The Life Attachment Scale (LAS-R).

INTRODUCTION: The proposed concept of secure/insecure lifeattachment reflects the experience of the world and life as a good (or insecure/threatening) place to be. The present article describes the theoretical foundation, development, and validation of a revised measure that captures the phenomenon of secure/insecure life attachment. The revised scale consists of seven dimensions: (1) Coexistence, (2) Reliability, (3) Safetiness, (4) Integration, (5) Inclusion, (6) Participation, and (7) Deliberation. METHODS: In three studies (N = 1,059), we examined the factor structure and the convergent and predictive validity of the Life Attachment Scale-Revised (LAS-R). RESULTS: Our results support a seven-factor structure of the scale, reflecting the aforementioned dimensions. Furthermore, convergent and predictive validity were established through correlations with related concepts of life satisfaction, flourishing, openness to the future, and perceived stress. CONCLUSION: We have devised and substantiated a scale adept at gauging dimensions of secure and insecure/disordered life attachment. Empirical evidence from statistical analyses supports the assumption that the LAS-R is psychometrically sound, establishing its reliability and validity as a dependable instrument. Thus, the scale has promising implications for developing the empirical base for research in many areas of psychology, sociology, and the social sciences.

Effect of Private Deliberation: Deception of Large Language Models in Game Play.

Integrating large language model (LLM) agents within game theory demonstrates their ability to replicate human-like behaviors through strategic decision making. In this paper, we introduce an augmented LLM agent, called the private agent, which engages in private deliberation and employs deception in repeated games. Utilizing the partially observable stochastic game (POSG) framework and incorporating in-context learning (ICL) and chain-of-thought (CoT) prompting, we investigated the private agent's proficiency in both competitive and cooperative scenarios. Our empirical analysis demonstrated that the private agent consistently achieved higher long-term payoffs than its baseline counterpart and performed similarly or better in various game settings. However, we also found inherent deficiencies of LLMs in certain algorithmic capabilities crucial for high-quality decision making in games. These findings highlight the potential for enhancing LLM agents' performance in multi-player games using information-theoretic approaches of deception and communication with complex environments.

Time pressure increases children's aversion to advantageous inequity.

The relative contribution of intuitive and reflective cognitive systems in cooperative decision making is a topic of hot debate. Research with adults suggests that intuition often favors cooperation, but these effects are contextually sensitive. Emerging evidence has shown that in many contexts children show a tendency toward intuitive cooperation, but research investigating these processes in children is sparse and has produced mixed findings. In the current study we investigated the influence of intuitive and reflective decision processes on children's fairness behavior by manipulating decision time. We tested (N = 158) pairs of children between 4 and 10 years of age from a rural community in Canada. Children's decisions to accept or reject allocations of candies were either made under time pressure or after a 10-s delay. We assessed the impact of decision time on children's aversion to inequitable distributions of resources by comparing their responses to equal allocations with either disadvantageous allocations or advantageous allocations. We found that children showed a greater age-related increase in advantageous inequity aversion when decisions were made under time pressure compared to when they were made after a delay. In contrast, we did not observe a significant impact of decision time on the development of disadvantageous inequity aversion. These findings suggest that intuitive decision processes may contribute to the development of fairness concerns in middle childhood.

Ethics support for ethics support: the development of the Confidentiality Compass for dealing with moral challenges concerning (breaching) confidentiality in moral case deliberation.

BACKGROUND: Confidentiality is one of the central preconditions for clinical ethics support (CES). CES cases which generate moral questions for CES staff concerning (breaching) confidentiality of what has been discussed during CES can cause moral challenges. Currently, there seems to be no clear policy or guidance regarding how CES staff can or should deal with these moral challenges related to (not) breaching confidentiality within CES. Moral case deliberation is a specific kind of CES. METHOD: Based on experiences and research into MCD facilitators' needs for ethics support in this regard, we jointly developed an ethics support tool for MCD facilitators: the Confidentiality Compass. This paper describes the iterative developmental process, including our theoretical viewpoints and reflections on characteristics of CES tools in general. RESULTS: The content and goals of the ethics support tool, which contains four elements, is described. Part A is about providing information on the concept of confidentiality in MCD, part B is a moral compass with reflective questions, part C focuses on courses of action for careful handling of moral challenges related to confidentiality. Part D contains general lessons, best practices and tips for dealing with confidentiality in future cases. CONCLUSIONS: This paper concludes with providing some lessons-learned related to developing ethics support tools and some reflections on issues of quality and normativity of ethics support tools.

