Non-compensatory aggregation rules are applied in a variety of problems such as voting theory, multi-criteria analysis, composite indicators, web ranking algorithms and so on. A major open problem is the fact that non-compensability implies the analytical cost of loosing all available information about intensity of preference, i.e. if some variables are measured on interval or ratio scales, they have to be treated as measured on an ordinal scale. Here this problem has been tackled in its most general formulation, (...) that is when mixed measurement scales (interval, ratio and ordinal) are used and both stochastic and fuzzy uncertainties are present. Objectives of this article are first to present a comprehensive review of useful solutions already proposed in the literature and second to advance the state of the art mainly in the theoretical guarantee that weights have the meaning of importance coefficients and they can be summarized in a voting matrix. This is a key result for using non-compensatory Condorcet consistent rules. A proof on the probability of existence of ties in the voting matrix is also developed. (shrink)

About twenty years ago, philosophers debated the verifiability of the statement “Last night everything doubled in size.” It seems that universal nocturnal expansion would double our rulers and tape measures making the size change indiscernible. I think that there is an internal analogue to the question “Did everything double in size last night?” The question “Did my preferences double in intensity last night?“ also raises problems of verification.

BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...) 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival, life expectancy, and cost of treatment. In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment. (shrink)

Background Moral distress has negative effects on physical and mental health. However, there is little information about nurses’ coping strategies reducing moral distress. Aim The purpose of this study was to investigate the coping strategies of intensive care unit nurses reducing moral distress in Iran. Study design This is a qualitative study with a content analysis approach. Participants and research context The research sample consisted of nurses working in intensive care units of teaching hospitals affiliated to Tehran University of Medical (...) Sciences. Samples were selected among eligible nurses by purposive sampling. Data were obtained through 17 in-depth, individual, and semi-structured interviews with 17 nurses. Graneheim and Lundman’s (2004) 6-step content analysis method was used to analyze the data. Data management was also performed by MAXQDA software version 20. The COREQ checklist was used to report the study. Ethical considerations This project was approved by the Ethics Committee of Tehran University of Medical Sciences. All ethical guidelines in research were followed. Finding The data analysis resulted in the formation of two main categories of desirable coping strategies (with two subcategories of compensation and rejuvenation) and less desirable coping strategies (with three subclasses of indifference over time, escape and concealment). Discussion The intensive care unit nurses in dealing with ethical problems first try to solve the problem through discussion, but when they fail to resolve it peacefully, they resort to several coping strategies. Factors, such as increasing experience, lack of support from hospital managers and officials, poor communication between colleagues, the need to maintain hierarchy, fear of reprimand, and a sense of powerlessness, changed the nurses’ preferred strategies. It is important for managers to provide a blame/punishment-free atmosphere for expression of ethical experiences; a supportive atmosphere in which staff can engage in ethical discussions without fear of punishment. They should also provide opportunities for rest, rejuvenation, and adequate training for their employees. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, (...) we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

Research misconduct is harmful because it threatens public health and public safety, and also undermines public confidence in science. Efforts to eradicate ongoing and prevent future misconduct are numerous and varied, yet the question of “what works” remains largely unanswered. To shed light on this issue, this study used data from both mail and online surveys administered to a stratified random sample of tenured and tenure-track faculty members (N = 613) in the social, natural, and applied sciences at America’s top (...) 100 research universities. Participants were asked to gauge the effectiveness of various intervention strategies: formal sanctions (professional and legal), informal sanctions (peers), prevention efforts (ethics and professional training), and reducing the pressures associated with working in research-intensive units. Results indicated that (1) formal sanctions received the highest level of support, (2) female scholars and researchers working in the applied sciences favored formal sanctions, and (3) a nontrivial portion of the sample supported an integrated approach that combined elements of different strategies. A key takeaway for university administrators is that a multifaceted approach to dealing with the problem of research misconduct, which prominently features enhanced formal sanctions, will be met with the support of university faculty. (shrink)

This paper draws on 'views and visions' responses collected at the time of the Land Use-UK project in 1996. Surveyors were groups of school children with contributions in more remote locations from adults. As well as mapping the landscape participants were asked about their hopes and visions for the grid squares surveyed. One kilometre squares were identified by stratified random sampling techniques from the Ordnance Survey National Grid. The responses indicated varying levels of optimism and pessimism. The sample of responses (...) in this paper relates to rural key squares ( N = 424) and urban key squares ( N = 413). Young surveyors appeared to be the most pessimistic and there was some correlation of increasing pessimism with increasing land use intensity. (shrink)

