I was in manufacturing for over thirty years and a manager for nearly twenty-five. During that time it never occurred to me that the consequentialist, utilitarian framework I used was inadequate as a conceptual framework for making decisions to ensure organisational viability and success.1 The framework gave three criteria which enabled me to construct a rational approach to issues associated with my role as a manager: To show that this framework is adequate as a basis for managerial decision (...) making I want to spell out the logical implications of the three criteria and show that they are necessary and jointly sufficient to provide an epistemically sound framework for managerial decisions. I will argue that we can look to managerial practice for examples which can serve as paradigms for constructing a pragmatic approach to management decision making, one that — when employed correctly — will result in the best moral outcome for all those affected by a decision.2 This approach is derived from, and ultimately justified by, the primary role responsibility of a manager to create and implement a healthy work environment. This is one designed to be viable so that the organisation can compete successfully in the marketplace and meet the morally minimal standard that we ought not to cause unnecessary and avoidable harm to innocent people. Because the approach is goal directed, it is teleological and consequential in nature. I maintain that a workplace, or organisation, is healthy when all the components that constitute it are working coherently together to achieve legitimate organisational goals designed to ensure the best chances of being viable and competitive. Such an organisation is what I term optimally functional.3. (shrink)

Every one of us will die, and the processes we go through will be our own - unique to our own experiences and life stories. End-of-Life Care and Pragmatic Decision Making provides a pragmatic philosophical framework based on a radically empirical attitude toward life and death. D. Micah Hester takes seriously the complexities of experiences and argues that when making end-of-life decisions, healthcare providers ought to pay close attention to the narratives of patients and the (...) communities they inhabit so that their dying processes embody their life stories. He discusses three types of end-of-life patient populations - adults with decision-making capacity, adults without capacity, and children - to show the implications of pragmatic empiricism and the scope of decision making at the end of life for different types of patients. (shrink)

The disjunction effect (Tversky & Shafir, 1992) occurs when decision makers prefer option x (versus y) when knowing that event A occurs and also when knowing that event A does not occur, but they refuse x (or prefer y) when not knowing whether or not A occurs. This form of incoherence violates Savage's (1954) sure-thing principle, one of the basic axioms of the rational theory of decision making. The phenomenon was attributed to a lack of clear reasons (...) for accepting an option (x) when subjects are under uncertainty. Through a pragmatic analysis of the task and a consequent reformulation of it, we show that the effect does not depend on the presence of uncertainty, but on the introduction of non-relevant goals into the text problem, in both the well-known Gamble problem and the Hawaii problem. (shrink)

n the nervous system, the orbitofrontal cortex, the amygdala, and the body proper are involved in personal and social decision making. Since normal conversational interaction involves making personal and social decisions on a moment to moment basis about what to say and how to say it, it is proposed that these areas of the nervous system, which subserve stimulus appraisal, attachment, affect regulation, and social cognition, also subserve decision making in language pragmatics.

In the nervous system, the orbitofrontal cortex, the amygdala, and the body proper are involved in personal and social decision making. Since normal conversational interaction involves making personal and social decisions on a moment to moment basis about what to say and how to say it, it is proposed that these areas of the nervous system, which subserve stimulus appraisal, attachment, affect regulation, and social cognition, also subserve decision making in language pragmatics.

This paper begins by reviewing dominant themes in current teaching of professional ethics in engineering education. In contrast to more traditional approaches that simulate ethical practice by using ethical theories to reason through micro-level ethical dilemmas, this paper proposes a pragmatic approach to ethics that places more emphasis on the practical plausibility of ethical decision-making. In addition to the quality of ethical justification, the value of a moral action also depends on its effectiveness in solving an ethical (...) dilemma, cultivating healthy working relationships, negotiating existing organizational cultures, and achieving contextual plausibility in everyday professional practice. This paper uses a cross-cultural ethics scenario to further elaborate how a pragmatic approach can help us rethink ethical reasoning, as well as ethics instruction and assessment. This paper is expected to be of interest to educators eager to improve the ability of engineers and other professional students to effectively and appropriately deal with the kinds of everyday ethical issues they will likely face in their careers. (shrink)

