A Personalized Patient Preference Predictor for Substituted Judgments in Healthcare: Technically Feasible and Ethically Desirable.

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient's (former) autonomy since it draws on the 'wrong' kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently 'fine-tuned' on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient's preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient's own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies.

Does it matter who harmed whom? A cross-cultural study of moral judgments about harm by and to insiders and outsiders.

This cross-cultural study compared judgments of moral wrongness for physical and emotional harm with varying combinations of in-group vs. out-group agents and victims across six countries: the United States of America (N = 937), the United Kingdom (N = 995), Romania (N = 782), Brazil (N = 856), South Korea (N = 1776), and China (N = 1008). Consistent with our hypothesis we found evidence of an insider agent effect, where moral violations committed by outsider agents are generally considered more morally wrong than the same violations done by insider agents. We also found support for an insider victim effect where moral violations that were committed against an insider victim generally were seen as more morally wrong than when the same violations were committed against an outsider, and this effect held across all countries. These findings provide evidence that the insider versus outsider status of agents and victims does affect moral judgments. However, the interactions of these identities with collectivism, psychological closeness, and type of harm (emotional or physical) are more complex than what is suggested by previous literature. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-023-04986-3.

Good scientific practice in EEG and MEG research: Progress and perspectives.

Good scientific practice (GSP) refers to both explicit and implicit rules, recommendations, and guidelines that help scientists to produce work that is of the highest quality at any given time, and to efficiently share that work with the community for further scrutiny or utilization. For experimental research using magneto- and electroencephalography (MEEG), GSP includes specific standards and guidelines for technical competence, which are periodically updated and adapted to new findings. However, GSP also needs to be regularly revisited in a broader light. At the LiveMEEG 2020 conference, a reflection on GSP was fostered that included explicitly documented guidelines and technical advances, but also emphasized intangible GSP: a general awareness of personal, organizational, and societal realities and how they can influence MEEG research. This article provides an extensive report on most of the LiveMEEG contributions and new literature, with the additional aim to synthesize ongoing cultural changes in GSP. It first covers GSP with respect to cognitive biases and logical fallacies, pre-registration as a tool to avoid those and other early pitfalls, and a number of resources to enable collaborative and reproducible research as a general approach to minimize misconceptions. Second, it covers GSP with respect to data acquisition, analysis, reporting, and sharing, including new tools and frameworks to support collaborative work. Finally, GSP is considered in light of ethical implications of MEEG research and the resulting responsibility that scientists have to engage with societal challenges. Considering among other things the benefits of peer review and open access at all stages, the need to coordinate larger international projects, the complexity of MEEG subject matter, and today's prioritization of fairness, privacy, and the environment, we find that current GSP tends to favor collective and cooperative work, for both scientific and for societal reasons.

Neural and Cognitive Signatures of Guilt Predict Hypocritical Blame.

A common form of moral hypocrisy occurs when people blame others for moral violations that they themselves commit. It is assumed that hypocritical blamers act in this manner to falsely signal that they hold moral standards that they do not really accept. We tested this assumption by investigating the neurocognitive processes of hypocritical blamers during moral decision-making. Participants (62 adult UK residents; 27 males) underwent functional MRI scanning while deciding whether to profit by inflicting pain on others and then judged the blameworthiness of others' identical decisions. Observers (188 adult U.S. residents; 125 males) judged participants who blamed others for making the same harmful choice to be hypocritical, immoral, and untrustworthy. However, analyzing hypocritical blamers' behaviors and neural responses shows that hypocritical blame was positively correlated with conflicted feelings, neural responses to moral standards, and guilt-related neural responses. These findings demonstrate that hypocritical blamers may hold the moral standards that they apply to others.

Freedom from what? Separating lay concepts of freedom.