This paper draws on 'views and visions' responses collected at the time of the Land Use-UK project in 1996. Surveyors were groups of school children with contributions in more remote locations from adults. As well as mapping the landscape participants were asked about their hopes and visions for the grid squares surveyed. One kilometre squares were identified by stratified random sampling techniques from the Ordnance Survey National Grid. The responses indicated varying levels of optimism and pessimism. The sample of responses (...) in this paper relates to rural key squares ( N = 424) and urban key squares ( N = 413). Young surveyors appeared to be the most pessimistic and there was some correlation of increasing pessimism with increasing land use intensity. (shrink)

In this work R. M. Martin carries his semiotical studies into the fields of intensional semantics and pragmatics, dealing with such philosophically important concepts as meaning, preference, reasonableness and indifference. The crucial notion is that of the meaning or intension of an expression. Two major categories are distinguished, objective intensions and subjective intensions. To deal with objective intensions an intensional semantics is developed as an extension of denotational semantics in the tradition of Tarski, Carnap and Martin's earlier Truth and (...) Denotation. In the treatment of subjective intensions Martin makes an advance over his earlier study of pragmatics by utilizing the work of von Neumann and Morgenstern in their Theory of Games and Economic Behavior.—R. H. K. (shrink)

A common criticism of plurality voting is that it fails to reflect the degree of intensity with which voters prefer the candidate or policy that they vote for. To rectify this, many critics of plurality voting have argued that vote buying should be allowed. Persons with more intense preferences for a candidate could buy votes from persons with less intense preferences for the opposing candidate and then cast them for the candidate that they intensely support. This paper argues that (...) instead of better reflecting voters’ weighted preferences, vote buying will lead to electoral outcomes that reflect them less accurately. (shrink)

The digitization of society and academic research endeavours have led to an explosion of interest in the potential uses of population data in research. Alongside this, increasing attention is focussing on the conditions necessary for maintaining a social license for research practices. Previous research has pointed to the importance of demonstrating “public benefits” from research for maintaining public support, yet there has been very little consideration of what the term “public benefits” means or what public expectations of “public benefits” are. (...) In order to address this pressing issue a series of deliberative workshops with members of the public were held across Scotland in May and June 2017. The workshops aimed to engage a cross-section of the Scottish population in in-depth discussions of the ways that the public – or publics – might benefit from data-intensive health research. The findings reported here discuss workshop participants’ understandings and expectations of health research; who they considered to be “the public” that should benefit from health research and; in what ways they felt “the public” should benefit. Workshop participants’ preference was clearly for the widest possible public benefit to be felt by all, but they also acknowledged the value in research aiming to primarily benefit vulnerable groups within society. A key focus of discussions was the extent to which workshop participants were confident that potential public benefits would be realised. A crucial consideration then is the extent to which mechanisms and political support are in place to realise and maximise the public benefits of data-intensive health research. (shrink)

In this work R. M. Martin carries his semiotical studies into the fields of intensional semantics and pragmatics, dealing with such philosophically important concepts as meaning, preference, reasonableness and indifference. The crucial notion is that of the meaning or intension of an expression. Two major categories are distinguished, objective intensions and subjective intensions. To deal with objective intensions an intensional semantics is developed as an extension of denotational semantics in the tradition of Tarski, Carnap and Martin's earlier Truth and (...) Denotation. In the treatment of subjective intensions Martin makes an advance over his earlier study of pragmatics by utilizing the work of von Neumann and Morgenstern in their Theory of Games and Economic Behavior.—R. H. K. (shrink)

If two stimuli need different times to be processed, this difference should in principle be reflected both by response times (RT) and by judgments of their temporal order (TOJ). However, several dissociations have been reported between RT and TOJ, e.g., RT is more affected than TOJ when stimulus intensity decreases. One account for these dissociations is to assume differences in the allocation of attention induced by the two tasks. To test this hypothesis, different distributions of attention were induced in (...) the present study between two stimulus positions (above and below fixation). Only bright stimuli appeared in one position and either bright or dim stimuli in the other. In the two RT experiments, participants had to respond to every stimulus appearing in one of the two positions. Reaction times to bright stimuli were faster when they appeared in the position where dim stimuli were likely to occur. This finding suggests that the allocation of attention was adapted to the asymmetrical arrangement of stimuli, not suggested by explicit instruction. In the two TOJ experiments, the temporal order of stimuli appearing in the two positions had to be judged. Although bright stimuli appearing at the bright-and-dim location were judged to be earlier, this effect was small and insignificant. Further, the intensity dissociation between RT and TOJ was insensitive to random vs blockwise presentations of intensities, therefore was not modified by attentional preferences. Thus, asymmetrical arrangement of stimuli has an impact on the allocation of attention, but only in the RT task. Therefore dissociations between TOJ and response times cannot be accounted for by an attentional bias in the TOJ task but probably by different use of temporal information in the two tasks. (shrink)