Through discourse with international groups of physicians, we conducted a cross-cultural analysis of the types of ethical dilemmas physicians face. Qualitative analysis was used to categorise the dilemmas into seven themes, which we compared among the physicians by country of practice. These themes were a-theoretically-driven and grounded heavily within the text. We then subjected the dilemmas to an analysis of moral intensity, which represents an important theoretical perspective of ethical decision making. These constructs represent salient determinants of ethical (...) behaviour and our cross-cultural sample afforded us the opportunity to consider both the pragmatic aspects of culture, as they are perceived by physicians, as well as the theory-driven concept of moral intensity. By examining both culture and moral intensity, we hope to better elucidate the complexities of ethical decision-making determinants among physicians in their daily practice. Doing so may potentially have practical implications for ethics training of medical students and foreign physicians. (shrink)

This introduction just aims to be a fast foreword to the special topic now turned into an e-book. The Editorial "Decision-Making Experiments under a Philosophical Analysis: Human Choice as a Challenge for Neuroscience" alongside with my opinion article "Neurophilosophical considerations on decision making: Pushing-up the frontiers without disregarding their foundations" play the real role of considering in more details the articles and the whole purpose of this e-book. What I must highlight in this foreword is that (...) our intention with such a project was to deepen into the very foundations of our current paradigms in decision neuroscience and to philosophically moot its foundations and repercussions. Normal Science (a term coined by Philosopher Thomas Kuhn) works under a research consensus among a scientific community: A shared paradigm, consolidated methods, widespread convictions. Pragmatically, winning formulas must be kept, although, not at any cost. What differentiates a gifted and revolutionary scientist from a more bureaucratic colleague is the capacity and willingness of constantly reevaluating, depurating and refining his/her own paradigm. That is best strategy to avoid that a paradigm itself would gradually come under challenge. In my view, some achievements, in this sense, were brought about in our project. The e-book will be inspiring and informative for both neuroscientists that are concerned with the very foundations of their works and for philosophers that are not blind to empirical evidence. Kant once said: “Thoughts without content are empty, intuitions without concepts are blind”. Paraphrasing Kant we could say: Philosophy without science is empty, science without philosophy is blind. (shrink)

Volume 19, Issue 10, October 2019, Page 97-98.

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and (...) triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

Unlike other classical arguments for the existence of God, Pascal’s Wager provides a pragmatic rationale for theistic belief. Its most popular version says that it is rationally mandatory to choose a way of life that seeks to cultivate belief in God because this is the option of maximum expected utility. Despite its initial attractiveness, this long-standing argument has been subject to various criticisms by many philosophers. What is less discussed, however, is the rationality of this choice in situations where (...) the decision-makers are confronted with greater uncertainty. In this paper, I examine the imprecise version of Pascal’s Wager: those scenarios where an agent’s credence that God exists is imprecise or vague rather than precise. After introducing some technical background on imprecise probabilities, I apply five different principles for decision-making to two cases of state uncertainty. In the final part of the paper, I argue that it is not rationally permitted to include zero as the lower probability of God’s existence. Although the conditions for what makes an act uniquely optimal vary significantly across those principles, I also show how the option of wagering for God can defeat any mixed strategy under two distinct interpretations of salvation. (shrink)

Ethical decision making is a core part of the work of social work and human service practitioners, who confront with regularity dilemmas of duty of care; confidentiality, privacy and disclosure; choice and autonomy; and distribution of increasingly scarce resources. This article details the development and application of the Inclusive Model of Ethical Decision Making, created in response to growing awareness of the complexities of work in both public and private sectors. The model rests on four key (...) platforms that are constructed from important foundational values and principles. These platforms are: Accountability, Consultation, Cultural Sensitivity and Critical Reflection, and underlie the dynamic five-step process that uses a reflective yet pragmatic approach to identify and analyze all relevant aspects of an ethical dilemma. The article begins by exploring the anatomy of an ethical dilemma, including the identification of competing ethical principles. It then moves on to highlight the different points in a decision-making process where difficulties typically arise for practitioners who may confront problems of interpretation of ethical codes, lack of access to needed resources and supports, or who may find themselves bound by legal or organizational restrictions. It is argued that this model has useful application for both social work education and practice. (shrink)

