Advance Medical Decision-Making Differs Across First- and Third-Person Perspectives.

BACKGROUND: Advance healthcare decision-making presumes that a prior treatment preference expressed with sufficient mental capacity ("T1 preference") should trump a contrary preference expressed after significant cognitive decline ("T2 preference"). This assumption is much debated in normative bioethics, but little is known about lay judgments in this domain. This study investigated participants' judgments about which preference should be followed, and whether these judgments differed depending on a first-person (deciding for one's future self) versus third-person (deciding for a friend or stranger) perspective. METHODS: A vignette-based survey was conducted (N = 1445 US Americans; gender-balanced sample), in a 3 (relationship: self, best friend, stranger) × 2 (T1 preference: treat, do not treat) × 2 (T2 contrary preference: ambiguous, unambiguous) design. RESULTS: Participants were more likely to defer to the incapacitated T2 preference of a third-party, while being more likely to insist on following their own T1 capacitated preference. Further, participants were more likely to conclude that others with substantial cognitive decline were still their "true selves," which correlated with increased deference to their T2 preferences. CONCLUSIONS: These findings add to the growing evidence that lay intuitions concerning the ethical entitlement to have decisions respected are not only a function of cognition, as would be expected under many traditional bioethical accounts, but also depend on the relationship of the decision to the decision-maker's true self.

Strong Bipartisan Support for Controlled Psilocybin Use as Treatment or Enhancement in a Representative Sample of US Americans: Need for Caution in Public Policy Persists.

The psychedelic psilocybin has shown promise both as treatment for psychiatric conditions and as a means of improving well-being in healthy individuals. In some jurisdictions (e.g., Oregon, USA), psilocybin use for both purposes is or will soon be allowed and yet, public attitudes toward this shift are understudied. We asked a nationally representative sample of 795 US Americans to evaluate the moral status of psilocybin use in an appropriately licensed setting for either treatment of a psychiatric condition or well-being enhancement. Showing strong bipartisan support, participants rated the individual's decision as morally positive in both contexts. These results can inform effective policy-making decisions around supervised psilocybin use, given robust public attitudes as elicited in the context of an innovative regulatory model. We did not explore attitudes to psilocybin use in unsupervised or non-licensed community or social settings.

Broad, subjective, relative: the surprising folk concept of basic needs.

Some normative theorists appeal to the concept of basic needs. They argue that when it comes to issues such as global justice, intergenerational justice, human rights or sustainable development our first priority should be that everybody is able to meet these needs. But what are basic needs? We attempt to inform discussions about this question by gathering evidence of ordinary English speakers' intuitions on the concept of basic needs. First, we defend our empirical approach to analyzing this concept and identify a number of its potential features. Then we present three preregistered empirical studies that were conducted to investigate the extent to which ordinary speakers endorse these features. The studies yield convergent evidence for the following three claims: (1) ordinary speakers sometimes apply the concept of basic needs to necessities for a flourishing (not just a minimally decent) life, (2) most ordinary speakers attribute at least some degree of subjectivity to the concept, and (3) most ordinary speakers attribute at least some degree of relativity to the concept. We discuss the implications of these findings for philosophical analyses of basic needs.

Moral appraisals guide intuitive legal determinations.

OBJECTIVES: We sought to understand how basic competencies in moral reasoning influence the application of private, institutional, and legal rules. HYPOTHESES: We predicted that moral appraisals, implicating both outcome-based and mental state reasoning, would shape participants' interpretation of rules and statutes-and asked whether these effects arise differentially under intuitive and reflective reasoning conditions. METHOD: In six vignette-based experiments (total N = 2,473; 293 university law students [67% women; age bracket mode: 18-22 years] and 2,180 online workers [60% women; mean age = 31.9 years]), participants considered a wide range of written rules and laws and determined whether a protagonist had violated the rule in question. We manipulated morally relevant aspects of each incident-including the valence of the rule's purpose (Study 1) and of the outcomes that ensued (Studies 2 and 3), as well as the protagonist's accompanying mental state (Studies 5 and 6). In two studies, we simultaneously varied whether participants decided under time pressure or following a forced delay (Studies 4 and 6). RESULTS: Moral appraisals of the rule's purpose, the agent's extraneous blameworthiness, and the agent's epistemic state impacted legal determinations and helped to explain participants' departure from rules' literal interpretation. Counter-literal verdicts were stronger under time pressure and were weakened by the opportunity to reflect. CONCLUSIONS: Under intuitive reasoning conditions, legal determinations draw on core competencies in moral cognition, such as outcome-based and mental state reasoning. In turn, cognitive reflection dampens these effects on statutory interpretation, allowing text to play a more influential role. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family bereavement and organ donation in Spain: a mixed method, prospective cohort study protocol.