Debates about freedom of will and action and their connections with moral responsibility have raged for centuries, but the opposing sides might disagree because they use different concepts of freedom. Based on previous work, we hypothesized that people who assert freedom in a determined (D) or counterfactual-intervener (CI) scenario assert this because they are thinking about freedom from constraint and not about freedom from determination (in D) or from inevitability (in CI). We also hypothesized that people who deny that freedom in D or in CI deny this because they are thinking about freedom from determination or from inevitability, respectively, and not about freedom from constraint. To test our hypotheses, we conducted two main online studies. Study I supported our hypotheses that people who deny freedom in D and CI are thinking about freedom from determinism and from inevitability, respectively, but these participants seemed to think about freedom from constraint when they were later considering modified scenarios where acts were not determined or inevitable. Study II investigated a contrary bypassing hypothesis that those who deny freedom in D denied this because they took determinism to exclude mental causation and hence to exclude freedom from constraint. We found that participants who took determinism to exclude freedom generally did not deny causation by mental states, here represented by desires and decisions. Their responses regarding causation by desires and decisions at most weakly mediated the relation between determinism and freedom or responsibility among this subgroup of our participants. These results speak against the bypassing hypothesis and in favor of our hypothesis that these participants were not thinking about freedom from constraint.

Which features of patients are morally relevant in ventilator triage? A survey of the UK public.

BACKGROUND: In the early stages of the COVID-19 pandemic, many health systems, including those in the UK, developed triage guidelines to manage severe shortages of ventilators. At present, there is an insufficient understanding of how the public views these guidelines, and little evidence on which features of a patient the public believe should and should not be considered in ventilator triage. METHODS: Two surveys were conducted with representative UK samples. In the first survey, 525 participants were asked in an open-ended format to provide features they thought should and should not be considered in allocating ventilators for COVID-19 patients when not enough ventilators are available. In the second survey, 505 participants were presented with 30 features identified from the first study, and were asked if these features should count in favour of a patient with the feature getting a ventilator, count against the patient, or neither. Statistical tests were conducted to determine if a feature was generally considered by participants as morally relevant and whether its mean was non-neutral. RESULTS: In Survey 1, the features of a patient most frequently cited as being morally relevant to determining who would receive access to ventilators were age, general health, prospect of recovery, having dependents, and the severity of COVID symptoms. The features most frequently cited as being morally irrelevant to determining who would receive access to ventilators are race, gender, economic status, religion, social status, age, sexual orientation, and career. In Survey 2, the top three features that participants thought should count in favour of receiving a ventilator were pregnancy, having a chance of dying soon, and having waited for a long time. The top three features that participants thought should count against a patient receiving a ventilator were having committed violent crimes in the past, having unnecessarily engaged in activities with a high risk of COVID-19 infection, and a low chance of survival. CONCLUSIONS: The public generally agreed with existing UK guidelines that allocate ventilators according to medical benefits and that aim to avoid discrimination based on demographic features such as race and gender. However, many participants expressed potentially non-utilitarian concerns, such as inclining to deprioritise ventilator allocation to those who had a criminal history or who contracted the virus by needlessly engaging in high-risk activities.

Some common fallacies in arguments from M/EEG data.

Like all humans, M/EEG researchers commit certain fallacies or mistakes in reasoning. This article surveys seven well-known but still common fallacies, including reverse inference, hasty generalization, hasty exclusion, inferring from group to individual, inferring from correlation to causation, affirming a disjunct, and false dichotomy. These fallacies are illustrated with classic EEG research by Libet and collaborators, but many researchers (not just Libet) continue to commit them in all areas of research (not just M/EEG). This article gives practical suggestions about how to spot and avoid each fallacy.

How does inequality affect our sense of moral obligation?

Tomasello's novel and insightful theory of obligation explains why we sometimes sense an obligation to treat each other equally, but he has not yet explained why human morality also allows and enables much inequality in wealth and power. Ullman-Margalit's (1977) account of norms of partiality suggested a different source and kind of norms that might help to fill out Tomasello's picture.

The central role of disgust in disorders of food avoidance.