Socially oriented preferences in decision making and their relation with work and home environment The aim of this paper was to create a psychometric instrument for the measurement of socially oriented preferences in economic decisions made in professional and private life as well as at scrutinizing the effects of various environmental variables on these preferences. For this purpose, two surveys were carried out on a group of adult working Poles. The idea of the new questionnaire and the results of factor (...) analysis are described herein, along with the other examinations confirming the accuracy of the new instrument. A significant correspondence between eight situational factors: five in professional life and three in private life, and the intensity of socially oriented preferences in economic decisions was confirmed. Both surveys showed that these preferences undergo significant alterations along with each slightest change in situational factors, even ones not directly connected with the decision at hand. Moreover, the studies indicate that the intensity of socially oriented preferences vary with respect to gender and age. Practitioner Points: Team goal setting strategy, work style, responsibility and non-financial rewards intense socially oriented preferences. Financial rewards are irrelevant for socially oriented preferences. (shrink)

In standard economic models, two basic assumptions are made: the first, that actors are rational, and the second, that actors’ preferences are a given and exogenously determined. Behavioral economics — followed by behavioral law and economics — has questioned the first assumption. This Article challenges the second one, arguing that in many instances, social welfare should be enhanced not by maximizing satisfaction of existing preferences but by changing the preferences themselves. The Article identifies seven categories of cases where the traditional (...) objections to intentional preference change by the state and the law lose force and argues that in these cases, such a change warrants serious consideration. It then proposes four different modes of intervention in people’s preferences, varying in intensity, on the one hand, and in the identity of their addressees, on the other, and explains the relative advantages and disadvantages of each form of intervention. (shrink)

Preference relations are intensively studied in Economics, but they are also approached in AI, Knowledge Representation, and Conceptual Modelling, as they provide a key concept in a variety of domains of application. In this paper, we propose an ontological foundation of preference relations to formalise their essential aspects across domains. Firstly, we shall discuss what is the ontological status of the relata of a preference relation. Secondly, we investigate the place of preference relations within a rich (...) taxonomy of relations (e.g. we ask whether they are internal or external, essential or contingent, descriptive or nondescriptive relations). Finally, we provide an ontological modelling of preference relation as a module of a foundational (or upper) ontology (viz. OntoUML). The aim of this paper is to provide a sharable foundational theory of preference relation that foster interoperability across the heterogeneous domains of application of preference relations. (shrink)

End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence (...) the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients’ preferences about DNR are elicited and honored. (shrink)

Wir diskutieren ethische Probleme der medizinischen Behandlung intersexueller Kinder. Gefragt wird nach dem Stellenwert von Elternwünschen nach eindeutiger Geschlechtszuweisung sowie nach den Konfliktfeldern, die zum einen zwischen konkurrierenden Wunschvorstellungen der Eltern und der behandelnden Ärzte, zum andern zwischen Kindeswohl und Kinderrechten entstehen können. Gegenwärtig wird Neugeborenen mit anatomisch uneindeutigem Genital trotz unsicherer Prognose über die Behandlungsergebnisse oft noch ein Geschlecht zugewiesen und operativ erstellt. Dieses Vorgehen ist von verschiedenen Seiten ethisch heftig kritisiert worden. Kipnis u. Diamond forderten 1998 im „Journal (...) of Clinical Ethics“ ein Moratorium für alle nicht vital indizierten geschlechtskorrigierenden Eingriffe. Diese Forderung orientiert sich am Interesse des zukünftigen Erwachsenen, betont dessen prospektive Autonomie und klammert den Elternwunsch aus. Dieses „Modell des antizipierten Konsenses“ kann jedoch mit Bezug auf Neugeborene und Kleinkinder bedeutsame Aspekte des Eltern-Kind-Verhältnisses nicht angemessen erfassen. Im Aufsatz werden Argumente angeführt, die es aus Sicht einer Ethik der Elternschaft rechtfertigen, ethische Entscheidungen auf der Basis eines beziehungsorientierten Modells zu treffen. In unserem Modell fallen Elternwünsche ethisch ins Gewicht. (shrink)

During a pandemic, demand for intensive care often exceeds availability. Experts agree that allocation should maximize benefits and must not be based on whether patients could have taken preventive measures. However, intensive care units are often overburdened by individuals with severe COVID-19 who have chosen not to be vaccinated to prevent the disease. This article reports an experiment that investigated the German public's prioritization preferences during the fourth wave of the coronavirus pandemic. In a series of scenarios, participants were asked (...) to decide on ICU admission for patients who differed in terms of health condition, expected treatment benefits, and vaccination status. The results reveal an in-group bias, as vaccinated individuals preferred to allocate more resources to the vaccinated than to the unvaccinated. Participants also favored admitting a heart attack patient rather than a COVID-19 patient with the same likelihood of benefiting from ICU admission, indicating a preference for maintaining regular ICU services rather than treating those with severe COVID-19. Finally, participants were more likely to admit a patient to intensive care when this meant withholding rather than withdrawing care from another patient. The results indicate that lay prioritizations violate established allocation principles, presaging potential conflicts between those in need of intensive care and those who provide and allocate it. It is therefore recommended that allocation principles should be explained to enhance public understanding. Additionally, vaccination rates should be increased to relieve ICUs and reduce the need for such triage decisions. (shrink)