Applying the sensemaking perspective in the field of corporate social responsibility is a recent but promising development. Using an in-depth exploratory case study, we analyze and discuss the CSR character of British American Tobacco Switzerland. Our findings indicate that BAT Switzerland does not follow traditional patters of building CSR. BAT Switzerland can be classified as a “legitimacy seeker,” characterized mainly by a relational identity orientation and legitimation strategies that might provide pragmatic and/or cognitive legitimacy. We conclude that understanding the (...) cognitive processes underlying the CSR decision-making process is of fundamental value when analyzing and changing the CSR approach of a firm. We discuss boundary conditions of the CSR character framework and expand it by differentiating between process and product legitimacy, as both perspectives have important but possibly different implications for the firm. (shrink)

Environmental pragmatists are committed to analyzing questions of environmental policy. Bryan Norton's pragmatic critique of environmental decision-making shows how an implicit commitment to the fact/value distinction has hindered productive environmental action. Nonetheless, Norton, as well as the majority of environmental ethicists, have devoted more attention to theorizing value disagreements as a primary cause of controversy than to examining epistemic structures. A case study demonstrates why and how Norton's procedural account may be supplemented with sensitive attention to the (...) construction of epistemic authority in environmental disputes. I recommend supporting the development of local knowledges and just distributions of epistemic authority. (shrink)

The Truth and Reconciliation Commission of Canada made it clear that understanding the historical, social, cultural, and political landscape that shapes the relationships between Indigenous peoples and social institutions, including the health care system, is crucial to achieving social justice. How to translate this recognition into more equitable health policy and practice remains a challenge. In particular, there is limited understanding of ways to respond to situations in which conventional practices mandated by the state and regulated by its legal apparatus (...) come into direct conflict with the values and autonomy of Indigenous individuals, communities, and nations. In this paper, we consider two cases of conflict between Indigenous and biomedical perspectives to clarify some of the competing values. We argue for the importance of person‐ and people‐centered approaches to health care. These value conflicts must be understood at multiple levels to clarify their personal, social, cultural, and political dimensions. Taking into account the divergence between epistemic cultures and communities allows us to understand the multiple narratives deployed in decision‐making processes in clinical, community, and juridical contexts. Recognizing the knowledge claims of Indigenous peoples in health care can help clinicians avoid reinforcing the divides created by the structural and institutional legacy of colonialism. This analysis also provides ways to adjudicate conflicts in health care decision‐making by disentangling cultural, political, medical, and pragmatic issues to allow for respectful dialogue. Insofar as the engagement with cultural pluralism in health care rights is conducted with reciprocal recognition, the medical community and Indigenous peoples can address together the difficult question of how to integrate different epistemic cultures in the health care system. (shrink)

This article explores the question of how scientific uncertainty can be managed in medical decision making using the Advisory Committee on Immunization Practices as a case study. It concludes that where a high degree of technical consensus exists about the evidence and data, decision makers act according to a clear decision rule. If a high degree of technical consensus does not exist and uncertainty abounds, the decision will be based on a variety of criteria, including (...) readily available resources, decision-process constraints, and the available knowledge base, among other things. Decision makers employ a variety of heuristic devices and techniques, thereby employing a pragmatic approach to uncertainty in medical decision making. The article concludes with recommendations for managing scientific uncertainty in medical decision making. (shrink)

Categorization and decision making are combined in a task with photorealistic faces. Two different types of face stimuli were assigned probabilistically into one of two fictitious groups; based on the category, faces were further probabilistically assigned to be hostile or friendly. In Part I, participants are asked to categorize a face into one of two categories, and to make a decision concerning interaction. A Markov model of categorization followed by decision making provides reasonable fits to (...) Part I data. A Markov model predicting decision making followed by categorization is rejected. In Part II, a no-parameter model predicts decisions using categorization and decision responses collected in separate trials, suggesting that Part 1 results are not an artifact of the presentation of categorization and decision questions within a single trial. Decisions concerning interaction appear to be based on information from the category decision, and not from the face stimuli alone. (shrink)

