Introduction. The inadequacy of the support measures provided to children with orphan diseases is exacerbated by the trend towards an increase in the number of children with such a diagnosis. Orphan diseases also include diseases caused by primary immunodeficiency or congenital errors of immunity, which are life-threatening. However, these people are part of society and require attention from it, and social and economic measures from the state. Most of them, with proper treatment, socialization and appropriate government support, can (...) lead a normal life and live a full life. Scientific novelty of the research. On the basis of the study results, the authors contribute to clarifying the principles used in the implementation of the security function of the social state. The targeting of social support measures must be supplemented with the principles of social justice and freedom to choose ways to meet the needs of specific categories of citizens, understood as follows. The welfare state supports those citizens who need it most of all, namely, the poor. Specific categories of citizens can satisfy their needs, while having the opportunity to choose. This opportunity arises thanks to the receipt of targeted assistance in the form of monthly or annual subsidies. Families with children with orphan diseases should also be included in these categories. If they have the right to receive annual government subsidies, they will be able to spend these funds depending on the current needs due to the state of health of their children with orphan diseases (for the purchase of socially important food products; medicines, medical nutrition, and various services). The aim of the work is to study the problems of providing support measures to children with orphan diseases in the context of the current model of the welfare state. The article analyzes the satisfaction of patients with congenital immunity errors with various types of state support, identifies problems that reduce their satisfaction. Methods. The authors use methods such as comparative analysis, study of regulatory legal acts, sociological analysis. Results. On the basis of the study results the effectiveness of measures of state support for children with orphan diseases, studying the best experience of foreign countries, proposals were made to clarify the principles used to implement the security function by the social state, to expand the composition of the subjects involved in providing support measures analyzed in the article. Conclusions. The results obtained make it possible to assert that the targeted approach, which is basic in the model of the welfare state, does not cover most of the problems of children with innate immunity errors and, accordingly, the families that represent their interests. (shrink)

Marine and coastal ecosystems are crucial in maintaining human livelihood, facilitating social development, and reducing climate change impacts. Studies have examined how the benefit perception of aquatic ecosystems, knowledge, and emotion about climate change affect peoples’ support for marine protection. However, their interaction effects remain understudied. The current study explores the intricate interaction effect of the benefit perception of aquatic ecosystems, knowledge, and worry about climate change on marine protection support. Bayesian Mindsponge Framework (BMF) analytics was employed on (...) a dataset of 709 stakeholders from 42 countries generated by MaCoBioS—a research project funded by the European Commission Horizon 2020. The statistical analysis shows that the impacts of benefit perception of ocean ecosystems, knowledge, and worry about climate change on marine protection support vary due to their interactions. Specifically, when stakeholders perceive ocean ecosystems to have little utility in mitigating climate change, greater climate change knowledge and concern are associated with a higher level of marine protection support. Nevertheless, in the scenarios where stakeholders perceive the benefits of ocean ecosystems, the effect of climate change knowledge becomes conditional on the worry level. If stakeholders are concerned about climate change, those with a greater level of climate change knowledge will associate with a higher level of marine protection support. Otherwise, greater climate change knowledge will result in lower support. These findings highlight emotion’s importance in directing climate change knowledge’s effect on marine protection support. Linking people’s “objects of care” to the consequences of climate change can help improve climate change communication effectiveness. (shrink)

A Boltzmann Brain, haphazardly formed through the unlikely but still possible random assembly of physical particles, is a conscious brain having experiences just like an ordinary person. The skeptical possibility of being a Boltzmann Brain is an especially gripping one: scientific evidence suggests our actual universe’s full history may ultimately contain countless short-lived Boltzmann Brains with experiences just like yours or mine. I propose a solution to the skeptical challenge posed by these countless actual Boltzmann Brains. My key idea is (...) roughly this: the skeptical argument that you’re one of the Boltzmann Brains requires you to make a statistical inference, but the Principle of Total Evidence blocks us from making the inference. I discuss how my solution contrasts with a recent suggestion, made by Sean Carroll and David Chalmers, for how to address the skeptical challenge posed by Boltzmann Brains. And I discuss how my solution handles certain relevant concerns about what to do when we have higher-order evidence indicating that our first-order evidence is misleading. (shrink)