Wir diskutieren ethische Probleme der medizinischen Behandlung intersexueller Kinder. Gefragt wird nach dem Stellenwert von Elternwünschen nach eindeutiger Geschlechtszuweisung sowie nach den Konfliktfeldern, die zum einen zwischen konkurrierenden Wunschvorstellungen der Eltern und der behandelnden Ärzte, zum andern zwischen Kindeswohl und Kinderrechten entstehen können. Gegenwärtig wird Neugeborenen mit anatomisch uneindeutigem Genital trotz unsicherer Prognose über die Behandlungsergebnisse oft noch ein Geschlecht zugewiesen und operativ erstellt. Dieses Vorgehen ist von verschiedenen Seiten ethisch heftig kritisiert worden. Kipnis u. Diamond forderten 1998 im „Journal (...) of Clinical Ethics“ ein Moratorium für alle nicht vital indizierten geschlechtskorrigierenden Eingriffe. Diese Forderung orientiert sich am Interesse des zukünftigen Erwachsenen, betont dessen prospektive Autonomie und klammert den Elternwunsch aus. Dieses „Modell des antizipierten Konsenses“ kann jedoch mit Bezug auf Neugeborene und Kleinkinder bedeutsame Aspekte des Eltern-Kind-Verhältnisses nicht angemessen erfassen. Im Aufsatz werden Argumente angeführt, die es aus Sicht einer Ethik der Elternschaft rechtfertigen, ethische Entscheidungen auf der Basis eines beziehungsorientierten Modells zu treffen. In unserem Modell fallen Elternwünsche ethisch ins Gewicht. (shrink)

Background: Theoretically, the principle of justice is strong in healthcare priorities both nationally and internationally. Research, however, has indicated that questions can be raised as to how this principle is dealt with in clinical intensive care. Objective: The objective of this article is to examine how significant others may affect the principle of justice in the medical treatment and nursing care of intensive care patients. Method: Field observations and in-depth interviews with physicians and nurses in intensive care units (ICU). Emphasis (...) was placed on eliciting the underlying rationale for prioritisations in clinical intensive care with particular focus on clinicians’ considerations when limiting ICU treatment. Results: Significant others could induce an unintentional discrimination of ICU patients. Family members who were demanding received more time and attention for both the patient and themselves. Patients’ and families’ status and position and/or an interesting medical diagnosis seemed to govern the clinicians’ priorities of patients and families—consciously as well as unconsciously. The clinicians emphasised that patient information given through families was important. However, patients’ preferences and values conveyed to clinicians through their families were not always taken seriously. This even applied in cases with very serious prognoses and an explicit patient wish to forego life-prolonging treatment. Conclusion: The principle of justice was violated when qualified attention was given to significant others, and through this also to patients. Attention given to significant others was influenced by the healthcare workers’ professional and personal values, attitudes and interests. (shrink)

In their contribution ‘Ethics of the algorithmic prediction of goal of care preferences’1 Ferrario et al elaborate a from theory to practice contribution concerning the realisation of artificial intelligence (AI)-based patient preference prediction (PPP) systems. Such systems are intended to help find the treatment that the patient would have chosen in clinical situations—especially in the intensive care or emergency units—where the patient is no longer capable of making that decision herself. The authors identify several challenges that complicate their effective (...) development, application and evaluation—and offer solutions to them. One of these issues is the question of who should ultimately use said systems. While it is undisputed that clinicians should use these AI systems for their decision-making process, there is an ongoing debate about whether next of kin should use them as well. The authors advocate that ‘’access should be provided to both clinicians and loved ones with due explanations and as desired’. We will disagree with this assessment and explain in our commentary why it is important that surrogates provide their own assessments with as little external (AI) influence as possible. Why do next of kin actually participate in the process of preference finding and treatment decision-making? A key reason is that clinicians usually …. (shrink)

The aim of this study was to assess the opinions and role of intensive care unit (ICU) nurses regarding the distribution of ICU beds. We conducted this research among 30% of the attendees at two ICU congresses in Turkey. A self-administered questionnaire was used, which included 13 cases and allocation criteria. Of the total (136 nurses), 53.7% participated in admission/discharge decisions. The most important criterion was quality of life as viewed by the physician; the least important was the patient’s social (...) status. According to the findings, the nurses thought that medical benefit and avoiding discrimination were important. On the other hand their ignorance of patients’ autonomous preferences arouses suspicions about these nurses’ role in advocating for patients’ rights. For this reason, nurses’ role in allocation decisions should be clearly described and should also be the basis on which intensive care nurses’ duties in allocation decisions should be determined. (shrink)

