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While death is surely inevitable, the timing and circumstances of our deaths may vary widely and are likely to be negotiable in response to the changing needs of patients and families for physical, emotional and spiritual support as their diseases and illnesses evolve. Patients and families need to become aware of specific care options and supports that are available for them so they can be accessed in order to achieve their own “good death”. The professional health care team is obliged to assist patients and families become knowledgeable about potentially appropriate resources to assist them to become more comfortable with their roles thus more effectively supporting the patient as well as each other. Through literature review and interviews with diverse stakeholders, I will explore what a good death means from the divergent perspectives of patients, families and the clinicians who provide care for hospitalized dying patients. / Urban Bioethics

No / This paper examines the extent of mental ill-health and probable depression among older people in long-term care. It presents selected findings from a study in Greater Belfast, Northern Ireland, that compared the quality of life, autonomy and mental health of older people living in nursing and residential homes with those of older people living in private households who were receiving domiciliary care. Structured interviews were conducted with 214 residents in institutions and 44 older people receiving domiciliary care. The study found that those in private households were more severely physically-impaired and had a higher level of mental ill-health than the residents of institutional homes. It is suggested, however, that the mental ill-health effects were associated less with physical impairments than with the restrictions placed on the older person's decisional autonomy, and that long-term care environments that constrain the older person's autonomy contribute to the development of depression. Although the UK National Service Framework for Older People specified that those with depression should be given treatment and support, priority should also be given to preventing the depression associated with living in long-term care settings.

The American Institute of Certified Public Accountants (AICPA) is presently considering a proposal to revise the enforcement system of the Code of Professional Ethics from the current complaint-based mechanism to a system based on reviews of practitioners and their work. Inherent within the proposal is the conclusion that the existing enforcement provisions, based on complaints about violations, are not adequate. Complaints about ethics violations can originate from practically anyone although two of the primary initiators of violation complaints are Certified Public Accountants (CPAs) and their clients. CPAs, however, may have limited opportunities to observe violations committed by colleagues. Clients, on the other hand, may be in a prime position to detect departures from the ethics code but may have no incentive to report violations committed by their CPAs; e.g., a violation may benefit the client. A survey of these two groups (CPAs and clients) indicated that while both groups are familiar with the code and believe that the rules of conduct are appropriate, clients do not tend to report violations and CPAs, on average, indicated that they would report observed violations slightly more than one-half the time. These findings suggest that an enforcement system based solely on the complaints of CPAs and clients cannot be effective. / Ph. D.

