Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

Intuitions for inferences

In this paper, I explore a question about deductive reasoning: why am I in a position to immediately infer some deductive consequences of what I know, but not others? I show why the question cannot be answered in the most natural ways of answering it, in particular in Descartes’s way of answering it. I then go on to introduce a new approach to answering the question, an approach inspired by Hume’s view of inductive reasoning.     

Cortisol response and psychological distress predict susceptibility to false memories for a trauma film

For eyewitness testimony to be considered reliable, it is important to ensure memory remains accurate following the event. As many testimonies involve traumatic, as opposed to neutral, events, it is important to consider the role of distress in susceptibility to false memories. The aim of this study was to investigate whether cortisol response following a stressor would be associated with susceptibility to false memories. Psychological distress responses were also investigated, specifically, dissociation, intrusions, and avoidance. Participants were allocated to one of three conditions: those who viewed a neutral film (N?=?35), those who viewed a real trauma film (N?=?35), and a trauma “reappraisal” group where participants were told the film was not real (N?=?35). All received misinformation about the film in the form of a narrative. Participants provided saliva samples (to assess cortisol) and completed distress and memory questionnaires. Cortisol response was a significant predictor of the misinformation effect. Dissociation and avoidance were related to confabulations. In conclusion, following a stressor an individual may differ with regard to their psychological response to the event, and also whether they experience a cortisol increase. This may affect whether they are more distressed later on, and also whether they remember the event accurately.     

Contrast effects in judgmental forecasting when assessing the implications of worst and best case scenarios

Two experiments investigated whether individuals' forecasts of the demand for products and a stock market index assuming a best or worst case scenario depend on whether they have seen a single scenario in isolation or whether they have also seen a second scenario presenting an opposing view of the future. Normatively, scenarios should be regarded as belonging to different plausible future worlds so that the judged implications of one scenario should not be affected when other scenarios are available. However, the results provided evidence of contrast effects in that the presentation of a second “opposite” scenario led to more extreme forecasts consistent with the polarity of the original scenario. In addition, people were more confident about their forecasts based on a given scenario when two opposing scenarios were available. We examine the implications of our findings for the elicitation of point forecasts and judgmental prediction intervals and the biases that are often associated with them.     

Obstructive sleep apnea and depression

Is there an association between obstructive sleep apnea (OSA) and depression? OSA is a common breathing-related sleep disorder. There have been reports that depressive symptoms can be associated with this sleep disorder. A number of investigations have addressed this issue. Although some have found no correlation, most studies have concluded that there is an association between OSA and depressive symptoms. Other investigations have shown that depressive symptoms improve with treatment of OSA, and that untreated OSA may contribute to treatment resistance in some cases of mood disorders. Within the framework of current psychiatric diagnostic criteria, the depressive symptoms associated with OSA can be viewed as a combination of a mood disorder secondary to a primary medical condition and an adjustment disorder with depressed mood. The question of whether OSA causes depressive symptoms can perhaps be best answered by viewing OSA and depression as having certain symptoms that are common to both disorders.     

There are higher levels of conspiracy beliefs in more corrupt countries

In four studies, I found evidence that people living in countries with higher levels of corruption have a greater tendency for conspiracy ideation. In Study 1 (21 countries, N = 20,207), participants living in more corrupt countries reported having higher COVID-19 and generic conspiracy beliefs. Study 2 (25 countries, N = 4935), Study 3 (25 countries, N = 24,424), and Study 4 (24 countries, N = 5973) replicated the same finding. Internal meta-analysis suggested that this association remained significant after adjusting for other relevant cross-country differences. Studies 1 and 2, but not 3 and 4, also showed that corruption moderated the association between individuals’ gullibility (i.e., lack of education) and their conspiracy beliefs, and this association was significant only in low-corruption countries. The findings suggest that country-level corruption breeds conspiracy beliefs and moderates the effect of individuals’ gullibility on conspiracy beliefs.     

Do changes in threat salience predict the moral content of sermons? The case of Friday Khutbas in Turkey

We analyzed the content of “Friday Khutbas” delivered in Turkish mosques between January 2001 and December 2018 to test the prediction of moral foundations theory (MFT) literature that threat salience would lead to an increased endorsement of binding moral foundations. As societal-level indicators of threat, we examined (a) historical data on the proportion of terrorism-related news published in a Turkish newspaper, (b) the geopolitical risk score of Turkey as measured by Geopolitical Risk Index, and (c) Google Trends data on the search frequency of words “terror”, “terrorism”, or “terrorist”. To measure the endorsement of moral foundations, we built a Turkish Moral Foundations Dictionary and counted the relative frequency of morality-related words in the khutbas delivered in Istanbul, Turkey. Time series analyses showed that risk salience in a certain month was positively related to endorsement of the loyalty/betrayal foundation in that month’s Friday Khutbas. There were mixed results for the other moral foundations.     

An Argument for Uniqueness About Evidential Support

White, Christensen, and Feldman have recently endorsed uniqueness, the thesis that given the same total evidence, two rational subjects cannot hold different views. Kelly, Schoenfield, and Meacham argue that White and others have at best only supported the weaker, merely intrapersonal view that, given the total evidence, there are no two views which a single rational agent could take. Here, we give a new argument for uniqueness, an argument with deliberate focus on the interpersonal element of the thesis. Our argument is that the best explanation of the value of promoting rationality is an explanation that entails uniqueness.     

Off the mark: Repetitive marking undermines essay evaluations due to boredom

Motivation and Emotion - Essay-style assessment is widespread in education. Nonetheless, research shows that this tool can suffer from low reliability and validity. We attribute this problem partly...     

A problem for rationalist responses to skepticism

Rationalism, my target, says that in order to have perceptual knowledge, such as that your hand is making a fist, you must “antecedently” (or “independently”) know that skeptical scenarios don’t obtain, such as the skeptical scenario that you are in the Matrix. I motivate the specific form of Rationalism shared by, among others, White (Philos Stud 131:525–557, 2006) and Wright (Proc Aristot Soc Suppl Vol 78:167–212, 2004), which credits us with warrant to believe (or “accept”, in Wright’s terms) that our senses are reliably veridical, where that warrant is one we enjoy by default, that is, without relying on any evidence or engaging in any positive argument. The problem with this form of Rationalism is that, even if you have default knowledge that your senses are reliable, this is not adequate to rule out every kind of skeptical scenario. The problem is created by one-off skeptical scenarios, scenarios that involve a highly reliable perceiver who, by a pure fluke, has a one-off, non-veridical experience. I claim you cannot infer that your present perceptual experience is veridical just on the basis of knowledge of your general reliability. More generally, if you infer that the present F is G, just on the basis of your knowledge that most Fs are Gs, this is what I call statistical inference, and, as I argue, statistical inference by itself does not generate knowledge. I defend this view of statistical inference against objections, including the objection that radical skepticism about our ordinary inductive knowledge will follow unless statistical inference generates knowledge.