Which kind of sameness? Disambiguating two senses of identity with a novel linguistic task.

When people report that a person's identity has changed, what do they mean by this? Recent research has often assumed that participants are indicating a change in numerical, rather than qualitative, identity. Investigations into this matter have been hampered by the fact that English has no clear way to demarcate one type of identity from the other. To resolve this matter, we develop and test a novel task in Lithuanian, which has lexical markers for numerical and qualitative identity. We apply this task to intuitions about changes in moral capacities, which has previously shown to lead to high ratings in identity change. We discover that, when people say that a morally altered person is dramatically different, they mean the person is qualitatively transformed, but numerically intact. We conclude that this methodology is a valuable tool not only for illuminating the specific phenomenon of the moral self, but for general use in studying folk ascriptions of identity persistence.

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.

Half a century of bioethics and philosophy of medicine: A topic-modeling study.

Topic modeling-a text-mining technique often used to uncover thematic structures in large collections of texts-has been increasingly frequently used in the context of the analysis of scholarly output. In this study, we construct a corpus of 19,488 texts published since 1971 in seven leading journals in the field of bioethics and philosophy of medicine, and we use a machine learning algorithm to identify almost 100 topics representing distinct themes of interest in the field. On the basis of intertopic correlations, we group the content-based topics into eight clusters, thus providing a novel, fine-grained intellectual map of bioethics and philosophy of medicine. Moreover, we conduct a number of diachronic analyses, examining how the "prominence" of different topics has changed across time. In this way, we are able to observe the distinct patterns in which bioethics and philosophy of medicine have evolved and changed their focus over the past half a century.

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 observer memories (accurate) memories? Insights from experimental philosophy.

A striking feature of our memories of the personal past is that they involve different visual perspectives: one sometimes recalls past events from one's original point of view (a field perspective), but one sometimes recalls them from an external point of view (an observer perspective). In philosophy, observer memories are often seen as being less than fully genuine and as being necessarily false or distorted. This paper looks at whether laypeople share the standard philosophical view by applying the methods of experimental philosophy. We report the results of five studies suggesting that, while participants clearly categorize both field and observer memories as memories, they tend to judge that observer memories are slightly less accurate than field memories. Our results suggest, however, that in lay thought, the difference between field and observer memories is not nearly as clear-cut as philosophers have generally taken it to be.

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.

Ethical issues in biomedical research using electronic health records: a systematic review.

Digitization of a health record changes its accessibility. An electronic health record (EHR) can be accessed by multiple authorized users. Health information from EHRs contributes to learning healthcare systems' development. The objective of this systematic review is to answer a question: What are ethical issues concerning research using EHRs in the literature? We searched Medline Ovid, Embase and Scopus for publications concerning ethical issues of research use of EHRs. We employed the constant comparative method to retrieve common ethical themes. We descriptively summarized empirical studies. The study reveals the breadth, depth, and complexity of ethical problems associated with research use of EHRs. The central ethical question that emerges from the review is how to manage access to EHRs. Managing accessibility consists of interconnected and overlapping issues: streamlining research access to EHRs, minimizing risk, engaging and educating patients, as well as ensuring trustworthy governance of EHR data. Most of the ethical problems concerning EHR-based research arise from rapid cultural change. The framing of concepts of privacy, as well as individual and public dimensions of beneficence, are changing. We are currently living in the middle of this transition period. Human emotions and mental habits, as well as laws, are lagging behind technological developments. In the medical tradition, individual patient's health has always been in the center. Transformation of healthcare care, its digitalization, seems to have some impacts on our perspective of health care ethics, research ethics and public health ethics.

Melody valve to replace the mitral valve in small children: Lessons learned.

OBJECTIVE: Infants requiring mitral valve replacement have few viable options. Recently, stented bovine jugular vein graft (Melody) has been surgically implanted in such cases. Herein, we report our experience, elaborating on evolution of implantation technique, pitfalls, as well as long-term outcome (including late dilatability). METHODS: Seven Melody valves were implanted (2013-2019). The median patient age and weight were 6.7 (1.8-30.5) months and 5.8 (4.6-9.5) kg, respectively. The indications for implantation were mitral stenosis and/or regurgitation postatrioventricular septal defect (AVSD) repair (5), congenital mitral valve dysplasia (1), and Shone's complex (1). Operative technique involved shortening the valve and creating a neo-sewing ring at 2/3 (atrial)-1/3 (ventricular) junction. Implantation was followed by intraoperative balloon dilatation. RESULTS: Five out of seven patients survived the perioperative period (one death due to technical failure and the other due to acute respiratory distress syndrome postcardiopulmonary bypass). Two out of five medium-term survivors got transplanted (1) or died due to acute myeloid leukemia (1). No valves were replaced. The mean echo gradient at discharge was a median 4 (2-6) mmHg. None of the patients showed left ventricular outflow tract or pulmonary venous obstruction. Two Melody valves were dilated late (5 months and 3 years postoperatively), resulting in decreasing mean gradients from 6 to 1 and from 17 to 4 mmHg. At last follow-up, surviving Melody had a mean gradient of 4 (1-9) mmHg. CONCLUSIONS: Mitral valve replacement with a Melody valve is feasible in infants, is reproducible, shows good immediate results, and offers the possibility of later dilatation. This technique offers a better solution compared to the existing alternatives for infants requiring a prosthetic mitral valve.