Public Reason, Bioethics, and Public Policy: A Seductive Delusion or Ambitious Aspiration?

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research.

What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?

BACKGROUND: The prioritization protocols for accessing adult critical care in the extreme pandemic context contain tiebreaker criteria to facilitate decision-making in the allocation of resources between patients with a similar survival prognosis. Besides being controversial, little is known about the public acceptability of these tiebreakers. In order to better understand the public opinion, Quebec and Ontario's protocols were presented to the public in a democratic deliberation during the summer of 2022. OBJECTIVES: (1) To explore the perspectives of Quebec and Ontario citizens regarding tiebreakers, identifying the most acceptable ones and their underlying values. (2) To analyze these results considering other public consultations held during the pandemic on these criteria. METHODS: This was an exploratory qualitative study. The design involved an online democratic deliberation that took place over two days, simultaneously in Quebec and Ontario. Public participants were selected from a community sample which excluded healthcare workers. Participants were first presented the essential components of prioritization protocols and their related issues (training session day 1). They subsequently deliberated on the acceptability of these criteria (deliberation session day 2). The deliberation was then subject to thematic analysis. RESULTS: A total of 47 participants from the provinces of Quebec (n = 20) and Ontario (n = 27) took part in the online deliberation. A diverse audience participated excluding members of the healthcare workforce. Four themes were identified: (1) Priority to young patients - the life cycle - a preferred tiebreaker; (2) Randomization - a tiebreaker of last resort; (3) Multiplier effect of most exposed healthcare workers - a median acceptability tiebreaker, and (4) Social value - a less acceptable tiebreaker. CONCLUSION: Life cycle was the preferred tiebreaker as this criterion respects intergenerational equity, which was considered relevant when allocating scarce resources to adult patients in a context of extreme pandemic. Priority to young patients is in line with other consultations conducted around the world. Additional studies are needed to further investigate the public acceptability of tiebreaker criteria.

Evaluating the use of casuistry during moral case deliberation in the ICU: A multiple qualitative case study.

Intensive care unit (ICU) professionals engage in ethical decision making under conditions of high stakes, great uncertainty, time-sensitivity and frequent irreversibility of action. Casuistry is a way by which actionable knowledge is obtained through comparing a patient case to previous cases from experience in clinical practice. However, within the field of study as well as in practice, evidence-based medicine is the dominant epistemic framework. This multiple case study evaluated the use of casuistic reasoning by intensive care unit (ICU) professionals during moral case deliberation. It took place in two Dutch hospitals between June 2020 and June 2022. Twentyfive moral case deliberations from ICU practice were recorded and analyzed using discourse analysis. Additionally, 47 interviews were held with ICU professionals who participated in these deliberations, analyzed using thematic analysis. We found that ICU professionals made considerable use of case comparisons when discussing continuation, withdrawal or limitation. Analogies played a role in justifying or complicating moral judgements, and also played a role in addressing moral distress. The language of case-based arguments is most often not overtly normative. Rather, the data shows that casuistic reasoning deals with the medical, ethical and contextual elements of decisions in an integrated manner. Facilitators of MCD have an essential role in (supporting ICU professionals in) scrutinizing casuistic arguments. The data shows that during MCD, actual reasoning often deviated from principle- and rule-based reasoning which ICU professionals preferred themselves. Evidence-based arguments often gained the character of analogical arguments, especially when a patient-at-hand was seen as highly unique from the average patients in the literature. Casuistic arguments disguised as evidence-based arguments may therefore provide ICU professionals with a false sense of certainty. Within education, we should strive to train clinicians and ethics facilitators so that they can recognize and evaluate casuistic arguments.