Conflict is an important consideration in the intensive care unit. In this setting, conflict most commonly occurs over the ‘best interests’ of the incapacitated adult patient; for instance, when families seek aggressive life-sustaining treatments, which are thought by the medical team to be potentially inappropriate. Indeed, indecision on futility of treatment and the initiation of end-of-life discussions are recognised to be among the greatest challenges of working in the ICU, leading to emotional and psychological ‘burnout’in ICU teams. When these disagreements (...) occur, they may be within the clinical team or among those close to the patient, or between the clinical team and those close to the patient. It is, therefore, crucial to have a theoretical understanding of decision-making itself, as unpicking misalignments in the family’s and clinical team’s decision-making processes may offer strategies to resolve conflict. Here, we relate Kahneman and Tversky’s work on cognitive biases and behavioural economics to the ICU environment, arguing that these biases could partly explain disparities in the decision-making processes for the two conflicting parties. We suggest that through the establishment of common ground, challenging of cognitive biases and formulation of mutually agreeable solutions, mediation may offer a pragmatic and cost-effective solution to conflict resolution. The litigation process is intrinsically adversarial and strains the doctor–patient–relative relationship. Thus an alternative external party should be considered, however mediation is not frequently used and more research is needed into its effectiveness in resolving conflicts in the ICU. (shrink)

In the domain of medical science, factual evidence is usually considered as the criterion on which to base decisions and construct hypotheses. Evidence-based medicine is the translation of this approach into the field of patient care, and it means providing only the type of care that is based on evidence that proves its effectiveness and appropriateness. However, while the literature has focused on the types and force of evidence used to establish the recommendation and treatment guidelines, the problem of how (...) evidence is used in doctor–patient interactions to motivate, or refuse, treatment or habit change has been almost completely neglected. In this specific context, characterized by the epistemic unbalance between the interlocutors and a specific conversational goal, the scientific categories of evidence are often irrelevant. The goal of this paper is to address this challenge by analyzing the role evidence plays in doctor–patient interactions in diabetes care. After introducing an analytical distinction between the epistemic and the pragmatic aspect of evidence, we will propose a classification of the types and functions of evidence in chronic care communication, and illustrate its possible uses through its application to our corpus of diabetes-care consultations. From our qualitative analyses, it is possible to observe how in this communicative context a crucial role is played by the conflicts of evidence, in which providers correct patients’ uses of evidence leading them to using less defeasible levels of evidence. (shrink)

Categorization and decision making are combined in a task with photorealistic faces. Two different types of face stimuli were assigned probabilistically into one of two fictitious groups; based on the category, faces were further probabilistically assigned to be hostile or friendly. In Part I, participants are asked to categorize a face into one of two categories, and to make a decision concerning interaction. A Markov model of categorization followed by decision making provides reasonable fits to (...) Part I data. A Markov model predicting decision making followed by categorization is rejected. In Part II, a no-parameter model predicts decisions using categorization and decision responses collected in separate trials, suggesting that Part 1 results are not an artifact of the presentation of categorization and decision questions within a single trial. Decisions concerning interaction (defensive/friendly) appear to be based on information from the category decision, and not from the face stimuli alone. (shrink)

The two target articles in this issue draw an important connection between disability bioethics and geriatric bioethics. Dominic JC Wilkinson makes a pragmatic case for using frailty as a fa...

