On the likelihood of surrogates conforming to the substituted judgment standard when making end-of-life decisions for their partner

A considerable proportion of end-of-life decisions are made by the patient’s next-of-kin, who can be asked to follow the substituted judgment standard and decide based on the patient’s wishes. The question of whether these surrogate decision makers are actually able to do so has become an important issue. In this study, we examined how the likelihood of surrogates conforming to the substituted judgment standard varies with individual differences in mortality acceptance and confidence in their decision making. We recruited 153 participants in romantic relationships between 18 and 80 years old from the general population. We asked them to make hypothetical end-of-life decisions for themselves and on behalf of their partner, as well as predict what their partner would do, and complete a series of questionnaires. Participants predicted that their partner would make similar decisions to their own but were more likely to accept a life-saving treatment that could result in reduced quality of life on their partner’s behalf than for themselves. Decisions made by older adults were more likely to conform to the substituted judgment standard, which is encouraging given that they are more likely to be confronted with these decisions in real life, although this was not due to differences in mortality acceptance. Older adults were also more likely to have had previous discussions with their partner and thereby know that person’s wishes and feel confident that they made the right decision, but these factors did not affect their likelihood of conforming to the substituted judgment standard. This shows that encouraging discussions about end of life among families would ease the decision process, but more work is needed to ensure that surrogates can adhere to the substituted judgment standard

Do our risk preferences change when we make decisions for others? A meta-analysis of self-other differences in decisions involving risk

BACKGROUND: Are we more risk-averse or risk-seeking when we make decisions on behalf of other people as opposed to ourselves? So far, findings have not been able to provide a clear and consistent answer. METHOD: We propose a meta-analysis to assess whether self-other differences vary according to particular features of the decision. We reviewed 78 effect sizes from 49 studies (7,576 participants). RESULTS: There was no overall self-other difference, but there were moderating effects of domain and frame. Decisions in the interpersonal domain were more risk-averse for self than for other. Decisions in the medical domain were more risk-seeking for self than for other. There were no overall self-other differences in the financial domain, however there was a moderating effect of frame: decisions in a gain frame were more risk-averse for self than other whereas decisions in a loss frame were more risk-seeking for self than other. This effect of frame was slightly different overall and in the medical domain, where self-other differences occurred in a loss frame but not in a gain frame. CONCLUSION: Future work should continue to investigate how the specific content and context of the decision impacts self-other differences in order to understand the effects of domain and frame we report

A mixed methods investigation of end-of-life surrogate decisions among older adults

Background: A large number of end-of-life decisions are made by a next-of-kin for a patient who has lost their decision-making capacity. This has given rise to investigations into how surrogates make these decisions. The experimental perspective has focused on examining how the decisions we make for others differ from our own, whereas the qualitative perspective has explored surrogate insights into making these decisions. Methods: We conducted a mixed methods study to bring these two perspectives together. This is crucial to comparing decision outcomes to the decision process. We asked older adult partners to make end-of-life decisions for each other. They then took part in a semi-structured interview about their decision process. Transcripts were analysed using thematic analysis. Results: 24 participants took part in the study. Surrogates were more likely to take a life-saving treatment at the risk of a diminished quality of life for their partner than for themselves. This was consistent with their transcripts which showed that they wanted to give their partner a better chance of living. Although there was evidence of surrogate inaccuracy in the decision task, participants overwhelmingly reported their intention to make a decision which aligns with the substituted judgment standard. However, uncertainty about their wishes pushed them to consider other factors. Conclusions: Taking a mixed methods approach allowed us to make novel comparisons between decision outcome and process. We found that the intentions of surrogates broadly align with the expectations of the substituted judgment standard and that previous discussions with their partner helps them to make a decision

Model synchronization: a formal framework for the management of heterogeneous models

International audienceIn this article, we present the conceptual foundations and implementation principles of model synchronization, a formal framework for the management of heterogeneous models. The proposed approach relies on S2ML (System Structure Modeling Language) as a pivot language. We show, by means of a case study, that model synchronization can be used to ensure the consistency between system architecture models designed with Capella and safety models written in AltaRica 3.0

Risk preferences in surrogate decision making

Decision research has long focused on how we make decisions for ourselves, yet a considerable proportion of the personal and professional decisions we make are on behalf of others, which we term surrogate decisions. This thesis investigates the psychological processes involved in surrogate decision making. It features a first set of studies which compare financial and medical surrogate decisions and a second which address the complex process of making difficult medical decisions for our loved ones. This thesis makes valuable contributions to the field by providing empirical, theoretical, methodological and practical insights into making decisions on behalf of other people