The impact of misinformation presented during jury deliberation on juror memory and decision-making.

When deliberating, jurors may introduce misinformation that may influence other jurors' memory and decision-making. In two studies, we explored the impact of misinformation exposure during jury deliberation. Participants in both studies read a transcript of an alleged sexual assault. In Study 1 (N = 275), participants encountered either consistent pro-prosecution misinformation, consistent pro-defense misinformation, or contradictory misinformation (pro-prosecution and pro-defense). In Study 2 (N = 339), prior to encountering either pro-prosecution or pro-defense misinformation while reading a jury deliberation transcript, participants either received or did not receive a judicial instruction about misinformation exposure during deliberation. Participants in both studies completed legal decision-making variables (e.g., defendant guilt rating) before and after deliberation, and their memory was assessed for misinformation acceptance via recall and source memory tasks. In Study 1, misinformation type did not influence legal decision-making, but pro-prosecution misinformation was more likely to be misattributed as trial evidence than pro-defense or contradictory misinformation. In Study 2, pro-defense misinformation was more likely to be misattributed to the trial than pro-prosecution misinformation, and rape myths moderated this. Furthermore, exposure to pro-defense misinformation skewed legal decision-making towards the defense's case. However, the judicial instruction about misinformation exposure did not influence memory or decision-making. Together, these findings suggest that misinformation in jury deliberations may distort memory for trial evidence and bias decision-making, highlighting the need to develop effective safeguards for reducing the impact of misinformation in trial contexts.

Integrating online deliberation into ecosystem service valuation.

Stated preference valuation of ecosystem services involves participants answering hypothetical questions to express preferences. Participants tend to respond to the hypothetical questions separately, without any deliberation (the process of considering and discussing within a group). However, a relatively recent development in deliberation research involves asking participants to state preferences via deliberation. Deliberation is historically conducted in-person but can now also be done online. This paper covers the strengths and limitations of integrating online deliberation into stated preference valuation, including: (1) comparison between stated preference valuation with and without deliberation, (2) comparison between in-person and online deliberation, and (3) comparison between online deliberation media, such as typing, video meetings, and voice calls. Conducting deliberation can broaden participants' understanding of the target ecosystem services and others' preferences. However, this requires participants' willingness to deliberate and increases time investment. Online deliberation has lower costs and travel restrictions and higher time efficiency and confidentiality of personal information than in-person deliberation. However, people with low abilities or willingness to use online media are disadvantaged. Differences in the online deliberation media may reduce or improve the inclusiveness, engagement, and openness of deliberations in ways that affect valuation results. We also provide suggestions for selecting deliberation media and mitigating deliberation bias derived from the choice of deliberation media. Further research should explore how to improve time efficiency and affordability of online deliberation, how to promote inclusiveness, engagement, and openness of online deliberation, and how different deliberation media affect deliberation quality and valuation results.

Guideline panel social dynamics influence the development of clinical practice recommendations: a mixed-methods systematic review.

OBJECTIVES: To synthesize empirical studies that investigate the cognitive and social processes involved in the deliberation process of guideline development meetings and determine the distribution of deliberated topics. STUDY DESIGN AND SETTING: We conducted a mixed-method systematic review using a convergent segregated approach. We searched for empirical studies that investigate the intragroup dynamics of guideline development meetings indexed in bibliographic databases. RESULTS: Of the 5,899 citations screened, 12 studies from six countries proved eligible. Chairs, cochairs, and methodologists contributed to at least one-third of the discussion time in guideline development meetings; patient partners contributed the least. In interdisciplinary groups, male gender and occupation as a physician were positively associated with the amount of contribution. Compared to groups that used the Grading of Recommendations Assessment, Development and Evaluation approach, for groups that did not, when faced with insufficient or low-quality evidence, relied more on their clinical experience. The presence of a cognitive "yes" bias was apparent in meetings: panelists tended to acquiesce with positive statements that required less cognitive effort than negative statements. CONCLUSION: The social dynamics of the discussions were linked to each panelist's activity role, professional background, and gender, all of which influenced the level of contributions they made in guideline development meetings.