Effective collaboration between humans and autonomous agents can improve productivity and reduce risks of human operators in safety-critical situations, with autonomous agents working as complementary teammates and lowering physical and mental demands by providing assistance and recommendations in complicated scenarios. Ineffective collaboration would have drawbacks, such as risks of being out-of-the-loop when switching over controls, increased time and workload due to the additional needs for communication and situation assessment, unexpected outcomes due to overreliance, and disuse of autonomy due to uncertainty and low expectations. Disclosing the information about the agents for communication and collaboration is one approach to calibrate trust for appropriate reliance and overcome the drawbacks in human-autonomy teaming. When disclosing agent information, the level of detail (LOD) needs careful consideration because not only the availability of information but also the demand for information processing would change, resulting in unintended consequences on comprehension, workload, and task performance. This dissertation investigates how visualization design at different LODs about autonomy influences transparency, trust, and, ultimately, the effectiveness of human autonomy teaming (HAT) in search and rescue missions. LOD indicates the amount of information aggregated or organized in communication for the human to perceive, comprehend, and respond, and could be manipulated by changing the granularity of information in a user interface. High LOD delivers less information so that users can identify overview and key information of autonomy, while low LOD delivers information in a more detailed manner. The objectives of this research were (1) to build a simulation platform for a representative HAT task affected by visualizations at different LODs about autonomy, (2) to establish the empirical relationship between LOD and transparency, given potential information overload with indiscriminate exposure, and (3) examine how to adapt LOD in visualization with respect to trust as users interact with autonomy over time. A web-based application was developed for wilderness SAR, which can support different visualizations of the lost-person model, UAV path-planner, and task assignment. Two empirical studies were conducted recruiting human participants to collaborate with autonomous agents, making decisions on search area assignment, unmanned aerial vehicle path planning, and object detection. The empirical data included objective measures of task performance and compliance, subjective ratings of transparency, trust, and workload, and qualitative interview data about the designs with students and search and rescue professionals. The first study revealed that lowering LODs (i.e., more details) does not lead to a proportional increase in transparency (ratings), trust, workload, accuracy, and speed. Transparency increased with decreased LODs up to a point before the subsequent decline, providing empirical evidence for the transparency paradox phenomenon. Further, lowering LOD about autonomy can promote trust with diminishing returns and plateau even with lowering LOD further. This suggests that simply presenting some information about autonomy can build trust quickly, as the users may perceive any reasonable forms of disclosure as signs of benevolence or good etiquette that promote trust. Transparency appears more sensitive to LOD than trust, likely because trust is conceptually less connected to the understanding of autonomy than transparency. In addition, the impacts of LODs were not uniform across the human performance measurements. The visualization with the lowest LOD yielded the highest decision accuracy but the worst in decision speed and intermediate levels of workload, transparency, and trust. LODs could induce the speed-accuracy trade-off. That is, as LOD decreases, more cognitive resources are needed to process the increased amount of information; thus, processing speed decreases accordingly. The second study revealed patterns of overall and instantaneous trust with respect to visualization at different LODs. For static visualization, the lowest LOD resulted in higher transparency ratings than the middle and high LOD. The lowest LOD generated the highest overall trust amongst the static and adaptive LODs. For visualizations of all LODs, instantaneous trust increased and then stabilized after a series of interactions. However, the rate of change and plateau for trust varied with LODs and modes between static and adaptive. The lowest, middle, and adaptive LODs followed a sigmoid curve, while the high LOD followed a linear one. Among the static LODs, the lowest LOD exhibits the highest growth rate and plateau in trust. The middle LOD developed trust the slowest and reached the lowest plateau. The high LOD showed a linear growth rate until a level similar to that of the lowest LOD. Adaptive LOD earned the trust of the participants at a very similar speed and plateau as the lowest LOD. Taking these results together, more details about autonomy are effective for expediting the process of building trust, as long as the amount of information is carefully managed to prevent overloading participants' information processing. Further, varying quantities of information in adaptive mode could yield very similar growth and plateau in trust, helping humans to deal with either the minimum or maximum amount of information. This adaptive approach could prevent situations where comprehension is hindered due to insufficient information or where users are potentially overloaded by details. Adapting LODs to instantaneous trust presents a promising technique for managing information exchange that can promote the efficiency of communication for building trust. The contribution of this research to literature is two-fold. The first study provides the first empirical evidence indicating that the impact of LODs on transparency and trust is not linear, which has not been explicitly demonstrated in prior studies about HAT. The impact of LOD on transparency is more sensitive than trust, calling for a more defined and consistent use of the term or concept - "transparency" and a deeper investigation into the relationships between trust and transparency. The second study presents the first examination of how static and dynamic LODs can influence the development of trust toward autonomy. The algorithm for adapting LOD for the adaptive visualization based on user trust is novel, and adaptive LODs in visualization could switch between detailed and abstract information to influence trust without always transmitting all the details about autonomy. Visualizations with different LODs in both static and adaptive modes present their own set of benefits and drawbacks, resulting in trade-offs concerning the speed of promoting trust and information quantity transmitted during communication. These findings indicate that LOD is an important factor for designing and analyzing visualization for transparency and trust in HAT. / Doctor of Philosophy / The collaboration between human and autonomous agents in search and rescue (SAR) missions aims to improve the success rate and speed of finding the lost person. In these missions, a human supervisor may coordinate with autonomous agents responsible for estimating lost person behavior, path planning, and unmanned aerial vehicles. The human SAR professional may rely on information from the autonomous agents to reinforce the search plan and make crucial decisions. Balancing the amount of information provided by the autonomous agents to the SAR professionals is critical, as insufficient information can hinder trust, leading to manual intervention, and excessive information can cause information overload, reducing efficiency. Both cases can result in human distrust of autonomy. Effective visualization of information can help study and improve the transmission of information between humans and autonomous agents. This approach can reduce unnecessary information in communication, thus conserving communication resources without sacrificing trust. This dissertation investigates how visualization design at the proper aggregation of details about autonomy, also referred to as level of detail (LOD), influences perceived understanding of the autonomous agents (i.e., transparency), trust, and ultimately, the effectiveness of human autonomy teaming (HAT) for wilderness SAR. A simulation platform was built for proof-of-concept, and two studies were conducted recruiting human participants to use the platform for completing simulated SAR tasks supported by visualizations at different LODs about autonomy. Study 1 results showed that transparency ratings increased with more details about autonomy up to a point and then declined with the most details (i.e., lowest LOD). Trust, workload, and performance also did not linearly improve with more details about autonomy. The non-linear relationships of LODs with transparency, trust, workload, and performance, confirmed the phenomenon of the transparency paradox, which refers to the disclosure of excessive information about autonomy may hinder transparency and subsequent performance. Study 2 results also illustrated that when visualization with LOD adapted to instant trust, the speed of building trust and the plateau of trust on autonomy can achieve the same level as the visualization provided with the most details, which performed the best in building trust. This adaptive approach minimized the amount of information displayed relative to the visualization, constantly presenting the most information, potentially easing the burden of communication. Taken together, this research highlights that the amount of information about autonomy to display must be considered carefully for both research and practice. Further, this dissertation advances the visualization design by illustrating that visualization adapting LODs based on trust is effective at building trust in a manner that minimizes the amount of information presented to the user.

