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Freedom of choice enhances our sense of agency. During goal-directed behavior, the freedom to choose between different response options increases the neural processing of positive and negative feedback, indicating enhanced outcome monitoring under conditions of high agency experience. However, it is unclear whether this enhancement is predominantly driven by an increased salience of self- compared to externally determined action outcomes or whether differences in the perceived instrumental value of outcomes contribute to outcome monitoring in goal-directed tasks. To test this, we recorded electroencephalography while participants performed a reinforcement learning task involving free choices, action-relevant forced choices, and action-irrelevant forced choices. We observed larger midfrontal theta power and N100 amplitudes for feedback following free choices compared with action-relevant and action-irrelevant forced choices. In addition, a Reward Positivity was only present for free but not forced choice outcomes. Crucially, our results indicate that enhanced outcome processing is not driven by the relevance of outcomes for future actions but rather stems from the association of outcomes with recent self-determined choice. Our findings highlight the pivotal role of self-determination in tracking the consequences of our actions and contribute to an understanding of the cognitive processes underlying the choice-induced facilitation in outcome monitoring.

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The ability to make one's own choices is vital to the experience of intentional behavior. Such agency experiences are reflected in the perceptual compression of time between actions and resulting outcomes. Whereas some studies show that choice limitations weaken temporal binding, other studies do not find such an effect. Reviewing the literature, we noted two potential factors that may moderate choice limitation effects on temporal binding: (a) the extent to which individuals represent their actions in terms of the consequences they produce; and (b) the response mode of the time interval estimation measurement where participants report numbers or use a slider to indicate time intervals. Testing these conceptual and methodological factors in two separate experiments yielded clear effects of choice limitation on temporal binding but no clear moderator role of the two factors. Interestingly, overall analyses showed that the choice limitation effect gradually vanishes over time.

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In his article in Science, Nicolas Gisin claimed that quantum correlations emerge from outside space-time. We explainthat they are due to space-time symmetries. This paper is a critical review of metaphysical conclusions found in many recent articles. It advocates the importance of contextuality, Einstein -causality and global symmetries. Bell tests allow only rejecting probabilistic coupling provided by a local hidden variable model, but they do not justify metaphysical speculations about quantum nonlocality and objects which know about each other's state, even when separated by large distances. The violation of Bell inequalities in physics and in cognitive science can be explained using the notion of Bohr- contextuality. If contextual variables, describing varying experimental contexts, are correctly incorporated into a probabilistic model, then the Bell-CHSH inequalities cannot be proven and nonlocal correlations may be explained in an intuitive way. We also elucidate the meaning of statistical independence assumption incorrectly called free choice, measurement independence or no- conspiracy. Since correlation does not imply causation, the violation of statistical independence should be called contextuality; it does not restrict the experimenter's freedom of choice. Therefore, contrary to what is believed, closing the freedom-of choice loophole does not close the contextuality loophole.

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Humans and some other animals can autonomously generate action choices that contribute to solving complex problems. However, experimental investigations of the cognitive bases of human autonomy are challenging, because experimental paradigms typically constrain behaviour using controlled contexts, and elicit behaviour by external triggers. In contrast, autonomy and freedom imply unconstrained behaviour initiated by endogenous triggers. Here we propose a new theoretical construct of adaptive autonomy, meaning the capacity to make behavioural choices that are free from constraints of both immediate external triggers and of routine response patterns, but nevertheless show appropriate coordination with the environment. Participants (N = 152) played a competitive game in which they had to choose the right time to act, in the face of an opponent who punished (in separate blocks) either choice biases (such as always responding early), sequential patterns of action timing across trials (such as early, late, early, late…), or predictable action-outcome dependence (such as win-stay, lose-shift). Adaptive autonomy was quantified as the ability to maintain performance when each of these influences on action selection was punished. We found that participants could become free from habitual choices regarding when to act and could also become free from sequential action patterns. However, they were not able to free themselves from influences of action-outcome dependence, even when these resulted in poor performance. These results point to a new concept of autonomous behaviour as flexible adaptation of voluntary action choices in a way that avoids stereotypy. In a sequential analysis, we also demonstrated that participants increased their reliance on belief learning in which they attempt to understand the competitor's beliefs and intentions, when transition bias and reinforcement bias were punished. Taken together, our study points to a cognitive mechanism of adaptive autonomy in which competitive interactions with other agents could promote both social cognition and volition in the form of non-stereotyped action choices.