Assessing Facilitator Fidelity to Principles of Public Deliberation: Tutorial.

Public deliberation, or deliberative democracy, is a method used to elicit informed perspectives and justifiable solutions to ethically fraught or contentious issues that affect multiple stakeholder groups with conflicting interests. Deliberative events bring together stakeholders (deliberants) who are provided with empirical evidence on the central issue or concern and then asked to discuss the evidence, consider the issue from a societal perspective, and collectively work toward a justifiable resolution. There is increasing interest in this method, which warrants clear guidance for evaluating the quality of its use in research. Most of the existing literature on measuring deliberation quality emphasizes the quality of deliberants' inputs (eg, engagement and evidence of compromise) during deliberative sessions. Fewer researchers have framed quality in terms of facilitator inputs, and these researchers tend to examine inputs that are consistent with generic group processes. The theory, process, and purpose of public deliberation, however, are distinct from those of focus groups or other group-based discussions and warrant a mechanism for measuring quality in terms of facilitator fidelity to the principles and processes of deliberative democracy. In our public deliberation on ethical conflicts in minor consent for biomedical HIV prevention research, we assessed facilitator fidelity to these principles and processes because we believe that such assessments serve as a component of a comprehensive evaluation of overall deliberation quality. We examined verbatim facilitator remarks in the deliberation transcripts and determined whether they aligned with the 6 principles of public deliberation: equal participation, respect for the opinions of others, adoption of a societal perspective, reasoned justification of ideas, expression of diverse opinions, and compromise or movement toward consensus. In this tutorial, we describe the development of a blueprint to guide researchers in assessing facilitator fidelity, share 3 templates that will assist them in the task, and describe the results of our assessment of facilitator fidelity in 1 of the 4 sites in which we conducted deliberations.

Having a real say: findings from first nations community panels on pandemic influenza vaccine distribution.

BACKGROUND: Recent deliberations by Australian public health researchers and practitioners produced an ethical framework of how decisions should be made to distribute pandemic influenza vaccine. The outcome of the deliberations was that the population should be considered in two categories, Level 1 and Level 2, with Level 1 groups being offered access to the pandemic influenza vaccine before other groups. However, the public health researchers and practitioners recognised the importance of making space for public opinion and sought to understand citizens values and preferences, especially First Nations peoples. METHODS: We conducted First Nations Community Panels in two Australian locations in 2019 to assess First Nations people's informed views through a deliberative process on pandemic influenza vaccination distribution strategies. Panels were asked to make decisions on priority levels, coverage and vaccine doses. RESULTS: Two panels were conducted with eighteen First Nations participants from a range of ages who were purposively recruited through local community networks. Panels heard presentations from public health experts, cross-examined expert presenters and deliberated on the issues. Both panels agreed that First Nations peoples be assigned Level 1 priority, be offered pandemic influenza vaccination before other groups, and be offered two doses of vaccine. Reasons for this decision included First Nations people's lives, culture and families are important; are at-risk of severe health outcomes; and experience barriers and challenges to accessing safe, quality and culturally appropriate healthcare. We found that communication strategies, utilising and upskilling the First Nations health workforce, and targeted vaccination strategies are important elements in pandemic preparedness and response with First Nations peoples. CONCLUSIONS: First Nations Community Panels supported prioritising First Nations peoples for pandemic influenza vaccination distribution and offering greater protection by using a two-dose full course to fewer people if there are initial supply limitations, instead of one dose to more people, during the initial phase of the vaccine roll out. The methodology and findings can help inform efforts in planning for future pandemic vaccination strategies for First Nations peoples in Australia.

Deliberative Democracy and Incompatibilities of Choice Norms.