There is a broadly held view that neonatologists are ethically obligated to act to override parental nontreatment decisions for imperiled premature newborns when there is a reasonable chance of a good outcome. It is argued here that three types of uncertainty undercut any such general obligation: (1) the vagueness of the boundary at which an infant’s deficits become so intolerable that death could be reasonably preferred; (2) the uncertainty about whether aggressive treatment will result in the survival of a reasonably (...) healthy child or, alternatively, the survival of a child with intolerable deficits; and (3) the inability to determine an acceptable ratio between the likelihoods of those two outcomes. It is argued that the broadly held view accords insufficient weight to the fact that newborn intensive care increases the likelihood of harm to the child by effecting survival with intolerable deficits. Though treatment may offer a reasonable chance of a good outcome, it is argued that there are situations in which neonatologists should nonetheless defer to parental nontreatment decisions. (shrink)

Background/Aim: The law on consent has changed in Scotland with the introduction of the Adults with Incapacity Act 2000. This Act introduces the concept of proxy consent in Scotland. Many patients in intensive care are unable to participate in the decision making process because of their illness and its treatment. It is normal practice to provide relatives with information on the patient’s condition, treatment, and prognosis as a substitute for discussion directly with the patient. The relatives of intensive care patients (...) appeared to believe that they already had the right to consent on behalf of an incapacitated adult. The authors’ aim was to assess the level of knowledge among relatives of intensive care patients of both the old and new law using a structured questionnaire.Methods: The next of kin of 100 consecutive patients completed a structured questionnaire. Each participant had the questions read to them and their answers recorded. Patients were not involved in the study.Results: Few were aware of the changes. Most thought that they previously could give consent on behalf of an incapacitated adult. Only 13% have ever discussed the preferences for life sustaining treatment with the patient but 84% felt that they could accurately represent the patient’s wishes.Conclusions: There appeared to be a lack of public awareness of the impending changes. The effectiveness of the Act at improving the care of the mentally incapacitated adult will depend largely on how successful it is at encouraging communication and decision making in advance of incapacity occurring. (shrink)

Background and PurposeMany critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission (...) and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process.Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N=203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool.ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS (F=6.39, p=.01) and total hospital charges (F=7.03, p=.009).ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)

A recent widely reported study found that some participants would prefer to self-administer a small electric shock than be bored. This flawed study serves as a departure point to diagram pain and sensation beyond the boundaries of the individual body, consisting of four sections. First, in terms of laboratory-based experimentation and auto-experimentation with pain, there is a long history of viewing pain and touch through introspective means. Second, later theories of pain successively widened the scope of the physiological mechanisms and (...) external influences on the organism, such as Melzack and Wall’s cybernetics-influenced gate control theory. Third, we briefly consider the nervous system as a homeostatic system, which finds an historical parallel in explanations of the milieu intérieur of the organism, via Claude Bernard and Kurt Goldstein. Fourth, pain helps tip the organism as a whole from perception to action, but also operates beyond the organism as a biopsychosocial phenomenon. (shrink)

This paper tries to investigate the future development tendency of five typical industries in China and find out whether there exists a different innovation strategy preference between Chinese firms of low- and high-knowledge density industry in the background of low-carbon sustainable development. First, this paper finds that the innovation driven-based trend of industrial development is further accelerated in China. Firms in industries with high knowledge and technology density, such as specialized-supplier, scale-intensive, and science-based industries, are more likely to choose (...) exploratory innovation strategy than exploitative innovation strategy. Firms in industries with low knowledge and technology density like service- and supplier-dominated industries are more likely to choose the exploitative innovation strategy. Second, results indicate that exploratory innovation can bring higher technological innovation performance than exploitative innovation. And the effect of the ambidextrous strategy is better than the single exploitative strategy in industries with high knowledge and technology density like specialized-supplier, scale-intensive, and science-based industries. Third, this paper suggests that innovation strategy preference plays a mediating role between industry type and technology innovation and a moderating effect of knowledge management capacity between innovation strategy and firms’ technology innovation. (shrink)

It is widely held that under ordinal utility, utility differences are ill-defined. Allegedly, for these to be well-defined (without turning to choice under risk or the like), one should adopt as a new kind of primitive quaternary relations, instead of the traditional binary relations underlying ordinal utility functions. Correlatively, it is also widely held that the key structural properties of quaternary relations are entirely arbitrary from an ordinal point of view. These properties would be, in a nutshell, the hallmark of (...) cardinal utility. While much is obviously true in these two tenets, this note explains why, as stated, they should be abandoned. Any ordinal utility function induces a rich quaternary relation. There is such a thing as ordinal utility differences. Furthermore, this induced quaternary relation respects, apart from completeness, the most standard structural properties of quaternary relations. These properties are, from an ordinal point of view, anything but arbitrary; from a quaternary perspective only completeness should be considered the hallmark—if any—of cardinal utility. These facts are explained to be especially relevant to the critical appreciation of the ordinalist methodology. (shrink)

This paper studies the welfare consequences of strategic voting in two commonly used parliamentary agendas by comparing the average utilities obtained in simulated voting under two behavioural assumptions: expected utility maximising behaviour and sincere behaviour. The average utility obtained in simulations is higher with expected utility maximising behaviour than with sincere voting behaviour under a broad range of assumptions. Strategic voting increases welfare particularly if the distribution of preference intensities correlates with voter types.