INTRODUCTION: There is a discrepancy in the literature as to whether authorising or refusing the recovery of organs for transplantation is of direct benefit to families in their subsequent grieving process. This study aims to explore the impact of the family interview to pose the option of posthumous donation and the decision to authorise or refuse organ recovery on the grieving process of potential donors' relatives. METHODS AND ANALYSIS: A protocol for mixed methods, prospective cohort longitudinal study is proposed. Researchers do not randomly assign participants to groups. Instead, participants are considered to belong to one of three groups based on factors related to their experiences at the hospital. In this regard, families in G1, G2 and G3 would be those who authorised organ donation, declined organ donation or were not asked about organ donation, respectively. Their grieving process is monitored at three points in time: 1 month after the patient's death, when a semistructured interview focused on the lived experience during the donation process is carried out, 3 months and 9 months after the death. At the second and third time points, relatives' grieving process is assessed using six psychometric tests: State-Trait Anxiety Inventory, Beck Depression Inventory-II, Inventory of Complicated Grief, The Impact of Event Scale: Revised, Posttraumatic Growth Inventory and Connor-Davidson Resilience Scale. Descriptive statistics (means, SDs and frequencies) are computed for each group and time point. Through a series of regression models, differences between groups in the evolution of bereavement are estimated. Additionally, qualitative analyses of the semistructured interviews are conducted using the ATLAS.ti software. ETHICS AND DISSEMINATION: This study involves human participants and was approved by Comité Coordinador de Ética de la Investigación Biomédica de Andalucía (CCEIBA) ID:1052-N-21. The results will be disseminated at congresses and ordinary academic forums. Participants gave informed consent to participate in the study before taking part.

Attitudes of European students towards family decision-making and the harmonisation of consent systems in deceased organ donation: a cross-national survey.

BACKGROUND: European countries are increasingly harmonising their organ donation and transplantation policies. Although a growing number of nations are moving to presumed consent to deceased organ donation, no attempts have been made to harmonise policies on individual consent and the role of the family in the decision-making process. Little is known about public awareness of and attitudes towards the role of the family in their own country and European harmonisation on these health policy dimensions. To improve understanding of these issues, we examined what university students think about the role of the family in decision-making in deceased organ donation and about harmonising consent policies within Europe. METHODS: Using LimeSurvey© software, we conducted a comparative cross-sectional international survey of 2193 university students of health sciences and humanities/social sciences from Austria (339), Belgium (439), Denmark (230), Germany (424), Greece (159), Romania (190), Slovenia (190), and Spain (222). RESULTS: Participants from opt-in countries may have a better awareness of the family's legal role than those from opt-out countries. Most respondents opposed the family veto, but they were more ambivalent towards the role of the family as a surrogate decision-maker. The majority of participants were satisfied with the family's legal role. However, those who were unsatisfied preferred to limit family involvement. Overall, participants were opposed to the idea of national sovereignty over consent policies. They favoured an opt-out policy harmonisation and were divided over opt-in. Their views on harmonisation of family involvement were consistent with their personal preferences. CONCLUSIONS: There is overall division on whether families should have a surrogate role, and substantial opposition to granting them sole authority over decision-making. If European countries were to harmonise their policies on consent for organ donation, an opt-out system that grants families a surrogate decision-making role may enjoy the widest public support.

Coordination and expertise foster legal textualism.

A cross-cultural survey experiment revealed a dominant tendency to rely on a rule's letter over its spirit when deciding which behaviors violate the rule. This tendency varied markedly across (k = 15) countries, owing to variation in the impact of moral appraisals on judgments of rule violation. Compared with laypeople, legal experts were more inclined to disregard their moral evaluations of the acts altogether and consequently exhibited stronger textualist tendencies. Finally, we evaluated a plausible mechanism for the emergence of textualism: in a two-player coordination game, incentives to coordinate in the absence of communication reinforced participants' adherence to rules' literal meaning. Together, these studies (total n = 5,794) help clarify the origins and allure of textualism, especially in the law. Within heterogeneous communities in which members diverge in their moral appraisals involving a rule's purpose, the rule's literal meaning provides a clear focal point-an identifiable point of agreement enabling coordinated interpretation among citizens, lawmakers, and judges.