Deliberative democracy aims at reaching collective decisions through mechanisms that involve flexible opinions, variable alternative sets and information gathering in the process of decision making as opposed to exogenously fixed alternative sets and preference rankings. Deliberative democracy includes elements derived from bargaining and negotiation. Among its virtues, some proponents of deliberative democracy have included the possibility that several important negative results of the theory of voting can be avoided. The basic stratagem is to dismiss the universal domain condition typically assumed in social choice results. Thus, the validity of the results escaped from is obviously not in question. The position taken in this paper is that, while in some respects plausible, the escape argument is based on a too narrow view of the incompatibility results of the social choice theory. Some fundamental paradoxes remain beyond the reach of the deliberative techniques and are even exacerbated by them. That said, the deliberative approach can certainly be adopted for making voting alternatives more meaningful to those involved.

Fostering moral resilience through moral case deliberation.

Moral distress forms a major threat to the well-being of healthcare professionals, and is argued to negatively impact patient care. It is associated with emotions such as anger, frustration, guilt, and anxiety. In order to effectively deal with moral distress, the concept of moral resilience is introduced as the positive capacity of an individual to sustain or restore their integrity in response to moral adversity. Interventions are needed that foster moral resilience among healthcare professionals. Ethics consultation has been proposed as such an intervention. In this paper, we add to this proposition by discussing Moral Case Deliberation (MCD) as a specific form of clinical ethics support that promotes moral resilience. We argue that MCD in general may contribute to the moral resilience of healthcare professionals as it promotes moral agency. In addition, we focus on three specific MCD reflection methods: the Dilemma Method, the Aristotelian moral inquiry into emotions, and CURA, a method consisting of four main steps: Concentrate, Unrush, Reflect, and Act. In practice, all three methods are used by nurse ethicists or by nurses who received training to facilitate reflection sessions with these methods. We maintain that these methods also have specific elements that promote moral resilience. However, the Dilemma Method fosters dealing well with tragedy, the latter two promote moral resilience by including attention to emotions as part of the reflection process. We will end with discussing the importance of future empirical research on the impact of MCD on moral resilience, and of comparing MCD with other interventions that seek to mitigate moral distress and promote moral resilience.

Iranian scientists and French showers: collaborative fact-checking of identity-salient online information.

In this study, we investigate what leads people to fact-check online information, how they fact-check such information in practice, how fact-checking affects their judgments about the information's credibility, and how each of the above processes is affected by the salience of the information to readers' cultural identities. Eight pairs of adult participants were recruited from diverse cultural backgrounds to participate online in joint fact-checking of suspect Tweets. To examine their collaborative deliberations we developed a novel experimental design and analytical model. Our analyses indicate that the salience of online information to people's cultural identities influences their decision to fact-check it, that fact-checking deliberations are often non-linear and iterative, that collaborative fact-checking leads people to revise their initial judgments about the credibility of online information, and that when online information is highly salient to people's cultural identities, they apply different standards of credibility when fact-checking it. In conclusion, we propose that cultural identity is an important factor in the fact-checking of online information, and that joint fact-checking of online information by people from diverse cultural backgrounds may have significant potential as an educational tool to reduce people's susceptibility to misinformation.

Leveraging AI for democratic discourse: Chat interventions can improve online political conversations at scale.

Political discourse is the soul of democracy, but misunderstanding and conflict can fester in divisive conversations. The widespread shift to online discourse exacerbates many of these problems and corrodes the capacity of diverse societies to cooperate in solving social problems. Scholars and civil society groups promote interventions that make conversations less divisive or more productive, but scaling these efforts to online discourse is challenging. We conduct a large-scale experiment that demonstrates how online conversations about divisive topics can be improved with AI tools. Specifically, we employ a large language model to make real-time, evidence-based recommendations intended to improve participants' perception of feeling understood. These interventions improve reported conversation quality, promote democratic reciprocity, and improve the tone, without systematically changing the content of the conversation or moving people's policy attitudes.

Comedy as dissonant rhetoric.

This article considers the normative and critical value of popular comedy. I begin by assembling and evaluating a range of political theory literature on comedy. I argue that popular comedy can be conducive to both critical and transformative democratic effects, but that these effects are contingent on the way comedic performances are received by audiences. I illustrate this by means of a case study of a comedic climate change 'debate' from the television show, Last Week Tonight. Drawing from recent scholarship on deliberation, judgment and rhetoric, I highlight both critical and transformative dimensions of the performance. I attribute these to the vignette's likely reception, which I describe as 'dissonant' - unresolved, affectively turbulent and aesthetically attuned. I argue that comedy is uniquely positioned to spur such 'dissonant' modes of engagement and, in so doing, to promote acknowledgement and reflective judgment.