Arrow's Independence of Irrelevant Alternatives (IIA) has been under criticism for decades for not taking account of preference intensities. Computer-simulation results by Aki Lehtinen concerning strategic voting under various voting rules show that this intensity argument does not need to rest on mere intuition. Voters may express intensities by voting strategically, and that this has beneficial aggregate-level consequences: utilitarian efficiency is higher if voters engage in strategic behaviour than if they always vote sincerely. Strategic voting is thus unambiguously (...) beneficial under a utilitarian evaluation of outcomes. What has been considered the main argument for IIA turns out to be one against it. This paper assesses the implications of these results for interpretations of Arrow's theorem and the Gibbard-Satterthwaite theorem in a discussion on the methodological and philosophical arguments concerning preference intensities and IIA. (shrink)

BackgroundPhysical activity has a significant health impact worldwide and has been linked to a lower risk of the common cold.ObjectiveThe aim of this study was to estimate the form of PA among Chinese adults and the correlation between PA and number of the common cold in China's eastern, central, and western areas.DesignA cross-sectional study.SettingChina's eastern, central, and western regions from 30 November 2020 to 30 March 2021.PatientsA total of 1,920 healthy participants, who aged over 18 years old, with Internet access, (...) were enrolled, and then self-reported PA behaviors and number of the common cold were collected.MeasurementsThe authors calculated preference, intensity, frequency, and duration of PA in Chinese based on gender, age, and broad occupational categories and explored the potential effect between these factors and the common cold.ResultsApproximately 20.4% of participants reported not participating in sports regularly. Except for gender, there were significant differences in PA preference and intensity among the remaining individuals. However, intensity shows a U-shaped dose-response relationship with colds, whereas the frequency and duration have an inverse dose-response relationship. High intensity combined with high frequency increased colds the most. Nevertheless, non-exercise groups always have the most colds in each comparison.LimitationsThe result may be vulnerable to recall bias.ConclusionIntensity showed that U-shape, frequency, and duration showed inverse response to the number of colds last year, but age, sex, and occupation had no significant effects. High intensity and high frequency mixed increased colds the most, regardless of duration. (shrink)

I prefer to put this in a letter to you instead of writing an article that would lead one to believe that I have any authority to speak on the subject of what has, in a roundabout way, become the H. and H. affair . In other words, a cause of extreme seriousness, already discussed many times although certainly endless in nature, has been taken up by a storm of media attention, which has brought us to the lowest of passions, (...) intense emotions, and even violence. I understand why people are talking about Victor Farias, who has contributed some unpublished information—with a polemical intent, it is true, that does not help one to appreciate its true value. But how has it happened that Philippe Lacoue-Labarthe’s book, published in 1987, was greeted by a silence that I am perhaps the first to break?1 It is because he avoids anecdotal accounts, all the while citing and situating most of the facts mentioned by Farias. He is severe and rigorous. He lays essential questions before us. 1. Philippe Lacoue-Labarthe, La Fiction du politique: Heidegger, l’art et la politique . I also cite Lacoue-Labarthe’s book, La Poésie comme experience , devoted to Paul Celan. Maurice Blanchot, one of France’s preeminent writers, has written, among many other books, The Last Man, Death Sentence, The Madness of the Day, and The Gaze of Orpheus and Other Literary Essays. Paula Wissing, a free-lance translator and editor, has recently translated Paul Veyne’s Did the Greeks Believe in Their Myths? (shrink)

This paper defendsintensional essentialism: a property (intensional entity) is not essential relative to an individual (extensional entity), but relative to other properties (or intensional entities). Consequently, an individual can have a property only accidentally, but in virtue of having that property the individual has of necessity other properties. Intensional essentialism is opposed to various aspects of the Kripkean notion of metaphysical modality, eg, varying domains, existence as a property of individuals, and its category of properties which are both empirical and (...) essential with respect to particular individuals and natural kinds. The key notion of intensional essentialism isrequisite. A requisite is explicated as a relation-in-extension between two intensions (functions from possible worlds and moments of time)X, Y such that wherever and wheneverX is instantiatedY is also instantiated. We predict three readings of the sentence. Every wooden table is necessarily wooden , one involving modalityde re and the other two modalityde dicto. The first reading claims that no individual which is a wooden table is necessarily wooden. The claim is backed up by bare particular anti-essentialism. The two other interpretations claim that it is necessary that whatever is a wooden table is wooden. However, as we try to show, one is logically far more perspicuous thanks to the concept of requisite and thus preferable to more standardde dicto formalizations. (shrink)