The author singles out various conceptions of rationality used in practical legal discourse: formal and substantive rationality, instrumental goal‐ and means‐rationality, communicative rationality. Practical rationality is expressed in decisions justified by epistemic and axiological premises according to the rules of justificatory reasoning. Five levels of analysis of this justification are identified. Rules, principles and evaluations are used as justifying arguments and their characteristics determine the dimensions of rationality of decision depending on the features of rules, various conceptions of principles, (...) and kinds of relativisation of evaluations. The dimensions of legal rationality depend mainly on three singled out conceptions of rationality, i.e., formal rationality dealing with the deep structure of justification, instrumentally oriented rationality as content of justifiability, and communicative rationality linked with the pragmatics of human interaction. Legitimacy, according to the presented analysis, appears as a subclass of external justification dealing with axiological premisses in terms of instrumental rationality and/or communicative rationality. (shrink)

In recent years, some epistemologists have argued that practical factors can make the difference between knowledge and mere true belief. While proponents of this pragmatic thesis have proposed necessary and sufficient conditions for knowledge, it is striking that they have failed to address Gettier cases. As a result, the proposed analyses of knowledge are either lacking explanatory power or susceptible to counterexamples. Gettier cases are also worth reflecting on because they raise foundational questions for the pragmatist. Underlying these challenges (...) is the fact that pragmatic epistemologies not only rely upon normative theories of rational choice but also require externalist standards to rule out epistemic luck. Unfortunately, we lack adequate externalist theories of rational choice. In response, I address these foundational challenges by offering the outlines of an externalist decision theory. While this task is an ambitious one that I cannot hope to complete, I survey the outlines of a decision-theoretic framework on which a richer pragmatic epistemology can be developed. My hope is that this framework opens up new avenues of exploration for the pragmatic epistemologist. (shrink)

We test conformity-related values applying the value-pragmatics hypothesis by evaluating how personal values related to compliance moderate the relationships between situational factors and unethical decisions. We examine the direct and indirect effects of the values of traditionalism, conformity, and stimulation, as they combine with the situational factors of rewards and punishments in the person–situation interaction model. We find strong support for the value-pragmatics view of ethical decision making and further build support for the person–situation interaction model.

In a two-tiered, or Dual Oughts, moral theory, the objective account of right and wrong is supplemented by decision guides designed to enable an agent, uncertain about the circumstances or consequences of her possible actions, to indirectly apply the objective theory by using an appropriate decision guide. But are the decision guides counsels of morality or counsels of rationality? Peter Graham argues they are counsels of pragmatic rationality. This paper shows Graham’s view is unsuccessful, and argues, (...) based on the approach recently developed in [Author] that decision guides must be seen as moral principles. An explanation is provided for why we may be tempted to interpret decision guides as principles of rationality. (shrink)

A pragmatic approach to business ethics is argued for in this volume, which demonstrates the usefulness of the approach by applying it to a variety of issues. These issues are broad and far-reaching and include the relations between rational and moral//ethical decision-making, the limits of loyalty to employers, the impact of trust on business and the role of commercial public opinion polling during elections. The author also covers advertising, tobacco promotion, manufacture and marketing of armaments, concentration and (...) taxation of wealth, and the North American Free Trade Agreement. (shrink)

My focus is on pragmatic arguments for various rationality constraints on a decision maker’s state of mind: on his beliefs or preferences. An argument of this kind purports to show that a violator of a given constraint can be exposed to a decision problem in which she will act to her guaranteed disadvantage. Dramatically put, she can be exploited by a clever bookie who doesn’t know more than the agent himself. Examples of pragmatic arguments of this (...) kind are synchronic Dutch Books, for the standard probability axioms, diachronic Dutch Books, for the more controversial principles of reflection and conditionalization, and Money Pumps, for the transitivity requirement on preferences. It is suggested that the proposed exploitation set-ups share a common feature. If the violator of a given constraint is logically and mathematically competent, she can be exploited only if she is disunified in his decision-making, i.e., only if she makes decisions on various issues she confronts separately rather than jointly. In other words, exploitation is possible only if the decision problem has been framed in a certain way. Unification in decision making is relatively unproblematic in synchronic contexts, but it may be quite costly and inconvenient diachronically, especially when the issues under consideration are widely spread over time. On my view, therefore, pragmatic arguments should be seen as delivering conditional recommendations: If you want to afford disunification, then you’d better satisfy these constraints. The arguments of this kind fail to establish the inherent rationality of the constraints under consideration. Isaac Levis view of the status of pragmatic arguments is diametrically opposed to mine. According to him, only synchronic pragmatic arguments are valid. The diachronic ones, he argues, lack any validity at all. This line of reasoning is questioned in my paper. (shrink)