Impact of information and deliberation on the consistency of preferences for prioritization in health care - evidence from discrete choice experiments undertaken alongside citizens' juries.

BACKGROUND: Public preferences are an important consideration for priority-setting. Critics suggest preferences of the public who are potentially naïve to the issue under consideration may lead to sub-optimal decisions. We assessed the impact of information and deliberation via a Citizens' Jury (CJ) or preference elicitation methods (Discrete Choice Experiment, DCE) on preferences for prioritizing access to bariatric surgery. METHODS: Preferences for seven prioritization criteria (e.g. obesity level, obesity-related comorbidities) were elicited from three groups who completed a DCE: (i) participants from two CJs (n = 28); (ii) controls who did not participate in the jury (n = 21); (iii) population sample (n = 1,994). Participants in the jury and control groups completed the DCE pre- and post-jury. DCE data were analyzed using multinomial logit models to derive "priority weights" for criteria for access to surgery. The rank order of criteria was compared across groups, time points and CJ recommendations. RESULTS: The extent to which the criteria were considered important were broadly consistent across groups and were similar to jury recommendations but with variation in the rank order. Preferences of jurors but not controls were more differentiated (that is, criteria were assigned a greater range of priority weights) after than before the jury. Juror preferences pre-jury were similar to that of the public but appeared to change during the course of the jury with greater priority given to a person with comorbidity. Conversely, controls appeared to give a lower priority to those with comorbidity and higher priority to treating very severe obesity after than before the jury. CONCLUSION: Being informed and undertaking deliberation had little impact on the criteria that were considered to be relevant for prioritizing access to bariatric surgery but may have a small impact on the relative importance of criteria. CJs may clarify underlying rationale but may not provide substantially different prioritization recommendations compared to a DCE.

Public preferences are an important consideration for priority-setting. However, some people worry that if the public doesn't know much about the issues, their opinions might not lead to the best decisions. To make these decisions, we used two different methods to get people's opinions: Deliberative methods and preference elicitation methods. Deliberative methods gather a small group of people and have them discuss an issue in detail, whereas preference elicitation methods seek opinions through surveying a large group of people.In this paper, we assessed the impact of information and deliberation via a deliberative method (Citizens' Jury, CJ) or a preference elicitation method (Discrete Choice Experiment, DCE) on preferences for prioritising access to bariatric surgery. We used data from two CJs and a DCE focussed on prioritising access to the surgery, to find out if the opinions of those in the CJs changed or stayed the same after they heard information from experts and discussed the topic.The results showed that the important criteria were rather similar across the groups, but the order of importance was a bit different. The people in CJs had more varied opinions after discussing it, while those who didn't discuss it had less varied opinions. The participants in CJs also prioritized those with other health problems more than they did at the beginning.This study helps us understand how different methods can be used to get the public's opinions on healthcare decisions.

The effect of fast and slow decision-making on equity-efficiency tradeoffs and moral repugnance.

Fast-and-slow models of decision-making are commonly invoked to explain economic behaviour. However, past research has focused on human cooperation and generosity and thus largely overlooked situations where there are sharp conflicts between efficiency and equality, or between efficiency and more intuitive moral values (repugnance). Here, we contribute to fill this gap in the literature. We conducted a preregistered experiment (n = 1500 recruited from Prolific) to assess the effects of fast, intuitive decisions, under time pressure versus slow, deliberate decisions, under time delay, on (i) people's distributional preferences and (ii) their attitudes toward repugnant transactions. The results show increased preference for equality and decreased preference for efficiency under time pressure, but no effects on moral repugnance. Exploratory analyses revealed that most of the observed treatment effects in our data were accounted for by women. Our results provide some support for theories that associate controlled cognition with concern for efficiency, and intuitive, emotional responses with inequality aversion.