Many Europeans are concerned about the living conditions of farm animals because they view animals as beings that possess interests of their own. Against this background the introduction of an animal welfare label is being intensively discussed in Europe. In choosing a market-based instrument to take these concerns into account, normative judgments are made about the formation of preferences, the value system that is implicitly assumed, and the distribution of property rights. From the perspective of classical institutional economics it can (...) be shown that the introduction of a label as an institutional change does not redefine institutions in a way that allows them to consider the interests of animals for their own sake. Rather, the label only redefines the property rights that humans have over animals. The market segregation into privileged and normal animals conflicts with the idea of equality between sentient animals. Within the group of humans only the interests of those who act on markets count. The commodification of their moral concerns assumes that people always decide based on their own interests, which can be traded off. The lexicographical ordering of preferences, which occurs when humans view animals as entities with rights, is not compatible with the normative assumptions of markets. Furthermore, interpreting animal suffering as market failure that can be corrected by labeling impedes a reasoned dialog within the society about the values and beliefs that serve as a basis for preference formation. Thus, an animal welfare label cannot replace a fundamental societal debate about legal standards on animal well-being. (shrink)

She was intensely sympathetic. She was immensely charming. She excelled in the difficult arts of family life. She sacrificed herself daily. If there was chicken, she took the leg, if there was a draught, she sat in it—in short, she was so constituted that she never had a mind or wish of her own, but preferred to sympathise always with the minds and wishes of others. — Virginia Woolf (1979, 59).

With a masterful sense of the place of rhetoric in both thought and practice and an ear attuned to the clarity, natural simplicity, and charm of Plato's Greek prose, James H. Nichols Jr., offers precise yet unusually readable translations of two great Platonic dialogues on rhetoric. The Gorgias presents an intransigent argument that justice is superior to injustice: To the extent that suffering an injustice is preferable to committing an unjust act. The dialogue contains some of Plato's most significant and (...) famous discussions of major political themes, and focuses dramatically and with unrivaled intensity on Socrates as a political thinker and actor. Featuring some of Plato's most soaringly lyrical passages, the Phaedrus investigates the soul's erotic longing and its relationship to the whole cosmos, as well as inquiring into the nature of rhetoric and the problem of writing. Nichols's attention to dramatic detail brings the dialogues to life. Plato's striking variety in conversational address is carefully reproduced, as is alteration in tone and implication even in the short responses. The translations render references to the gods accurately and non-monotheistically for the first time, and include a fascinating variety of oaths and invocations. A general introduction on rhetoric from the Greeks to the present shows the problematic relation of rhetoric to philosophy and politics, states the themes that unite the two dialogues, and outlines interpretive suggestions that are then developed more fully for each dialogue. The twin dialogues reveal both the private and the political rhetoric emphatic in Plato's philosophy, yet often ignored in commentaries on it. Nichols believes that Plato's thought on rhetoric has been largely misunderstood, and he uses his translations as an opportunity to reconstruct the classical position on right relations between thought and public activity. (shrink)

Appropriate information and consent has been one of the most intensely discussed topics within the context of biobank research. In parallel to the normative debate, many socio-empirical studies have been conducted to gather experiences, preferences and views of patients, healthy research participants and further stakeholders. However, there is scarcity of literature which connects the normative debate about justifications for different consent models with findings gained in empirical research. In this paper we discuss findings of a limited review of socio-empirical research (...) on patients’ and healthy research participants’ experiences and views regarding consent to biobank research in light of ethical principles for appropriate information and consent. (shrink)