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BACKGROUND: Reducing the spread of infectious diseases through vaccination faces the challenge of vaccine hesitancy: referring to questions, concerns and doubts arising when making a vaccine-related decision. A motivational state often arising within people exposed to health messages supporting informed decision making is psychological reactance, functioning as a driver to behavior opposed to the one recommended through the health message. Hence, there is a pressing need for communication strategies effective in counteracting reactance to health messages. METHODS: This study tested two communication strategies that can potentially reduce psychological reactance and ameliorate evaluations of the message and subsequent behavioral vaccination intentions in the context of COVID-19. These were: (1) explicitly reminding individuals of their freedom of choice (to either accept or refuse the vaccine) and (2) providing a two-sided message, including, apart from evidence-based information on the necessity of vaccines, a set of concerns, and questions (about the vaccines) which are refuted immediately. A total of 234 participants who indicated having concerns about the COVID-19 vaccine participated in a 2 (freedom of choice: no choice vs. choice) × 2 (message sidedness: one-sided vs. two-sided) between-subjects online experiment where they received an informational brochure about COVID-19 vaccination. RESULTS: The results show that emphasizing freedom of choice significantly increased perceived credibility of the message, perceived information utility, and ultimately, vaccination intentions. A decrease in psychological reactance mediated these effects. Message sidedness did only show a significant direct effect on perceived information utility. No interaction effect was found. CONCLUSION: These findings indicate the importance of freedom of choice in reducing psychological reactance, which in its turn can lead to an increase of positive message evaluations and vaccination intentions among individuals who express concerns. The opportunities of message sidedness as an efficacious vaccination communication strategy should be further investigated.

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Sense of agency, the feeling of being in control of one's actions and their effects, is particularly relevant during goal-directed actions. During feedback learning, action effects provide information about the best course of action to reinforce positive and prevent negative outcomes. However, it is unclear whether agency experience selectively affects the processing of negative or positive feedback during the performance of goal-directed actions. As an important marker of feedback processing, we examined agency-related changes in midfrontal oscillatory activity in response to performance feedback using electroencephalography. Thirty-three participants completed a reinforcement learning task during which they received positive (monetary gain) or negative (monetary loss) feedback following item choices made either by themselves (free-choice) or by the computer (forced-choice). Independent of choice context, midfrontal theta activity was more enhanced for negative than positive feedback. In addition, free, compared to forced choices increased midfrontal theta power for both gain and loss feedback. These results indicate that freedom of choice in a motivationally salient learning task leads to a general enhancement in the processing of affective action outcomes. Our findings contribute to an understanding of the neuronal mechanisms underlying agency-related changes during action regulation and indicate midfrontal theta activity as a neurophysiological marker important for the monitoring of affective action outcomes, irrespective of feedback valence.

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It has been suggested that avoiding choice represents an anxiety-avoidance strategy, which has not been investigated in the context of social media. To this end, the current study explored the relationship between social media dependency and a preference for 'forced' choice, along with its association with anxiety, intolerance of uncertainty, and experiential avoidance. The sample comprised 151 volunteer participants (18-32 years) who completed a psychometric test battery, including: the Bergen Social Media Addiction Scale; Spielberger Trait Anxiety Inventory; Intolerance of Uncertainty Scale; and Brief Experiential Avoidance Questionnaire. They also undertook a behavioural assessment based on a paradigm developed for pigeons, in which they selected either a situation with a free choice of alternatives, and one with a forced choice. Intolerance of uncertainty mediated the relationship between social media dependency and anxiety. In addition, those with lower social media dependency preferred being able to choose the contingency they worked on, while those with higher scores exhibited no such preference. This partly confirmed that social media dependency is associated with a reduced preference for freedom, but does not suggest social media dependency actively produced a preference for a lack of freedom. The speed of decision making was also faster in those with high social media dependency scores, in line with previous findings that they show higher levels of impulsive behaviours. The results suggest that anxiety and social media dependency are related, and fear of uncertainty and is linked with digital experiential avoidance.