This paper aims to explain why the laws of nature are held fixed in counterfactual reasoning. I begin by highlighting three salient features of counterfactual reasoning: it is conservative, nomically guided, and it uses hindsight. I then present a rationale for our engagement in counterfactual reasoning that aims to make sense of these features. In particular, I argue that counterfactual reasoning helps us evaluate the evidential relations between unanticipated pieces of evidence and various hypotheses of interest about the history of (...) the actual world. Given this goal, it makes a great deal of sense that counterfactual reasoning would have the aforementioned features. Additionally, it turns out that this account of counterfactual reasoning is nicely congruent with Humean views of laws. Specifically, it can explain, in a Humean-friendly way, both why the laws are counterfactually resilient, and why we may be inclined to have anti-Humean intuitions in the first place, even if some form of Humeanism is correct. (shrink)

This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are (...) available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a “bottom-up” perspective might give healthcare personnel opportunities to think and reflect more than a “top-down” perspective. A “bottom-up” approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a “top-down” approach risks removing such moral responsibility. (shrink)

BackgroundEthical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding ethics education (...) that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.MethodsIn this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.ResultsThe review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.ConclusionsThe review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations. (shrink)

Objective of this study is to investigate the impact of perceived social support on the self-esteem, mental wellbeing, and school readiness of left-behind children. It further aims at understanding the mediating role of psychological resilience between the relationships of perceived social support and self-esteem, mental wellbeing, and school readiness. For this purpose, population frame of the LB children between the ages of 8–12 years in Mainland China was taken. The sample size of 335 was taken to reach the (...) findings through partial least square structural equation modeling. The SmartPLS has been used to analyze the data. The results obtained in this study have shown that the perceived social support plays a very significant role in enhancing the mental wellbeing, self-esteem, and school readiness of the LB children. It has also been found that the perceived social support plays a positive role in the psychological resilience. Furthermore, it has also been found that the psychological resilience is an important predictor of self-esteem and school readiness. Further, the psychological resilience has proved to be significant mediator between the relationship of the perceived social support and self-esteem; and also between the relationship of the perceived social support and school readiness. (shrink)

The current study examined the additive and interactive effects of early adolescents’ social achievement goals and perceived relational support from teachers and peers on their social behavior. Adolescents’ social achievement goals, perceived relational support from teachers and peers, and social behavior were assessed in a sample of fifth and sixth graders nested within 26 classrooms. Multilevel modeling results indicated that social goals and relational support from teachers and peers made additive contributions to adolescents’ social behavior. Results also (...) indicated the evidence of interactive effects, such that relational support from teachers was negatively associated with overt and relational aggression primarily among adolescents who had high social demonstration-approach goals. Findings underscore the need to consider adolescents’ social goals in conjunction with their perceived relational support for educators and practitioners. (shrink)

It is commonly maintained that neuroplastic mechanisms in the brain provide empirical support for the hypothesis of multiple realizability. We show in various case studies that neuroplasticity stems from preexisting mechanisms and processes inherent in the neural structure of the brain. We argue that not only does neuroplasticity fail to provide empirical evidence of multiple realization, its inability to do so strengthens the mind-body identity theory. Finally, we argue that a recently proposed identity theory called Flat Physicalism can be (...) enlisted to explain the current state of the mind-body problem more adequately. (shrink)

Peter Achinstein has argued at length and on many occasions that the view according to which evidential support is defined in terms of probability-raising faces serious counterexamples and, hence, should be abandoned. Proponents of the positive probabilistic relevance view have remained unconvinced. The debate seems to be in a deadlock. This paper is an attempt to move the debate forward and revisit some of the central claims within this debate. My conclusion here will be that while Achinstein may be (...) right that his counterexamples undermine probabilistic relevance views of what it is for e to be evidence that h, there is still room for a defence of a related probabilistic view about an increase in being supported, according to which, if p > p, then h is more supported given e than it is without e. My argument relies crucially on an insight from recent work on the linguistics of gradable adjectives. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee (...) in Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

Volume 20, Issue 6, June 2020, Page 75-77.

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These limitations (...) warrant research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES (...) that exist in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how-to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

In this paper we assume that ‘theory’ is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES.A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES (...) that exist in North‐America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including ‘how‐to’ questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end‐of‐life decisions (major ethical topics).In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi‐centre context in several healthcare institutions. We conceptualize three ‘pillars’ as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP.We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. (shrink)

Volume 20, Issue 6, June 2020, Page 70-72.