The typicality effect in basic needs.

According to the so-called Classical Theory, concepts are mentally represented by individually necessary and jointly sufficient application conditions. One of the principal empirical objections against this view stems from evidence that people judge some instances of a concept to be more typical than others. In this paper we present and discuss four empirical studies that investigate the extent to which this 'typicality effect' holds for the concept of basic needs. Through multiple operationalizations of typicality, our studies yielded evidence for a strong effect of this kind: (1) Participants tended to recall the same core examples of the concept in a free-listing task. (2) They judged some basic needs to be more typical than others. (3) The items that were judged to be more typical were listed more frequently in the free-listing task. (4) These items were listed earlier on in the free-listing task. (5) Typical basic needs, as well as non needs, were classified faster than atypical basic needs in a reaction time study. These findings suggest that the concept of basic needs may have a non-classical (e.g., exemplar or prototype) structure. If so, the quest for a simple and robust intensional analysis of the concept may be futile. Supplementary Information: The online version contains supplementary material available at 10.1007/s11229-022-03859-9.

New Findings on Unconsented Intimate Exams Suggest Racial Bias and Gender Parity.

Testimony from hundreds of medical students and numerous physicians and scholars suggests that unconsented intimate exams (UIEs) are unlikely to be rare, isolated incidents. However, much is unknown about the frequency of these exams and the circumstances in which they take place. The Community Bioethics Forum, founded and chaired by one of the authors of this commentary, is a consultative group of diverse community members who provide insights on law and policy to policy-makers and medical associations. Connecticut legislators asked the CBF to provide their views on proposed "explicit consent" legislation, and during those discussions, concerning narratives emerged about members' (and their loved ones') personal experiences with UIEs. To gain greater clarity on the demographic patterns and frequency of UIEs, we conducted the first national survey on UIEs. Data from this survey suggest that UIEs may occur under a broader range of circumstances than addressed by most law and policy. The survey resulted in nearly the exact same rate of affirmative responses between males and females in answer to whether they had received a UIE within the past five years. The survey results also showed evidence of racial disparity. Additional research is needed to understand the nature of UIEs.

Guilt Without Fault: Accidental Agency in the Era of Autonomous Vehicles.

The control principle implies that people should not feel guilt for outcomes beyond their control. Yet, the so-called 'agent and observer puzzles' in philosophy demonstrate that people waver in their commitment to the control principle when reflecting on accidental outcomes. In the context of car accidents involving conventional or autonomous vehicles (AVs), Study 1 established that judgments of responsibility are most strongly associated with expressions of guilt-over and above other negative emotions, such as sadness, remorse or anger. Studies 2 and 3 then confirmed that, while people generally endorse the control principle, and deny that occupants in an AV should feel guilt when involved in an accident, they nevertheless ascribe guilt to those same occupants. Study 3 also uncovered novel implications of the observer puzzle in the legal context: Passengers in an AV were seen as more legally liable than either passengers in a conventional vehicle, or even their drivers-especially when participants were prompted to reflect on the passengers' affective experience of guilt. Our findings document an important conflict-in the context of AV accidents-between people's prescriptive reasoning about responsibility and guilt on one hand, and their counter-normative experience of guilt on the other, with apparent implications for liability decisions.

Trolleys, triage and Covid-19: the role of psychological realism in sacrificial dilemmas.

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people's moral attitudes toward the triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did not stem from period change in moral attitudes relative to pre-pandemic levels-but rather, from the heightened realism of triage dilemmas. Participants favoured utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas-and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarisation surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people's robust support for utilitarian measures in the face of a global public health threat, and illustrate how the dominant methods in moral psychology (e.g. trolley cases) may deliver insights that do not generalise to real-world moral dilemmas.

Whose Words Hurt? Contextual Determinants of Offensive Speech.

Tracing the boundaries of freedom of expression is a matter of wide societal and academic import-especially, as these boundaries encroach on the politics of inclusion. Yet, the elements that constitute offensive speech and determine its legal status remain poorly defined. In two studies, we examined how lay judges evaluate the offensiveness of apparently descriptive statements. Replicating prior work, we found that non-linguistic features (including speaker intent and outcomes on the audience) modulated the statements' meaning. The speaker's identity-and, in particular, their membership in the target group-independently influenced evaluations of offensive speech among conservatives and progressives alike. When asked to disclose their abstract principles, or jointly evaluate two contrastive cases, participants tended to deny the relevance of identity while primarily endorsing the intent principle. Taken together, our findings confirm that assessments of offensive speech are governed by contextual features, some of which are not introspectively deemed relevant.