I defend a one category ontology: an ontology that denies that we need more than one fundamental category to support the ontological structure of the world. Categorical fundamentality is understood in terms of the metaphysically prior, as that in which everything else in the world consists. One category ontologies are deeply appealing, because their ontological simplicity gives them an unmatched elegance and spareness. I’m a fan of a one category ontology that collapses the distinction between particular and property, replacing it (...) with a single fundamental category of intrinsic characters or qualities. We may describe the qualities as qualitative charactersor as modes, perhaps on the model of Aristotelian qualitative (nonsubstantial) kinds, and I will use the term “properties” interchangeably with “qualities”. The qualities are repeatable and reasonably sparse, although, as I discuss in section 2.6, there are empirical reasons that may suggest, depending on one’s preferred fundamental physical theory, that they include irreducibly intensive qualities. There are no uninstantiated qualities. I also assume that the fundamental qualitative natures are intrinsic, although physics may ultimately suggest that some of them are extrinsic. On my view, matter, concrete objects, abstract objects, and perhaps even spacetime are constructed from mereological fusions of qualities, so the world is simply a vast mixture of qualities, including polyadic properties (i.e., relations). This means that everything there is, including concrete objects like persons or stars, is a quality, a qualitative fusion, or a portion of the extended qualitative fusion that is the worldwhole. I call my view mereological bundle theory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:diacritics 33.2 (2005) 3-9 [Access article in PDF] The Suspended Substantive On Animals and Men in Giorgio Agamben's The Open Leland de la Durantaye Giorgio Agamben. The Open: Man and Animal. Trans. Kevin Attell. Stanford: Stanford UP, 2004. [O] Trans. of L'aperto: L'uomo e l'animale. Torino: Bollati Boringhieri, 2002. [A] With a title as enigmatic as The Open, the reader might well wonder, "the open what?" Is the title's (...) adjective to stand alone? Does it need no substantive to support it? This unfamiliar title is not what one might first guess—it is not an awkward translation from the work's original title. No substantive follows in the original, and none is meant to. The idea that gives Agamben's book its title is that of an openness which is unconditioned—and perhaps unconditional, an openness which is unspecified—and perhaps unspecifiable.If the answer to the question "the open what?" can be answered with no substantive, might we ask in what this opening occurs? Between what more substantive things has an indefinable space been opened? The first answer to the question can be found in the work's subtitle—Man and Animal. The open space in question is that which separates and distinguishes man from animal. Philosophers, anthropologists, social scientists, zoologists, chemists, taxonomists—and many others—have had no small difficulty in agreeing upon the matter.Philosophers have traditionally had a low opinion of animals [cf. de Fontenay]. Descartes had especially little respect for the minds of animals and influentially classified them as automata mechanica. As Agamben notes, the great naturalist and taxonomist Linnaeus responded to this assertion with the laconic rejoinder: "Descartes obviously never saw an ape" [cf. O 23/A 30; translation modified]. Philosophers have been more eager than taxonomists to put distance between themselves and the animals—and for this reason have been particularly interested in studying what separates man from animal. The last great philosophical attempt in this regard is that of Martin Heidegger. Despite his preference for the primordial, his openness to the woods and the wilderness, his opinion of animals' faculties was not much higher than that of Descartes. In his view, animals live in an environment in which they are receptive to various stimuli, but where they have nothing approximating what we call a "world"—animals are, as he claims, "poor in world" (weltarm)—or even "without world" (weltlos). They live in such intense and incessant proximity to their environment and its stimuli that they do not see the existential forest for the environmental trees. They can never take a step away from the immediacy of their perception and for this reason cannot be said to possess a "world" in the sense that man, in Heidegger's view, does.As mentioned above, the title The Open is, for all its strangeness, not the result of [End Page 3] an awkward translation from Agamben's Italian. Its strangeness stems, nevertheless, in large part from a translation. Or, to be more precise, from two translations. The first of these is from the German. The German in question is a special one—that of the profoundly idiosyncratic technical vocabulary that Heidegger fashioned for his philosophical purposes. For Heidegger, "the open" is something literally fundamental which lay at the heart of his thought. "The open" is the space revealed to us in the moment when the world we live in, which because of our many tasks and travails we tend to take no distance from (like animals with their stimuli), opens out onto something larger. This moment of distancing ourselves from our everyday concern with means and ends, with stimuli and response, is what gives us not just an environment, but a "world." "The open" is what we find ourselves in when the bustle and haste of our environment recedes and we see that environment in all its strangeness and immensity—as a "world," greater and less graspable than our restricted and finite representations. This experience of "the open" is, for Heidegger, what makes us human, and... (shrink)

This article criticises one of Stuart Rachels' and Larry Temkin's arguments against the transitivity of 'better than'. This argument invokes our intuitions about our preferences of different bundles of pleasurable or painful experiences of varying intensity and duration, which, it is argued, will typically be intransitive. This article defends the transitivity of 'better than' by showing that Rachels and Temkin are mistaken to suppose that preferences satisfying their assumptions must be intransitive. It makes cler where the argument goes wrong (...) by showing that it is a version of Zeno's paradox of Achilles and the Tortoise. (shrink)

This paper examines the moral case for a right to religious accommodation, which requires that religious conduct be free of any serious burdens placed on it by the state. Two different types of normative argument for this right are outlined and rejected. The first appeals to religion as a ‘basic good’, and the second to religion as an ‘intense preference’. In place of these, I suggest that a third type of argument has greater prospects of success. Religious accommodation is (...) justified on the grounds that religious conduct is a ‘derivative good’— that is, it derives its value from its being necessary for something else, namely, the integrity of the religious person. (shrink)