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert (...) scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

Human interactions are often improvised rather than scripted, which suggests that efficient coordination can emerge even when collective plans are largely underspecified. One possibility is that such forms of coordination primarily rely on mutual influences between interactive partners, and on perception–action couplings such as entrainment or mimicry. Yet some forms of improvised joint actions appear difficult to explain solely by appealing to these emergent mechanisms. Here, we focus on collective free improvisation, a form of highly unplanned creative practice where both (...) agents' subjective reports and the complexity of their interactions suggest that shared intentions may sometimes emerge to support coordination during the course of the improvisation, even in the absence of verbal communication. In four experiments, we show that shared intentions spontaneously emerge during collective musical improvisations, and that they foster coordination on multiple levels, over and beyond the mere influence of shared information. We also show that musicians deploy communicative strategies to manifest and propagate their intentions within the group, and that this predicts better coordination. Overall, our results suggest that improvised and scripted joint actions are more continuous with one another than it first seems, and that they differ merely in the extent to which they rely on emergent or planned coordination mechanisms. (shrink)

Customer citizenship behavior has attracted widespread attention from scholars due to its capacity of enabling enterprises to gain competitive advantages of low costs and high efficiency by giving full play to the initiative of customers. Based on the S-O-R Model, we have established the theoretical model to study the influence imposed by social support of online travel platform enterprises on customer citizenship behavior against the backdrop of the sharing economy. This research tests the fitting of the theoretical model and (...) its fundamental hypotheses using 626 samples acquired from the investigation with SPSS26.0 and AMOS25.0. Results indicate that the social support has a positive influence on customer citizenship behavior. Social support could have a positive influence on positive emotions. Social support has no significant negative effect on negative emotions. Positive emotions have a positive influence on customer citizenship behavior. Negative emotions have a negative influence on customer citizenship behavior. Positive emotions play a mediating effect in the positive influence of social support on customer citizenship behavior. Social support could have a positive influence on customer satisfaction. Customer satisfaction has a positive influence on customer citizenship behavior. Customer satisfaction plays a mediating effect in the positive effect of social support on customer citizenship behavior. Positive emotions and customer satisfaction play a chain mediating effect in the positive effect of social support on customer citizenship behavior. (shrink)

Recent research illustrates substantial gaps between entrepreneurial intentions and behavior. This is a challenge for entrepreneurship promotion interventions that have primarily focused on stimulating entrepreneurial intentions. However, extant literature suggests that implementation intentions enhance the likelihood of acting congruently to the behavioral intention. Furthermore, theory also suggests the condition effects of situations and the perceived control over them. We therefore hypothesized that implementation intentions mediate the relationship between entrepreneurial intention and action, while perceived family support moderates the movement from (...) implementation intention to entrepreneurial action. Using two-wave survey data from a sample of students at an African university, we measured two psychological attributes as important precursors of entrepreneurship and entrepreneurial intentions present before undertaking an innovations and entrepreneurship course. Implementation intentions regarding entrepreneurship, entrepreneurial actions, and perceived parental support for entrepreneurial activities were also measured 2 weeks after completion of the course. Our results demonstrate support for the proposed moderated double mediation model in which the effects of the two psychological attributes on entrepreneurial actions are explained via entrepreneurial intentions and implementation intentions. We further find moderation effects of perceived family support indicating that implementation intentions more likely predicted entrepreneurial actions in cases of higher family support. (shrink)

An intuitively appealing argument for pluralism in economics can be made on the grounds that schools of economic thought complement one another. Let us call this the complementarity-based argument for pluralism (CAP). The concepts of complementarity, pluralism, and school of thought are scrutinized in this paper to evaluate this argument. I argue that the complementarity of schools is relative to scientific goals, which implies that discussing complementarity of schools of economic thought requires discussing the goals of economic research. I also (...) distinguish weak from strong complementarity and show that some alleged complementarity relations between schools are weak and thus provide little support for CAP. However, if strong complementarity relations, relative to a valuable goal, can be demonstrated to exist between specific schools, this is a strong reason for pluralism about those schools. Finally, I provide suggestions on how to distinguish strong from weak complementarity. (shrink)

