) carry out their health campaigns and build a public health infrastructure. On the other hand, a new generation of Jewish women needed job opportunities that would enable them to make a living and be independent. More broadly this case study shows that the implementation of American “reformative” ideals into the local Polish reality, including in the newly emerging public health field, involved adaptation, negotiation, and in some cases, resentment. (shrink)

Fiction can help make students better thinkers about some philosophical issues, but this does not mean it will make them morally better people.

Should a brain-dead woman be artificially maintained for the sake of her fetus? Does a physician have the right to administer a life-saving transfusion despite the patient's religious beliefs? Can a family request a hysterectomy for their retarded daughter? Physicians are facing moral dilemmas with increasing frequency. But how should these delicate questions be resolved and by whom? A Casebook of Medical Ethics offers a real-life view of the central issue involved in clinical medical ethics. Since the analysis of cases (...) plays a critical role in this study, the authors have assembled a broad collection of histories encountered in their work as medical ethics educators and consultants. The cases are developed in substantial detail to reflect the rich medical and psychosocial complexity involved, and each is brought to a decision point at which a course of action must be chosen. Among the issues examined are conflicts between patients' wishes and respect for their well-being, tensions concerning duties to patients unable to care for themselves and obligations to family members, and clashes between patient care obligations and the interests of other persons, including physicians, third parties, and the general public. The book also includes commentaries that combine general discussion of ethical principles with specific analysis of the cases examined in the text, as well as various options for resolving conflicts. Readers are invited to assess the comparative merits and liabilities of these approaches. An ideal text for undergraduate and medical school courses, A Casebook of Medical Ethics brings readers to the forefront of medicine, where they share in the determination of crucial ethical decisions. (shrink)

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

Consider these three positions about physician-assisted suicide:Physician-assisted suicide should be illegal for everyone.Physician-assisted suicide should be legal for only the terminally ill.Physician-assisted suicide should be legal for all competent adults.So far, the debate in America has been primarily between positions 1 and 2. I think it should be between positions 1 and 3. Both those positions embody reasonable viewpoints, and I will not try to decide between them in this chapter. But I will argue that the double standard embodied in (...) position 2 is morally untenable. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a (...) tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

Anyone who thinks contemporary American society is hopelessly contentious and lacking in shared values has probably not been paying attention to the way the popular media portray the hospice movement. Over and over, we are told such things as that “Humane care costs less than high-tech care and is what patients want and need,” that hospices are “the most effective and least expensive route to a dignified death,” that hospice personnel are “heroic,” that their “compassion and dedication seem inexhaustible,” and (...) that “few could argue with the powerful message that it is better [for dying patients] to leave wrapped in the love of family and care givers than locked in the cold, metallic embrace of a machine.“. (shrink)

There have been essentially two types of theoretical approaches to account for the grammatical relations associated with the causee argument of causative constructions. Ignoring the specifics of particular theories, there are transitivity based approaches in which the causee is a direct object when the embedded clause is intransitive, and an indirect object or oblique when the embedded clause is transitive. This pattern finds considerable cross-linguistic support. On the other hand, there are languages in which the causee exhibits alternative grammatical relations (...) irrespective of transitivity: the causee direct object correlates with direct causation, while indirect object or oblique causees are associated with indirect causation. Such phenomena have motivated a semantic approach.Focusing primarily on data from Spanish, we account for both sorts of phenomena by proposing a novel extension of Dowty's [(1991) Language 67, 547–619] proto-property proposal, thereby rendering it a comprehensive model of argument selection for both simple and complex predicates. According to Dowty's original Argument Selection Principle, the most proto-patientive argument in a single argument structure tends to be encoded as a direct object. In the case of causatives with intransitive base predicates, the most proto-patientive argument will be the causee. However, if the embedded clause is transitive, the causee will be less proto-patientive that the embedded patient, and will not be encoded as a direct object. Thus, the Argument Selection Principle, operating in a syntagmatic fashion over co-arguments, effectively derives the transitivity-determined causee encodings. In order to address the effects associated with the semantic approach, we develop paradigmatic interpretation of the Argument Selection Principle. That is, when the causee argument varies in degree of proto-patientivity, the most proto-patientive alternant is encoded as a direct object, and any decrease in proto-patientivity is reflected by relational encodings that are sequentially lower than direct object on the relational hierarchy. Thus, the transitivity and semantic effects of causee encoding are accounted for by the interaction of the syntagmatic and paradigmatic argument selection strategies. We propose that these two strategies represent organizing principles for argument selection information associated with lexical entries. (shrink)

My little girl has leukemia; she has had it for over a year, and now she needs at least five pints of blood a day. Not the whole blood, just the platelets. Most of our relatives and friends have given at least a few times. But we need more. Now I have to go to strangers.So begins Roberta Silman's short story, “Giving Blood,” a story about illness and charity. When the narrator's husband solicited blood donations at his workplace, “he thought (...) everyone would help…He must have asked a hundred people. Thirty gave. His officemate…turned green and said, ‘Oh, no, anything but that. I'm scared of needles.'”. (shrink)

Offers a compelling vision of how to achieve and conduct a liberal but democratic society through the ideal of Neutrality--between people and ideas of the good--and using the tool of Neutral dialogue.

ArgumentWe examine the creation and functioning of the “Pasteur Institute in Palestine” focusing on the relationship between biological science, health policy, and the creation of a “new society” within the framework of Zionism. Similar to other bacteriological institutes founded by colonial powers, this laboratory was developed in response to public health needs. But it also had a political role. Dr. Leo Böhm, a Zionist physician, strived to establish his institution along the lines of the Zionist aspiration to develop a national (...) entity based on strong scientific foundations. Even though the institute enjoyed several fruitful years of operation, mainly during World War I, it achieved no lasting national or scientific importance in the country. Böhm failed to adapt to new ways of knowledge production, scientifically and socially. The case study of the “Pasteur Institute in Palestine” serves as a prism to view the role of the public health laboratory in the history of Palestine with its ongoing changes of scientific, organizational, and political context. (shrink)

A. NATURAL. HISTORY. OF. THE. SENSES. “This is one of the best books of the year—by any measure you want to apply. It is interesting, informative, very well written. This book can be opened on any page and read with relish.... thoroughly  ...

Scientific medicine carries within it an inherent contradiction. On the one hand, given its general scientific inquiry into health and disease, their conditions, etiologies, and treatments, it makes a claim for universality. To justify this claim, at different times and in different places, scientific medicine has prioritized techniques such as the medical gaze and autopsies to assure its diagnoses; it has applied numerical methods in order to have a better grasp of diseases and their possible treatments; it has used laboratory (...) analyses in order to understand life at its molecular level; and more recently it has introduced Randomized Clinical Trials in order to generalize clinical treatments. On the other hand, contrary to its universalistic claims, scientific medicine sets up and reifies boundaries. It creates distinctions between the healthy and the sick and defines categories, such as gender and race, that have deep political and social meanings. (shrink)