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Do people know when they act freely and autonomously versus when their actions are influenced? While the human aspiration to freedom is widespread, little research has investigated how people perceive whether their choices are biased. Here, we explored how actions congruent or incongruent with suggestions are perceived as influenced or free. Across three experiments, participants saw directional stimuli cueing left or right manual responses. They were instructed to follow the cue's suggestion, oppose it or ignore it entirely to make a 'free' choice. We found that we could bias participants' 'free responses' towards adherence or opposition, by making one instruction more frequent than the other. Strikingly, participants consistently reported feeling less influenced by cues to which they responded incongruently, even when response habits effectively biased them towards such opposition behaviour. This effect was so compelling that cues that were frequently presented with the Oppose instruction became systematically judged as having less influence on behaviour, artificially increasing the sense of freedom of choice. Taken together, these findings demonstrate that acting contrarian distorts the perception of autonomy. Crucially, we demonstrate the existence of a novel illusion of freedom evoked by trained opposition. Our results have important implications for understanding mechanisms of persuasion.

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The paper focuses on the role of consumer confidence and selected well-being measures in aggregate consumption and in subsets of aggregate consumption on a broad set of 22 OECD countries. Consumer confidence played a positive and statistically significant role in the development of expenditures especially on durable and semi-durable goods and services. The increase in cognitive, affective and eudaimonic measures of well-being, measured by the Cantril ladder, positive and negative affect and freedom to make life choices variables, had negative impact on total consumption and expenditures on semi-durable goods and services. Possible explanations for these estimates are provided in the paper. Based on the purpose of expenditure, consumer confidence was a significant determinant of all expenditures except for unavoidable spending such as food, health, housing, water, energy, and fuel. The subjective well-being indicators showed a negative impact on expenditures on clothing and footwear, recreation and culture, and restaurants and hotels. Possible explanations for the positive and negative effects of subjective well-being measures on consumption, benefits of including the freedom of choice variable, and directions for future research regarding the introduction of understudied variables are discussed.

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One of the critical aspects in discussing human dignity is the establishment of its criterion, a standard unique to humans. This criterion should effectively create a fundamental and structural distinction from other creatures. Initially, our focus was on the endeavors of biologists to differentiate the human species from others, emphasizing the physical aspects. However, physical and genetic differences lack the necessary characteristics to serve as a criterion for dignity. Subsequently, we explored the notion of this criterion in human behavior. Yet, given that behavior stems from human thought, it proves unsuitable as a criterion for dignity. Thus, our quest led us to explore human wisdom. However, since wisdom, like other abilities, serves as a tool for improved living and is present to some extent in other animals, it proves inadequate as a criterion. We have determined that the distinguishing characteristic lies in the power of choice or free will, setting humans apart from other living beings whose behavior is solely instinctual or driven by needs. Consequently, free choice forms the foundation of dignity, assigning value to the chooser based on the choices made.

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Public policies fostering the freedom of choice of provider in the healthcare sector are increasingly common in many countries and regions, where policymakers wish to empower patients and improve health service performance. However, in the literature there is not clear consensus about the impact of expanded patient choice on healthcare quality yet. This study investigates whether increasing patients' freedom of choice influences health system outcomes in terms of various non-clinical aspects of care, a dimension often overlooked by researchers in this field. Our study considers a "natural experiment" that took place within the Spanish National Health System in 2009 under which citizens of the Community (region) of Madrid were allowed to freely choose among any GP and/or specialist in their region. The empirical analysis was conducted by using Spanish microdata for the period 2002-2016 and used synthetic control estimation techniques. The key findings show the reform had a strong and long-lasting impact, reducing average waiting times and increasing patients' satisfaction with the specialist attention received. We did not detect any statistically significant impact of the reform on the other responsiveness domains analysed. Our analysis shows that freedom of choice policies could improve health system performance if they are combined with appropriate economic incentives for health providers.