This study investigates the relations among Machiavellianism, the stakeholder orientation, and Italian managers' support for corporate social and environmental reporting (SER). These relationships have not previously been investigated among a sample of experienced managers but have important implications. As anticipated, Machiavellianism had a strong negative association with the support for SER. Machiavellianism was also negatively related to the stakeholder orientation, which in turn was positively correlated with the support for SER. Support for the stakeholder orientation partially (...) mediated the association between Machiavellianism and SER. The findings advance our understanding of the motivations for sustainability reporting by documenting that managers' fundamental personality traits and economic ideologies are closely associated and are important determinants of normative support for social and environmental disclosures. We further suggest that the results support the case for mandated compliance‐with‐standard sustainability reports coupled with a requirement that such reports be independently audited. (shrink)

This paper presents arguments and evidence from psychology and neuroscience supporting Lipton’s 2004 claim that scientists create knowledge through an abductive process that he calls “Inference to the Best Explanation”. The paper develops two conclusions. Conclusion 1 is that without conscious effort on our part, our brains use a process very similar to abduction as a powerful way of interpreting sensory information. To support Conclusion 1, evidence from psychology and neuroscience is presented that suggests that what we humans perceive (...) through our senses is not reality, but rather, our ‘brain’s “best guess” of the causes of its sensory input. The implication of this best guessing is that our brains use a process very similar to abduction throughout our lives to inform us of what is happening in the world around us. In addition, an argument based on Darwinian evolution is presented claiming that our brains do an excellent job of interpreting sensory information from the outside world. (If they did not, we, as a species, could hardly have survived.) Combining these two claims leads to Conclusion 1. Building on Conclusion 1, Conclusion 2 is that Lipton and others are correct in claiming that scientists use abduction when creating scientific theories. Abduction must be strong, because Nature chose abduction for its own sensemaking purposes. This paper’s contribution to knowledge is in pointing out that recent psychological and neuroscientific research has major implications for the philosophical world’s confidence in the probable validity of abductive inference. The punchline is simple: Nature chose abduction! (shrink)

In this study we examined whether parents’ perceptions of students’ anxiety as well as perceived support from both teachers and classmates were predictive of changes in students’ academic motivation during the first wave of COVID-19. To this end, we used a retrospective pretest-posttest design together with a latent change score model to analyze our data. From April to May of 2020, 394 Portuguese parents of students in grades 1–9 participated in this study. Our results showed that students’ anxiety and (...) teachers’ social support, as perceived by parents, were highly significant predictors of academic motivation changes. Specifically, we found a negative effect of anxiety and a positive effect of teachers’ social support on students’ academic motivation. Our results did not show, however, a significant predictive role of classmates’ social support. This study provides an important contribution to further understand the intrapersonal and interpersonal factors that are associated with the decline of students’ academic motivation during the COVID-19 pandemic. The pivotal role of teachers in sustaining students’ academic motivation and other relevant educational implications for the ongoing pandemic are discussed. (shrink)

This paper contributes to the ongoing discussion of sustainability behaviors by introducing the construct of perceived organizational support toward the environment. We propose and empirically test an integrated model whereby we test the association of POS-E with employees’ organizational citizenship behaviors toward the environment as well as to job attitudes. Results indicated that POS-E was positively related to OCB-E, job satisfaction, organizational identification, and psychological empowerment, and negatively related to turnover intentions. We also found that psychological empowerment partially mediated (...) the relationship between POS-E and the dependent variables. We discuss the theoretical implications as well as practical implications for managers seeking to encourage sustainability in their organizations. (shrink)

Physicians and other healthcare professionals are increasingly finding ways to use artificial intelligent decision support systems in their work. IBM Watson Health, for example, is a commercially available technology that is providing AI-DDS services in genomics, oncology, healthcare management and more.1 AI’s ability to scan massive amounts of data, detect patterns, and derive solutions from data is vastly more superior than that of humans. AI technology is undeniably integral to the future of healthcare and public health, and thoughtful consideration (...) of the legal, ethical and moral issues surrounding this technology is a must. The authors of the article, Responsibility, Second Opinions, and Peer-Disagreement—Ethical and Epistemological Challenges of Using AI in Clinical Diagnostic Contexts, provide an informed discussion of how AI-DSS may be used, both practically and ethically, to assist healthcare professionals in cooperative diagnostic processes2. The authors propose a process, whereby AI-DSS would provide a physician a second opinion, and when there is a mismatch between opinions, another physician would provide a third opinion. This approach maintains a ‘physician-in-charge’ perspective, and suggests that decision-making must ultimately be made by a person. This approach is also consistent with the ‘physician in-the-loop’ concept, such that even when increasingly autonomous AI-DSSs are put to use, physicians will still be providing checks and overseeing clinical decisions. The authors conceptualise AI as a replacement of human cognitive labour. That is, AI is used to supplant a human professional in particular functions …. (shrink)