Risk preferences in surrogate decision making

There is growing evidence that decisions made on behalf of other people differ from the decisions we make for ourselves because we are less affected by the subjective experience of their outcome. As a result, the decisions we make for other people can be more optimal. This experiment investigated surrogate decision making using a probability discounting task where participants made choices between risky and sure options. Psychological distance between the decision maker and the recipient was manipulated by having participants make decisions for themselves, their friend, and another unknown participant. Risk preferences were closer to neutrality (i.e., more consistent with expected value) when making decisions on behalf of another participant than when making decisions for themselves or a friend. We conclude that subjective risk preferences are attenuated in surrogate decision making. Findings are discussed in relation to inconsistencies in the literature and theories of surrogate decision making

Exploring How Accountability Affects the Medical Decisions We Make for Other People

In the event that a patient has lost their decision-making capacity due to illness or injury, a surrogate is often appointed to do so on their behalf. Research has shown that people take less risk when making treatment decisions for other people than they do for themselves. This has been discussed as surrogates employing greater caution for others given the accountability they are faced with. We tested the prediction that making accountability salient reduces risk-taking for others relative to the self by manipulating the information shown to participants while they made treatment choices. One group was asked to focus on the consequences for the recipient’s family, another on the legal implications of their decisions, and another was not given additional information. Participants reduced their risk-taking for others compared to themselves, irrespective of the condition they were in. Although participants in each condition reported thinking about these factors to different extents, there were no clear differences in risk-taking between groups. However, we did find that, across all participants, thinking about legal consequences reduces risk-taking. We suggest that future research investigates how the effect of thinking about accountability on surrogate choices is mediated by feelings of accountability, in order to further examine the explanations suggested in the literature

StreaMulT: Streaming Multimodal Transformer for Heterogeneous and Arbitrary Long Sequential Data

The increasing complexity of Industry 4.0 systems brings new challenges regarding predictive maintenance tasks such as fault detection and diagnosis. A corresponding and realistic setting includes multi-source data streams from different modalities, such as sensors measurements time series, machine images, textual maintenance reports, etc. These heterogeneous multimodal streams also differ in their acquisition frequency, may embed temporally unaligned information and can be arbitrarily long, depending on the considered system and task. Whereas multimodal fusion has been largely studied in a static setting, to the best of our knowledge, there exists no previous work considering arbitrarily long multimodal streams alongside with related tasks such as prediction across time. Thus, in this paper, we first formalize this paradigm of heterogeneous multimodal learning in a streaming setting as a new one. To tackle this challenge, we propose StreaMulT, a Streaming Multimodal Transformer relying on cross-modal attention and on a memory bank to process arbitrarily long input sequences at training time and run in a streaming way at inference. StreaMulT improves the state-of-the-art metrics on CMU-MOSEI dataset for Multimodal Sentiment Analysis task, while being able to deal with much longer inputs than other multimodal models. The conducted experiments eventually highlight the importance of the textual embedding layer, questioning recent improvements in Multimodal Sentiment Analysis benchmarks.Comment: 11 pages, 6 figures, 3 table

Jörn Leonhard(dir.),Vergleich und Verflechtung, Deutschland und Frankreich im 20. Jahrhundert

Le présent ouvrage est le résultat d’un colloque organisé par le Frankreich Zentrum de l’Université de Fribourg-en-Brisgau en 2013 à l’occasion du 50e anniversaire du Traité de l’Élysée et publié en 2015, sous la direction de l’historien Jörn Leonhard. Il réunit des contributions de spécialistes reconnus des relations franco-allemandes et de l’histoire de la France et de l’Allemagne venus des deux pays. Une première remarque s’impose sur le titre de l’ouvrage, Vergleich und Verflechtung, qui ..

Être député en France et en Allemagne fédérale au cours de la crise de 1968. Étude comparée des parlementaires de la FGDS et du SPD (1967-1968)

La crise des années 1968 plaça les partis politiques occidentaux devant un défi important, qui vint remettre en cause leur légitimité démocratique et leur capacité à représenter le peuple. Ce mouvement se nourrit d’interactions transnationales, de la reprise de causes similaires et de pratiques de mobilisation semblables. Confrontés à une problématique identique, les partis politiques de la gauche non communiste apportèrent-ils les mêmes réponses ? À l’exemple des groupes parlementaires FGDS en France et SPD en Allemagne fédérale, cet article montrera comment les stratégies adoptées furent marquées par le contexte national et par un rapport différencié à l’institution parlementaire.The 1968 crisis posed a grave issue for Western political parties and challenged their democratic legitimacy, as well as their ability to represent the people. The 1968 movement was built on transnational interactions, shared causes, and similar modes of mobilization. Did non-Communist left-wing parties respond to this crisis in the same way? This article will take the example of the French Federation of the Democratic and Socialist Left (FGDS) and German Social Democratic (SPD) parliamentary groups to show how the strategies of these political parties were influenced by their domestic context and the different ways in which the parliament was perceived in both countries