Experimental philosophical bioethics and normative inference.

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called "experimental philosophical bioethics" (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people's moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments.

Are There Cross-Cultural Legal Principles? Modal Reasoning Uncovers Procedural Constraints on Law.

Despite pervasive variation in the content of laws, legal theorists and anthropologists have argued that laws share certain abstract features and even speculated that law may be a human universal. In the present report, we evaluate this thesis through an experiment administered in 11 different countries. Are there cross-cultural principles of law? In a between-subjects design, participants (N = 3,054) were asked whether there could be laws that violate certain procedural principles (e.g., laws applied retrospectively or unintelligible laws), and also whether there are any such laws. Confirming our preregistered prediction, people reported that such laws cannot exist, but also (paradoxically) that there are such laws. These results document cross-culturally and -linguistically robust beliefs about the concept of law which defy people's grasp of how legal systems function in practice.

Governance quality indicators for organ procurement policies.

BACKGROUND: Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries. METHODS: Between 2017-2019, we conducted a convenience sample survey of students (n = 2006) in Austria (AT), Belgium (BE), Denmark (DK), Germany (DE), Greece (GR), Slovenia (SI) and Spain (ES), asking participants about their donation preferences, as well as their beliefs and views about the policy in place. From these measures, we computed indices of informedness, policy support, and fulfilment of unexpressed preferences, which we compared across countries and consent systems. RESULTS: Our study introduces a tool for analyzing policy governance in the context of OP. Wide variation in policy awareness was observed: Most respondents in DK, DE, AT and BE correctly identified the policy in place, while those in SI, GR and ES did not. Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place (with one exception, i.e., SI), whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support-either informed or uninformed-in opt-out countries. We also found informed divergence in opt-in countries and a tendency for convergence-either informed or uninformed-among opt-out countries. CONCLUSION: Our study offers a novel tool for analyzing governance quality and illustrates, in the context of OP, how the strengths and weaknesses of different policy implementations can be estimated and compared using quantitative survey data.

Absolutely Right and Relatively Good: Consequentialists See Bioethical Disagreement in a Relativist Light.

BACKGROUND: Contemporary societies are rife with moral disagreement, resulting in recalcitrant disputes on matters of public policy. In the context of ongoing bioethical controversies, are uncompromising attitudes rooted in beliefs about the nature of moral truth? METHODS: To answer this question, we conducted both exploratory and confirmatory studies, with both a convenience and a nationally representative sample (total N = 1501), investigating the link between people's beliefs about moral truth (their metaethics) and their beliefs about moral value (their normative ethics). RESULTS: Across various bioethical issues (e.g., medically-assisted death, vaccine hesitancy, surrogacy, mandatory organ conscription, or genetically modified crops), consequentialist attitudes were associated with weaker beliefs in an objective moral truth. This association was not explained by domain-general reflectivity, theism, personality, normative uncertainty, or subjective knowledge. CONCLUSIONS: We find a robust link between the way people characterize prescriptive disagreements and their sensibility to consequences. In addition, both societal consensus and personal conviction contribute to objectivist beliefs, but these effects appear to be asymmetric, i.e., stronger for opposition than for approval.

How pills undermine skills: Moralization of cognitive enhancement and causal selection.

Despite the promise to boost human potential and wellbeing, enhancement drugs face recurring ethical scrutiny. The present studies examined attitudes toward cognitive enhancement in order to learn more about these ethical concerns, who has them, and the circumstances in which they arise. Fairness-based concerns underlay opposition to competitive use-even though enhancement drugs were described as legal, accessible and affordable. Moral values also influenced how subsequent rewards were causally explained: Opposition to competitive use reduced the causal contribution of the enhanced winner's skill, particularly among fairness-minded individuals. In a follow-up study, we asked: Would the normalization of enhancement practices alleviate concerns about their unfairness? Indeed, proliferation of competitive cognitive enhancement eradicated fairness-based concerns, and boosted the perceived causal role of the winner's skill. In contrast, purity-based concerns emerged in both recreational and competitive contexts, and were not assuaged by normalization.