My focus is on pragmatic arguments for various rationality constraints on a decision maker’s state of mind: on his beliefs or preferences. An argument of this kind purports to show that a violator of a given constraint can be exposed to a decision problem in which she will act to her guaranteed disadvantage. Dramatically put, she can be exploited by a clever bookie who doesn’t know more than the agent himself. Examples of pragmatic arguments of this (...) kind are synchronic Dutch Books, for the standard probability axioms, diachronic Dutch Books, for the more controversial principles of reflection and conditionalization, and Money Pumps, for the transitivity requirement on preferences. It is suggested that the proposed exploitation set-ups share a common feature. If the violator of a given constraint is logically and mathematically competent, she can be exploited only if she is disunified in his decision-making, i.e., only if she makes decisions on various issues she confronts separately rather than jointly. In other words, exploitation is possible only if the decision problem has been framed in a certain way. Unification in decision making is relatively unproblematic in synchronic contexts, but it may be quite costly and inconvenient diachronically, especially when the issues under consideration are widely spread over time. On my view, therefore, pragmatic arguments should be seen as delivering conditional recommendations: If you want to afford disunification, then you’d better satisfy these constraints. The arguments of this kind fail to establish the inherent rationality of the constraints under consideration. Isaac Levis view of the status of pragmatic arguments is diametrically opposed to mine. According to him, only synchronic pragmatic arguments are valid. The diachronic ones, he argues, lack any validity at all. This line of reasoning is questioned in my paper. (shrink)

Definition of the problemFrom an ethical point of view we analyse the ruling of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA) of September 2019 to revise the guidelines about the coverage of noninvasive prenatal tests (NIPT) by mandatory health insurance, in order to include them under specified conditions. The decision contains four essential elements: a definition of the aim of NIPT testing (to avoid invasive testing), a criterion of access (test must be “necessary” for the pregnant woman to (...) tackle her individual situation), statements about the process of decision-making (after counselling by a physician and case by case) and a normative contextualization (termination of pregnancy under § 218 a German penal law) which is to be found in its explanations. There are tensions in the proposed model that oscillate about two axes: (1) The suffering that results from a possible birth of a child with trisomy or from not knowing about the genetic condition of the fetus can ultimately only be evaluated subjectively, from the perspective of the pregnant woman. (2) The meaning of an individual decision in the case-by-case model remains unclear because when judging about individual cases general points of view also need to be considered. However, we argue that the model of the G‑BA could be a sociopolitically and ultimately also ethically defensible pragmatic solution, exactly because of its paradoxes and its inherent flexibility. (shrink)

In this paper I argue that the search for explainable models and interpretable decisions in AI must be reformulated in terms of the broader project of offering a pragmatic and naturalistic account of understanding in AI. Intuitively, the purpose of providing an explanation of a model or a decision is to make it understandable to its stakeholders. But without a previous grasp of what it means to say that an agent understands a model or a decision, the (...) explanatory strategies will lack a well-defined goal. Aside from providing a clearer objective for XAI, focusing on understanding also allows us to relax the factivity condition on explanation, which is impossible to fulfill in many machine learning models, and to focus instead on the pragmatic conditions that determine the best fit between a model and the methods and devices deployed to understand it. After an examination of the different types of understanding discussed in the philosophical and psychological literature, I conclude that interpretative or approximation models not only provide the best way to achieve the objectual understanding of a machine learning model, but are also a necessary condition to achieve post hoc interpretability. This conclusion is partly based on the shortcomings of the purely functionalist approach to post hoc interpretability that seems to be predominant in most recent literature. (shrink)