Metaphysical grounding has received a great deal of attention in the metaphysics literature within the last decade, offering what many see as an attractive theoretical alternative to other attempts to analyze the nature of fundamentality, e.g., dependence, supervenience, identity, conceptual analysis, etc. Still, a number of commentators note a bevy of issues facing the notion of grounding, leading some to believe it cannot perform the relevant work it has been tasked to do. One such issue is the purity dilemma, posed by Ted Sider, which follows from a plausible constraint placed on our theorizing about fundamentality, viz., that the fundamental bedrock of the world contains nothing but purely fundamental phenomena. It is argued that purity creates a problem for metaphysical grounding in that it makes it increasingly difficult to see what might ground the facts about what grounds what. In this paper, I explicate the purity dilemma, and an attempt made by Shamik Dasgupta to sidestep the challenge, and provide a secure grounding foundation for such facts. I then proceed to defend Dasgupta's view from objections made by Sider, and conclude that, at the very least, the crucial notion (autonomy) on which the former's view rests is intelligible, if it is not tenable. / Master of Arts / In this paper I discuss an ongoing debate over the nature of metaphysical grounding. Metaphysical grounding (or, “grounding”) is of interest to metaphysicians due to the satisfying way in which it handles a number of long-standing problems in the field. As Johnathan Schaffer (2009) notes, metaphysics has often concerned itself with what the most basic nature of reality is like, and grounding promises to furnish many of our metaphysical theories with the tools to answer such questions. Still, there remains a number of problems with characterizing grounding. The relevant problem I tackle in this paper has to do with whether or not grounding can be understood in its own terms. Ted Sider, for example, has suspicions that it cannot. I argue, on the behalf of Shamik Dasgupta, that there is an intelligible way to understand grounding in its own terms, and work to provide constructive answers to some of Sider’s objections.

No / The community care reforms enabled some older people with severe disabilities to remain at home with domiciliary care services, as an alternative to institutional admission. This paper explores the extent to which the reforms actually enabled older people receiving domiciliary care to have greater choice and control in their daily lives than older people living in institutions. Findings are reported from a comparative study carried out in Greater Belfast, Northern Ireland, that determined the extent to which the subjective quality of life of older people--particularly autonomy--varied according to the type of setting. The older people were interviewed using a structured interview schedule and subjective autonomy was assessed using a measure of perceived choice. The measure consisted of 33 activities relating to aspects of everyday life such as what time to get up, when to see visitors or friends, and how much privacy was available. Qualitative data were also recorded which informed on the older people's perspectives on their own lives, particularly the extent to which they exercised choice on a daily basis. Two-hundred and fourteen residents in 45 residential and nursing homes were interviewed, as were 44 older people receiving domiciliary care in private households. The study found that older people living in institutions perceived themselves to have greater decisional autonomy in their everyday lives than did older people receiving domiciliary care. Indeed, it was clear that living at home did not ensure that one's decisional autonomy would be supported. However, living alone may facilitate exercising a relatively higher degree of autonomy when living at home. Whilst the community care reforms have provided some older people who have severe disabilities with the option of receiving care at home, this has not necessarily enabled them to have greater choice and control in their everyday lives than older people admitted to institutions.

Finding a fire inside of a structure without knowing its conditions poses a dangerous threat to the safety of firefighters. As a result, robots are being explored to increase awareness of the conditions inside structures before having firefighter enter. This thesis presents a method that autonomously guides a robot to the location of a fire inside a structure. The method uses classification of fire, smoke, and other fire environment objects to calculate a weighted probability. Weighted probability is a measurement that indicates the probability that a given region on an infra-red image will lead to fire. This method was tested on large-scale fire videos with a robot moving towards a fire and it is also compared to following the highest temperatures on the image. Sending a robot to find a fire has the potential to save the lives of firefighters. / Master of Science / Finding a fire inside of a structure without knowing its conditions poses a dangerous threat to the safety of firefighters. As a result, robots are being explored to increase awareness of the conditions inside structures before having firefighter enter. This thesis presents a method that autonomously guides a robot to the location of a fire inside a structure. The method uses classification of fire, smoke, and other fire environment objects to calculate a weighted probability. Weighted probability is a measurement that indicates the probability that a given region on an infra-red image will lead to fire. This method was tested on large-scale fire videos with a robot moving towards a fire and it is also compared to following the highest temperatures on the image. Sending a robot to find a fire has the potential to save the lives of firefighters.