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INTRODUCTION: Assisted suicide and euthanasia are controversial issues today and have been throughout the history of humanity, mainly because there are individuals for and against them. Currently, the legalization of these practices is being discussed in Chile, and the perception of physicians regarding this issue is unknown. Therefore, this study aimed to assess physicians' perception of Chile's euthanasia and assisted suicide. METHODS: A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes and opinions on assisted suicide and euthanasia was used. The population was the doctors who work in Chile, and the sample was convenient with a sample calculation of 384 physicians. About 20 variables were considered and included in a form created through the Google forms option, which was distributed through social networks: LinkedIn, Facebook, Twitter, and WhatsApp. To guarantee the anonymity of the participants, the option to request and remember the participant's email was deactivated. A generated database allowed the quantitative analysis of the variables and their expression through frequencies, percentages, and graphs. The European University of the Atlantic's research ethics committee approved this study as stated in the document CE-55 of March 2021. RESULTS: A total of 410 physicians were surveyed. 50.7% (n = 208) of the participants identified themselves as men, and 69.8% (n = 286) were Chilean. The city of Santiago was the area of residence of 72.9% (n = 299) of the participants. About 34.6% (n = 142) of participants were general practitioners, and 39.3% (n = 161) of the physicians had more than 20 years of experience. About 68.7% had favorable attitudes toward euthanasia and 54.4% toward assisted suicide; However, although the majority favored legalizing euthanasia and assisted suicide, approximately 48.8% stated that they would not participate in an assisted suicide procedure. CONCLUSIONS: There was evidence of support for the implementation and legalization of euthanasia and assisted suicide by physicians in Chile. However, there are still professionals who have not yet decided on a definitive position on these practices.

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Background: Vertical transmission of HIV infection may occur during pregnancy, at childbirth or through breastfeeding. Recommendations on the safety of breastfeeding of HIV-infected women on effective antiretroviral treatment are not univocal among international guidelines (WHO 2010, EACS 2017, DHHS 2017), leaving space for variability at the patient's level. Methods: We collected clinical, laboratory and outcome data from 13 HIV-infected pregnant women who, between March 2017 and June 2021, elected to breastfeed their children against specific medical advice. All mothers were on antiretroviral therapy with darunavir or raltegravir plus emtricitabine/tenofovir disoproxil and remained HIV-RNA undetectable and >400 cells/mmc CD4+ lymphocytes during pregnancy and breastfeeding. Prophylactic antiretroviral therapy (zidovudine for 4 weeks) was started immediately after birth in all newborns. The mean duration of breastfeeding was 5.4 months. Newborns were tested for HIV-RNA multiple times: at birth, 1, 3, and 6 months after birth, and 1, 3 and 6 months after the end of breastfeeding. Results: None of the infants were infected by HIV. Conclusions: Our experience, gathered in the setting of freedom of choice on the patient's side, while insufficient to address the eventual safety of breastfeeding in HIV-infected mothers since the represented cohort is numerically irrelevant, supports the extension of the U=U (Undetectable Equals Untransmittable) paradigm to this setting. Since breastfeeding is often requested by women with HIV planning pregnancy, more extensive comparative studies should be performed.

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Improving nutrition improves health outcomes. Eating in a catering system may provide an environment for promoting healthy dietary choices. To map the factors that shape the food choices of diners who routinely eat in catering systems, we collected and analyzed qualitative data about diners' perceptions of their food choices in communal dining rooms in three kibbutzim in Israel. From May to July 2014, we conducted in-depth, semi-structured, face-to-face interviews with 13 diners who ate at least three lunches per week in the kibbutz's dining room. Data analysis followed thematic analysis principles. Two categories of themes emerged from the interviews. In the personal context category, the themes identified were eating as a task and attempts to control one's eating. In the contextual aspects of eating in the catering system category, themes identified were eating in the dining room as a default, the characteristics of the food served, routine, and personal versus public aspects. The sub-theme of the diners' freedom of choice emerged in the two categories of themes. Diners' wishes of maintaining their freedom of choice may be an important contribution to the debate of whether catering systems should provide only healthy foods, which may jeopardize diners' freedom of choice.

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Judgements of wrongdoing in humans often hinge upon an assessment of whether a perpetrator acted out of free choice: whether they had more than one option. The classic inhibitors of free choice are constraint (e.g. having your hands tied together) and ignorance (e.g. being unaware that an alternative exists). Here, across two studies, we investigate whether chimpanzees consider these factors in their evaluation of social action. Chimpanzees interacted with a human experimenter who handed them a non-preferred item of food, either because they were physically constrained from accessing the preferred item (Experiment 1) or because they were ignorant of the availability of the preferred item (Experiment 2). We found that chimpanzees were more likely to accept the non-preferred food and showed fewer negative emotional responses when the experimenter was physically constrained compared with when they had free choice. We did not, however, find an effect of ignorance on chimpanzee's evaluation. Freedom of choice factors into chimpanzees' evaluation of how they are treated, but it is unclear whether mental state reasoning is involved in this assessment.