Scientific malpractice is not just due to researchers having bad intentions, but also due to a lack of education concerning research integrity practices. Besides the importance of institutionalised trainings on research integrity, research supervisors play an important role in translating what doctoral students learn during research integrity formal sessions. Supervision practices and role modelling influence directly and indirectly supervisees’ attitudes and behaviour toward responsible research. Research supervisors can not be left alone in this effort. Research institutions are responsible for supporting (...) supervisors in being more aware of their RI function, and in supporting responsible supervision practices to have a positive cascading effect on supervisees’ research practices. We interviewed 22 European research supervisors to investigate how they perceive their role as research integrity trainers and their real-life supervision practices. Moreover, we investigated their points of view concerning the role of research institutions in supporting supervision practices. Although there are different commonalities in supervisors’ perception of their research integrity-related role, differences are emphasised depending on the supervisors’ characteristics such as academic domain, seniority, working country and gender. In addition, supervisors’ way of mentoring depend also on supervisees’ learning curve. Overall, all supervisors agreed on institutions playing an important role in support their supervision effort and practices. This study aims to be a starting point for better understanding research integrity supervision practices and the role of institutions in supporting them. Moreover, it puts the basis to further investigate differences in supervision practices depending on supervisors’ characteristics. (shrink)

Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support inspired by Habermas’ theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of (...) this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved. (shrink)

Igor Douven establishes several new intransitivity results concerning evidential support. I add to Douven’s very instructive discussion by establishing two further intransitivity results and a transitivity result.

Objective: Based on the theory of perceived organizational support (POS), conservation of resource (COR) and job demands-resources (JD-R) model, this study establishes a moderated mediation model to test the role of job satisfaction in mediating the relationship between perceived organizational support and job burnout, as well as the role of regulatory emotional self-efficacy in moderating the above mediating process. Method: A total of 784 police officers were surveyed with the Perceived Organizational Support Scale, the Job Burnout Questionnaire, (...) the Regulatory Emotional Self-Efficacy Scale, and the Minnesota Job Satisfaction Questionnaire. Results: (1) After controlling for gender, seniority, age, police classification, education, and marital status, regression analysis showed a significant negative correlation between perceived organizational support and burnout (r = -0.42, p < 0.01), and the former had a significant negative predictive effect on job burnout (β = -0.42, p < 0.001). (2) The mediating effect test shows that job satisfaction plays a partial role in mediating the relationship between perceived organizational support and job burnout. (3) Through the analysis of the moderated mediation model test, regulatory emotional self-efficacy moderates the first half of the path of “perceived organizational support → job satisfaction → job burnout". Conclusion: Perceived organizational support not only directly affects police job burnout but also indirectly affects police job burnout through job satisfaction. Regulatory emotional self-efficacy enhances the influence of organizational support on job satisfaction. This study indicates the combined effect of perceived organizational support, job satisfaction and regulatory emotional self-efficacy on job burnout and has certain guiding significance for alleviating police job burnout. Keywords: Perceived organizational support, Job burnout, Job satisfaction, Regulatory emotional self-efficacy, Moderated mediation. (shrink)

This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual (...) reports of, existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals. (shrink)

The pace of change and, indeed, the sheer number of clinical ethics committees has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. The recent case of Great Ormond Street (...) Hospital for Children NHS Foundation Trust v MX, FX and X, [21]–[23] and [58]) has highlighted the importance of patient/family representation at clinical ethics committee meetings. The court viewed these meetings as making decisions about such treatment. We argue that this misunderstands the role of ethics support, with treatment decisions remaining with the clinical team and those providing their consent. The considered review by clinical ethics committees of the moral issues surrounding complex treatment decisions is not a matter of determining a single ethical course of action. In this article, we consider current legal understandings of clinical ethics committees, explore current concepts of ethics support and suggest how they may evolve, considering the various mechanisms of the inclusion of patients and their representatives in ethics meetings which is not standard in the UK. (shrink)

1. The last 25 years have seen an increasing interest in the area of formal argumentation. The ultimate goal of the field is to come up with computational models of how we make decisions, based on...