BACKGROUND: Individuals with extreme food avoidance such as Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing physical and mental health consequences from nutrition of insufficient variety or/and quantity. Identifying mechanisms contributing to food avoidance is essential to develop effective interventions. Anxiety figures prominently in theoretical models of food avoidance; however, there is limited evidence that repeated exposures to foods increases approach behavior in ARFID. Studying disgust, and relationships between disgust and anxiety, may offer novel insights, as disgust is functionally associated with avoidance of contamination from pathogens (as may occur via ingestion) and is largely resistant to extinction. METHOD: This exploratory, cross-sectional study included data from 1,644 adults who completed an online questionnaire. Participant responses were used to measure ARFID classification, picky eating, sensory sensitivity, disgust, and anxiety. Structural equation modeling tested a measurement model of latent disgust and anxiety factors as measured by self-reported frequency of disgust and anxiety reactions. Mediational models were used to explore causal ordering. RESULTS: A latent disgust factor was more strongly related to severity of picky eating (B ≈ 0.4) and ARFID classification (B ≈ 0.6) than the latent anxiety factor (B ≈ 0.1). Disgust partially mediated the association between anxiety and picky eating and fully mediated the association between anxiety and ARFID. Models testing the reverse causal ordering demonstrated poorer fit. Findings suggest anxiety may be associated with food avoidance in part due to increased disgust. CONCLUSIONS: Disgust may play a prominent role in food avoidance. Findings may inform novel approaches to treatment.

The need for feasible compromises on conscientious objection: response to Card.

Robert Card criticises our proposal for managing some conscientious objections in medicine. Unfortunately, he severely mischaracterises the nature of our proposal, its scope and its implications. He also overlooks the fact that our proposal is a compromise designed for a particular political context. We correct Card's mischaracterisations, explain why we believe compromise is necessary and explain how we think proposed compromises should be evaluated.

Do framing effects debunk moral beliefs?

May argues that framing effects do not undermine moral beliefs, because they affect only a minority of moral judgments in small ways. We criticize his estimates of the extent of framing effects on moral judgments, and then we argue that framing effects would cause trouble for moral judgments even if his estimates were correct.

How to Allow Conscientious Objection in Medicine While Protecting Patient Rights.

Paradigmatic cases of conscientious objection in medicine are those in which a physician refuses to provide a medical service or good because doing so would conflict with that physician's personal moral or religious beliefs. Should such refusals be allowed in medicine? We argue that (1) many conscientious objections to providing certain services must be allowed because they fall within the range of freedom that physicians have to determine which services to offer in their practices; (2) at least some conscientious objections to serving particular groups of patients should be allowed because they are not invidiously discriminatory; and (3) even in cases of invidiously discriminatory conscientious objections, legally prohibiting individual physicians from refusing to serve patients on the basis of such objections is not always the best solution.

Distinct neuronal patterns of positive and negative moral processing in psychopathy.

Psychopathy is a disorder characterized by severe and frequent moral violations in multiple domains of life. Numerous studies have shown psychopathy-related limbic brain abnormalities during moral processing; however, these studies only examined negatively valenced moral stimuli. Here, we aimed to replicate prior psychopathy research on negative moral judgments and to extend this work by examining psychopathy-related abnormalities in the processing of controversial moral stimuli and positive moral processing. Incarcerated adult males (N = 245) completed a functional magnetic resonance imaging protocol on a mobile imaging system stationed at the prison. Psychopathy was assessed using the Hare Psychopathy Checklist-Revised (PCL-R). Participants were then shown words describing three types of moral stimuli: wrong (e.g., stealing), not wrong (e.g., charity), and controversial (e.g., euthanasia). Participants rated each stimulus as either wrong or not wrong. PCL-R total scores were correlated with not wrong behavioral responses to wrong moral stimuli, and were inversely related to hemodynamic activity in the anterior cingulate cortex in the contrast of wrong > not wrong. In the controversial > noncontroversial comparison, psychopathy was inversely associated with activity in the temporal parietal junction and dorsolateral prefrontal cortex. These results indicate that psychopathy-related abnormalities are observed during the processing of complex, negative, and positive moral stimuli.

Readiness potentials driven by non-motoric processes.