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Based on the perspective of self-determination theory (SDT) and the cross-cultural, the aim of the present study was to explore the effect of "freedom of choice" on the well-being of institution-dwelling older adults (elderly residences and nursing homes), in particular during leisure activities. Participants (NChina = 67, Mage = 80.55 years; NFrance = 90, Mage = 82.19 years) were randomly assigned to the "elderly-choice" group or "staff choice" group to participate in a puzzle game. Consistent with SDT, results showed that basic psychological needs satisfaction (autonomy, competence, relatedness) was positively associated with elderly well-being. However, our findings did not demonstrate the importance of freedom of choice for promoting such well-being in the context of leisure activities for either culture; this may be related to the recompense of close relationships or else the particularity of the elderly population. Interestingly, competence satisfaction was observed to act as a complete mediating variable between task performance and well-being only in the French population.

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BACKGROUND: A link between mental health and freedom of choice has long been established, in fact, the loss of freedom of choice is one of the possible defining features of mental disorders. Freedom of choice has internal and external aspects explicitly identified within the capability approach, but received little explicit attention in capability instruments. This study aimed to develop a feasible and linguistically and culturally appropriate Hungarian version of the Oxford CAPabilities questionnaire-Mental Health (OxCAP-MH) for mental health outcome measurement. METHODS: Following forward and back translations, a reconciled Hungarian version of the OxCAP-MH was developed following professional consensus guidelines of the International Society for Pharmacoeconomics and Outcomes Research and the WHO. The wording of the questionnaire underwent cultural and linguistic validation through content analysis of cognitive debriefing interviews with 11 Hungarian speaking mental health patients in 2019. Results were compared with those from the development of the German version and the original English version with special focus on linguistic aspects. RESULTS: Twenty-nine phrases were translated. There were linguistic differences in each question and answer options due to the high number of inflected, affixed words and word fragments that characterize the Hungarian language in general. Major linguistic differences were also revealed between the internal and external aspects of capability freedom of choices which appear much more explicit in the Hungarian than in the English or German languages. A re-analysis of the capability freedom of choice concepts in the existing language versions exposed the need for minor amendments also in the English version in order to allow the development of future culturally, linguistically and conceptually valid translations. CONCLUSION: The internal and external freedom of choice impacts of mental health conditions require different care/policy measures. Their explicit consideration is necessary for the conceptually harmonised operationalisation of the capability approach for (mental) health outcome measurement in diverse cultural and linguistic contexts.

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Young children, like adults, understand that human agents can flexibly choose different actions in different contexts, and they evaluate these agents based on such choices. However, little is known about children's tendencies to attribute the capacity to choose to robots, despite increased contact with robotic agents. In this paper, we compare 5- to 7-year-old children's and adults' attributions of free choice to a robot and to a human child by using a series of tasks measuring agency attribution, action prediction, and choice attribution. In morally neutral scenarios, children ascribed similar levels of free choice to the robot and the human, while adults were more likely to ascribe free choice to the human. For morally relevant scenarios, however, both age groups considered the robot's actions to be more constrained than the human's actions. These findings demonstrate that children and adults hold a nuanced understanding of free choice that is sensitive to both the agent type and constraints within a given scenario.

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First mapping the main ethical issues surrounding prenatal testing, we then analyze which concerns are specific to non-invasive methods. Presupposing the privatization premise for reproductive autonomy in fundamentally liberal societies, we go on to specify common concerns about non-invasive prenatal testing (NIPT) covered by the term 'routinization', and conceptually unravel the frequently expressed worry of increasing 'pressure' to test and/or terminate affected pregnancies. We argue that mindful decision-making should be a key educational goal (not only) of NIPT counseling which could be achieved through stepwise disclosure. In addition, we identify indirect social pressure as the most plausible threat to reproductive freedom. While continuous efforts need to be made to prevent such pressure - not least by ensuring balanced availability of options -, restricting testing options, and thus freedom of choice, cannot be the answer to this concern. Lastly, we suggest abandoning the vague term 'routinization' and instead focusing on specified concerns to enable a fruitful debate.

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