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision support service, (...) based on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital. (shrink)

The rapidly expanding aging population presents an urgent global challenge cutting through just about every dimension of worldly life, including the social, political, cultural, and economic. Developing innovations in health and assistive technology (AT) are poised to support effective and sustainable health care in the face of this challenge, yet there is scant (but growing) discussion of the ethical issues surrounding AT for older persons with dementia. Demands for ethical frameworks that can respond to frontline dilemmas regarding AT development (...) and provision, and how the needs of aging persons themselves are defined throughout this development process, are increasing. This article suggests that fulfilling the promises of AT to provide effective and ethically informed solutions may demand shifting away from standard bioethical analyses that centralize the principle of respect for autonomy. An autonomy-centric paradigm is dubiously equipped to theorize the foundational ethical issues in dementia care and to effectively guide AT development and implementation. An agency-centered approach to dementia care, which could engage more adaptively with the perspectives and choices of older persons themselves while offering strong support to AT research and stakeholders, may offer an attractive alternative. (shrink)

Much is said about Middle Eastern and North African publics opposing gender equality, often referring to patriarchal Islam. However, nuanced large-scale studies addressing which specific aspects of religiosity affect support for gender equality across the MENA are conspicuously absent. This study develops and tests a gendered agentic socialization framework that proposes that MENA citizens are not only passively socialized by religion but also have agency. This disaggregates the influence of religiosity, highlights its multifacetedness, and theorizes the moderating roles that (...) gender and sociocognitive empowerment play via gendered processes of agentic dissociations. Using 15 World Values Surveys and multilevel models, our analyses show that most dimensions of religiosity fuel opposition to gender equality. However, the salience of religion in daily life is found to increase women’s support for gender equality and cushion the negative impact of religious service attendance. Also, gender and education moderate the impacts of several religiosity dimensions; for instance, women’s support for gender equality more sharply declines with increased service attendance than men’s. Altogether, this study finds that religious socialization is multifaceted and gendered, and that certain men and women are inclined and equipped to deviate from dominant patriarchal religious interpretations. (shrink)

With the rise and public accessibility of AI-enabled decision-support systems, individuals outsource increasingly more of their decisions, even those that carry ethical dimensions. Considering this trend, scholars have highlighted that uncritical deference to these systems would be problematic and consequently called for investigations of the impact of pertinent technology on humans’ ethical decision-making. To this end, this article conducts a systematic review of existing scholarship and derives an integrated framework that demonstrates how intelligent decision-support systems (IDSSs) shape humans’ (...) ethical decision-making. In particular, we identify resulting consequences on an individual level (i.e., deliberation enhancement, motivation enhancement, autonomy enhancement and action enhancement) and on a societal level (i.e., moral deskilling, restricted moral progress and moral responsibility gaps). We carve out two distinct methods/operation types (i.e., processoriented and outcome-oriented navigation) that decision-support systems can deploy and postulate that these determine to what extent the previously stated consequences materialize. Overall, this study holds important theoretical and practical implications by establishing clarity in the conceptions, underlying mechanisms and (directions of) influences that can be expected when using particular IDSSs for ethical decisions. (shrink)

We describe and analyze 13 cases handled by our ethics consultation service (ECS) in which families requested continuation of physiological support for loved ones after death by neurological criteria (DNC) had been declared. These ethics consultations took place between 2005 and 2013. Patients’ ages ranged from 14 to 85. Continued mechanical ventilation was the focal intervention sought by all families. The ECS’s advice and recommendations generally promoted “reasonable accommodation” of the requests, balancing compassion for grieving families with other ethical (...) and moral concerns such as stewardship of resources, professional integrity, and moral distress. In cases we characterized as finitegoal accommodation, a “reasonable accommodation” strategy proved effective in balancing stakeholders’ interests and goals, enabling steady progress toward resolution. When a family objected outright to a declaration of DNC and asked for an indefinite accommodation, the “reasonable accommodation” approach offered clinicians little practical direction, and resolution required definitive action by either the family or the clinical team. Based on our analysis and reflections on these 13 cases, we propose ethically justified and practical guidelines to assist healthcare professionals, administrators, and ECSs faced with similar cases. (shrink)