An increase in brain activity known as the "readiness potential" (RP) can be seen over central scalp locations in the seconds leading up to a volitionally timed movement. This activity precedes awareness of the ensuing movement by as much as two seconds and has been hypothesized to reflect preconscious planning and/or preparation of the movement. Using a novel experimental design, we teased apart the relative contribution of motor-related and non-motor-related processes to the RP. The results of our experiment reveal that robust RPs occured in the absence of movement and that motor-related processes did not significantly modulate the RP. This suggests that the RP measured here is unlikely to reflect preconscious motor planning or preparation of an ensuing movement, and instead may reflect decision-related or anticipatory processes that are non-motoric in nature.

Neuroprediction of future rearrest.

Identification of factors that predict recurrent antisocial behavior is integral to the social sciences, criminal justice procedures, and the effective treatment of high-risk individuals. Here we show that error-related brain activity elicited during performance of an inhibitory task prospectively predicted subsequent rearrest among adult offenders within 4 y of release (N = 96). The odds that an offender with relatively low anterior cingulate activity would be rearrested were approximately double that of an offender with high activity in this region, holding constant other observed risk factors. These results suggest a potential neurocognitive biomarker for persistent antisocial behavior.

Hypnotizing Libet: Readiness potentials with non-conscious volition.

The readiness potential (RP) is one of the most controversial topics in neuroscience and philosophy due to its perceived relevance to the role of conscious willing in action. Libet and colleagues reported that RP onset precedes both volitional movement and conscious awareness of willing that movement, suggesting that the experience of conscious will may not cause volitional movement (Libet, Gleason, Wright, & Pearl, 1983). Rather, they suggested that the RP indexes unconscious processes that may actually cause both volitional movement and the accompanying conscious feeling of will (Libet et al., 1983; pg. 640). Here, we demonstrate that volitional movement can occur without an accompanying feeling of will. We additionally show that the neural processes indexed by RPs are insufficient to cause the experience of conscious willing. Specifically, RPs still occur when subjects make self-timed, endogenously-initiated movements due to a post-hypnotic suggestion, without a conscious feeling of having willed those movements.

Moral foundations vignettes: a standardized stimulus database of scenarios based on moral foundations theory.

Research on the emotional, cognitive, and social determinants of moral judgment has surged in recent years. The development of moral foundations theory (MFT) has played an important role, demonstrating the breadth of morality. Moral psychology has responded by investigating how different domains of moral judgment are shaped by a variety of psychological factors. Yet, the discipline lacks a validated set of moral violations that span the moral domain, creating a barrier to investigating influences on judgment and how their neural bases might vary across the moral domain. In this paper, we aim to fill this gap by developing and validating a large set of moral foundations vignettes (MFVs). Each vignette depicts a behavior violating a particular moral foundation and not others. The vignettes are controlled on many dimensions including syntactic structure and complexity making them suitable for neuroimaging research. We demonstrate the validity of our vignettes by examining respondents' classifications of moral violations, conducting exploratory and confirmatory factor analysis, and demonstrating the correspondence between the extracted factors and existing measures of the moral foundations. We expect that the MFVs will be beneficial for a wide variety of behavioral and neuroimaging investigations of moral cognition.

Barking up the wrong free: readiness potentials reflect processes independent of conscious will.

In the early 1980s, Libet found that a readiness potential (RP) over central scalp locations begins on average several hundred milliseconds before the reported time of awareness of willing to move (W). Haggard and Eimer Exp Brain Res 126(1):128-133, (1999) later found no correlation between the timing of the RP and W, suggesting that the RP does not reflect processes causal of W. However, they did find a positive correlation between the onset of the lateralized readiness potential (LRP) and W, suggesting that the LRP might reflect processes causal of W. Here, we report a failure to replicate Haggard and Eimer's LRP finding with a larger group of participants and several variations of their analytical method. Although we did find a between-subject correlation in just one of 12 related analyses of the LRP, we crucially found no within-subject covariation between LRP onset and W. These results suggest that the RP and LRP reflect processes independent of will and consciousness. This conclusion has significant implications for our understanding of the neural basis of motor action and potentially for arguments about free will and the causal role of consciousness.

What makes killing wrong?

What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.