The weirdness of belief in free will.

It has been argued that belief in free will is socially consequential and psychologically universal. In this paper we look at the folk concept of free will and its critical assessment in the context of recent psychological research. Is there a widespread consensus about the conceptual content of free will? We compared English "free will" with its lexical equivalents in Lithuanian, Hindi, Chinese and Mongolian languages and found that unlike Lithuanian, Chinese, Hindi and Mongolian lexical expressions of "free will" do not refer to the same concept free will. What kind people have been studied so far? A review of papers indicate that, overall, 91% of participants in studies on belief in free will were WEIRD. Thus, given that free will has no cross-culturally universal conceptual content and that most of the reviewed studies were based on WEIRD samples, belief in free will is not a psychological universal.

Two-stage repair of interrupted aortic arch type A: Arch reconstruction and pulmonary artery banding without CPB through a left thoracotomy.

Treatment of interrupted aortic arch (IAA) is inherently challenging. Single-stage complete repair has become the norm in contemporary practice.  While palliation, in general, has fallen out of favor, a 2-stage approach to correcting selected type A IAA appears to be a productive, safe, and effective option, considering the neonatal age at repair. In this video tutorial, we demonstrate our preferred technique for neonatal aortic arch repair and pulmonary artery banding, which constitute the first stage of the 2-stage repair. Key steps of stage 1 repair are demonstrated and the arguments supporting our approach are presented. This approach significantly reduces morbidity and results in a well-palliated ventricular septal defect (VSD).  We also briefly discuss stage 2 of the repair, which is a straightforward VSD closure and pulmonary artery debanding procedure when the child is older and more resilient.

Surgical Melody® valve implantation to replace the mitral valve in children.

In this video tutorial we present our technique for hybrid surgical Melody® valve implantation in the left atrio-ventricular valve (henceforth referred to as mitral valve) position in children. The key steps, including valve preparation, implantation, and balloon dilatation, are depicted. We discuss the short-term outcome, we red-flag potential complications, and we hypothesize medium-term outcomes, including late balloon dilatation.

Dysphagia and an aberrant subclavian artery: more than just a coincidence.

Aberrant subclavian artery (arteria lusoria) is the most common congenital malformation of the aortic arch in the general population. As patients are more often asymptomatic, indications for correcting this abnormality, even in those having dysphagia, are very vague. While presenting a case of a 10-year-old girl who suffered from dysphagia lusoria for 2 years before being cured by a simple surgical translocation, we review the literature and debate various aspects of its management from diagnosis to surgery and cosmesis.

Minds, brains, and hearts: an empirical study on pluralism concerning death determination.

Several authors in bioethics literature have expressed the view that a whole brain conception of death is philosophically indefensible. If they are right, what are the alternatives? Some authors have suggested that we should go back to the old cardiopulmonary criterion of death and abandon the so-called Dead Donor Rule. Others argue for a pluralist solution. For example, Robert Veatch has defended a view that competent persons should be free to decide which criterion of death should be used to determine their death. However, there is very little data on people's preferences about death determination criteria. We conducted online vignette-based survey with Latvian participants (N = 1416). The data suggest that the pluralist solution fits best with the way our study participants think about death determination-widely differing preferences concerning death determination criteria were observed. Namely, most participants choose one of the three criteria discussed in the literature: whole brain, higher brain, and cardiopulmonary. Interestingly, our data also indicate that study participants tend to prefer less restrictive criteria for determination of their own deaths than for determination of deaths of their closest relatives. Finally, the preferences observed in our sample are largely in accord with the Dead Donor Rule for organ procurement for transplantation.

Balancing professional obligations and risks to providers in learning healthcare systems.

Clinicians and administrators have a professional obligation to contribute (OTC) to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution's sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework (EF) for learning healthcare systems (LHSs) does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we analyse the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider's legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: the self-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers' interests and interests of a health system; and the mediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers' interests and the regulatory model for weighing opposite interests in LHSs.

Transparent Defaults and Consent for Participation in a Learning Health Care System: An Empirical Study.

We report a preregistered study that was designed to answer three questions about using transparent defaults to increase participation in a hypothetical learning health care system. Do default options influence consent to participate in learning activities within a learning health care system? Does transparency about default options decrease the effect of the defaults? Do people reconsider their choice of participation once they are informed about the defaults applied? In our study, application of the defaults did not have influence on rates of consent, nor did transparency about defaults have an effect on the rates of consent. Participants were also not likely to change their choice after being informed that defaults were applied to their previous choice. In general, our study raises doubts that defaults (both covert and transparent) can be used as an effective means in significantly increasing participation in learning health care systems.