This article examines our ethical responsibility toward artists engaged in harmful behaviors. Specifically, I demonstrate when and why we are morally obligated to withdraw our public and financial support from Artists Who Cause Harm such as Louis C.K., Terry Richardson, and Ryan Adams. Using a moral distinction presented by Philippa Foot and others, I identify this support as enabling harm when the wealth and influence that we support removes typical barriers that protect victims from harm and interposes (...) barriers that prevent victims from avoiding harm. I proceed to demonstrate that our personal support is morally significant, and we have a moral responsibility to make contributions to collective action when the cost is low or the degree of belief that others will contribute is high. Here we have both a strong belief that others will withdraw support and a relatively low cost to ourselves to do so. I acknowledge that enabling current harms is only a sufficient condition to withdrawing support from an artist and should not minimize other reasons for avoiding certain artists and their works. However, when we do believe that our support enables an artist engaged in harmful behaviors, we have an obligation to withdraw that support. (shrink)

When engaging in community-based research, it is important to consider ethical research practices throughout the project. While current research practices require many investigators to obtain approval from an ethics review board before starting a project, more is required to ensure that ethical principles are applied once the investigations begin and after the investigations are complete. In response to this concern, as expressed by workers at a feminist non-profit during a community placement, we developed a tool to foster both greater ethical (...) and feminist research practice in community-based research. Using feminist theories, methodologies, and concepts such as epistemic justice, epistemic trust, and coauthorship, a tool was developed to support researchers and other collaborators in building relationships of reciprocity. This tool, called the Research Responsibility Agreement (RRA) invites all members of a research project to explicitly reflect on their role in the research, their relationships with other collaborators, their responsibility to contributing meaningfully in the project, and their plans to remain accountable to one another. In doing so, the RRA adds to existing tools that support ethical research by sharing explicit reflections from all collaborators on how to prevent harm and by asking them to reflect on ethical practices beyond the initial stages of the project. The RRA also encourages greater engagement from researchers and collaborators toward building meaningful relationships with each other, and with participants, to work together in advancing social change. As a practical tool that promotes reflection, that builds relationships, and that holds all parties accountable to ethical and feminist research practices, the RRA has the potential to generate impactful change in community-based research projects and beyond. While the RRA is tailored to community-based research, it can be applied widely to any research project and has the potential to revolutionize how research relationships are built across disciplines. (shrink)

Despite the reasonable explanatory power of existing models of consumers’ ethical decision making, a large part of the process remains unexplained. This article draws on previous research and proposes an integrated model that includes measures of the theory of planned behavior, personal norms, self-identity, neutralization, past experience, and attitudinal ambivalence. We postulate and test a variety of direct and moderating effects in the context of a large scale survey study in London, UK. Overall, the resulting model represents an empirically robust (...) and holistic attempt to identify the most important determinants of consumers’ support for the fair-trade movement. Implications and avenues for further research are discussed. (shrink)

In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding (...) these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation. (shrink)

As organizational leaders worry about the appalling low percentage of people who feel engaged in their work, academics are trying to understand what causes an increase in engagement. We collected survey data from 231 team members from two organizations. We examined the impact of team members’ emotional intelligence (EI) and their perception of shared personal vision, shared positive mood, and perceived organizational support (POS) on the members’ degree of organizational engagement. We found shared vision, shared mood, and POS have (...) a direct, positive association with engagement. In addition, shared vision and POS interact with EI to positively influence engagement. Besides highlighting the importance of shared personal vision, positive mood, and POS, our study contributes to the emergent understanding of EI by revealing EI’s amplifying effect on shared vision and POS in relation to engagement. We conclude by discussing the research and practical implications of this study. (shrink)

The purpose of this multi-study article was to investigate the roles of adaptability and social support in predicting a variety of psychological outcomes. Data were collected from Year 12 college students, university students, and non-studying members of the general public. Findings showed that, beyond variance attributable to social support, adaptability made a significant independent contribution to psychological wellbeing and psychological distress across all studies. Beyond the effects of adaptability, social support was found to make a significant independent (...) contribution to most wellbeing outcomes. In a multi-group analysis comparing predictors of psychological wellbeing in university students and non-studying adults, where the same outcome measures were used, it was found that adaptability played a stronger role for university students, whereas social support played a stronger role for non-studying adults. Finally, there was no evidence of an interaction between adaptability and social support predicting psychological outcomes—adaptability and social support operated as independent main effects. These findings demonstrate the importance of adaptability and social support in uniquely predicting psychological wellbeing in different sample groups. It is argued here that these two factors, should be given greater consideration in discussions of psychological wellbeing, and are relevant to psychological wellbeing at different major developmental life stages. (shrink)

Objectives: Athlete burnout is a crucial concern affecting the development and athletic performance of young weightlifters. To reduce or relieve the prevalence of athlete burnout, this study examined the relationship across social support, sports motivation, mental toughness, and athlete burnout in weightlifters.Methods: A total of 315 weightlifters aged 17–28 years old from Sichuan, Chongqing, and Shanxi in China participated in this survey. The Perceived Available Support in Sport Questionnaire, Sports Motivation Questionnaire, Sports Mental Toughness Questionnaire, and Athlete Burnout (...) Questionnaire were used in this study. SPSS Statistics 19.0, AMOS 21.0, and PROCESS 3.0 macro were used to analyze the collected data.Results: The results indicated that weightlifters’ social support could negatively significantly affect athlete burnout [beta = −0.398; 95% confidence interval : −0.3699, −0.2184; P < 0.05) via mental toughness and sports motivation. The mediation analysis revealed that they had partial mediating effect, including three paths: First, social support had a direct effect on athlete burnout ; second, sport mental toughness had a mediating effect on athlete burnout ; and finally, sports motivation had a mediating effect on athlete burnout.Conclusion: The findings revealed that social support could inhibit or prevent athlete burnout via mental toughness and sports motivation; thus, to decrease or relieve the prevalence of burnout in weightlifters, it is an important solution to enhance their social support. (shrink)

ABSTRACT This study seeks exploration of how employees’ moral identity is related to voice behavior in the current organizational dynamics. By integrating the self-consistency theory with a situational strength perspective, a moderated mediation model was constructed to examine connections among moral identity, leader secure-base support, work engagement, and voice behavior. Surveys were collected at 2 time points, 1 month apart, from 206 full-time employees in various organizations and industries in Taiwan. Supporting results indicated that employees’ moral identity was positively (...) related to voice behavior. The mediating impact of work engagement as a motivational mechanism between moral identity and voice behavior was observed. Relative to when LSBS was low, the effect of moral identity on work engagement and the indirect effect of moral identity on voice behavior through work engagement were more substantial when LSBS was high. Academic and managerial implications were discussed. (shrink)

Contemporary medical diagnostics has a dynamic moral landscape, which includes a variety of agents, factors, and components. A significant part of this landscape is composed of information technologies that play a vital role in doctors’ decision-making. This paper focuses on the so-called Intelligent Decision-Support System that is widely implemented in the domain of contemporary medical diagnosis. The purpose of this article is twofold. First, I will show that the IDSS may be considered a moral agent in the practice of (...) medicine today. To develop this idea I will introduce the approach to artificial agency provided by Luciano Floridi. Simultaneously, I will situate this approach in the context of contemporary discussions regarding the nature of artificial agency. It is argued here that the IDSS possesses a specific sort of agency, includes several agent features (e.g. autonomy, interactivity, adaptability), and hence, performs an autonomous behavior, which may have a substantial moral impact on the patient’s well-being. It follows that, through the technology of artificial neural networks combined with ‘deep learning’ mechanisms, the IDSS tool achieves a specific sort of independence (autonomy) and may possess a certain type of moral agency. Second, I will provide a conceptual framework for the ethical evaluation of the moral impact that the IDSS may have on the doctor’s decision-making and, consequently, on the patient’s wellbeing. This framework is the Object-Oriented Model of Moral Action developed by Luciano Floridi. Although this model appears in many contemporary discussions in the field of information and computer ethics, it has not yet been applied to the medical domain. This paper addresses this gap and seeks to reveal the hidden potentialities of the OOP model for the field of medical diagnosis. (shrink)

The last 20 years have witnessed the dramatic growth of the animal rights movement and a concurrent increase in its social scientific scrutiny. One of the most notable and consistent findings to emerge from this body of research has been the central role of women in the movement. This paper uses General Social Survey data to examine the influence of views of the relationship of humanity to nature on this gender difference. Holding a Romantic view of nature is associated with (...) higher levels of support for extending moral rights to animals and lower levels of support for animal-based testing. A Darwinian view is associated with greater support for testing on animals but is unrelated to views on moral rights for animals. In general, views of nature affect animal rights advocacy to a greater extent among males than females. (shrink)