In this paper I argue that the search for explainable models and interpretable decisions in AI must be reformulated in terms of the broader project of offering a pragmatic and naturalistic account of understanding in AI. Intuitively, the purpose of providing an explanation of a model or a decision is to make it understandable to its stakeholders. But without a previous grasp of what it means to say that an agent understands a model or a decision, the (...) explanatory strategies will lack a well-defined goal. Aside from providing a clearer objective for XAI, focusing on understanding also allows us to relax the factivity condition on explanation, which is impossible to fulfill in many machine learning models, and to focus instead on the pragmatic conditions that determine the best fit between a model and the methods and devices deployed to understand it. After an examination of the different types of understanding discussed in the philosophical and psychological literature, I conclude that interpretative or approximation models not only provide the best way to achieve the objectual understanding of a machine learning model, but are also a necessary condition to achieve post hoc interpretability. This conclusion is partly based on the shortcomings of the purely functionalist approach to post hoc interpretability that seems to be predominant in most recent literature. (shrink)

Pragmatic trials aim to directly inform health care decision-making through the collection of so-called ‘real world data’ from observations of comparative treatment effects in clinical practice. In order to ensure the applicability and feasibility of a pragmatic trial, design features may be necessary that deviate from standard research ethics requirements. Examples are traditional requirements to seek written informed consent and to perform extensive data and safety monitoring. Proposals for deviations from standard research ethics practice have resulted (...) in controversy about their ethical acceptability. One of the justifications for altered procedures is the allegedly high social value of pragmatic trials. In order to properly operationalize the concept in the ethical assessment of pragmatic trial designs, specification is warranted. We identified three determinants from common claims about a pragmatic trial's social value: the extent to which the research question has real world relevance, the trial design's ability to generate a real world answer and the probability of direct uptake of the results by decision-makers in practice. Subsequently, we discuss how these determinants should be applied to the practice of pragmatic trials, and to what extent they might be applicable to explanatory trials. (shrink)

Naive versions of decision theory take probabilities and utilities as primitive and use expected value to give norms on rational decision. However, standard decision theory takes rational preference as primitive and uses it to construct probability and utility. This paper shows how to justify a version of the naive theory, by taking dominance as the most basic normatively required preference relation, and then extending it by various conditions under which agents should be indifferent between acts. The resulting (...) theory can make all the decisions of classical expected utility theory, plus more in cases where expected utilities are infinite or undefined. Although the theory requires similarly strong assumptions to classical expected utility theory, versions of the theory can be developed with slightly weaker assumptions, without having to prove a new representation theorem for the weaker theory. This alternate foundation is particularly useful if probability is prior to preference, as suggested by the recent program to base probabilism on accuracy and alethic considerations rather than pragmatic ones. (shrink)

Heterogeneous treatment effects represent a major issue for medicine as they undermine reliable inference and clinical decision-making. To overcome the issue, the current vision of precision and personalized medicine acknowledges the need to control individual variability in response to treatment. In this paper, we argue that gene-treatment-environment interactions (G × T × E) undermine inferences about individual treatment effects from the results of both genomics-based methodologies—such as genome-wide association studies (GWAS) and genome-wide interaction studies (GWIS)—and randomized controlled trials (...) (RCTs). Then, we argue that N-of-1 trials can be a solution to overcome difficulties in handling individual variability in treatment response. Although this type of trial has been suggested as a promising strategy to assess individual treatment effects, it nonetheless has limitations that limit its use in everyday clinical practice. We analyze the existing variability within the designs of N-of-1 trials in terms of a continuum where each design prioritizes epistemic and pragmatic considerations. We then support wider use of the designs located at the pragmatic end of the explanatory-pragmatic continuum. (shrink)

'If' is one of the most important words in the English language, being used to express hypothetical thought. The use of conditional terms such as 'if' distinguishes human intelligence from that of all other animals. In this volume, Jonathan Evans and David Over present a new theoretical approach to understanding conditionals. The book draws on studies from the psychology of judgement and decision making, as well as philosophical logic.

Biologically, pain is neither intrinsically good nor bad, but is a communication mechanism designed to serve organismal ends. Pain for any given person at any given time should be evaluated on the basis of “success” (or not) in serving those purposes. Yet, the physiological, psychological, and cultural complexity of the experience makes moral consideration of pain complicated. This is especially the case with infants in pain. The competence of the infant as a “decision maker” cannot, of course, be assumed. (...) Even if the child “thinks” about pain, an epistemological barrier exists in that the child cannot clearly communicate about the pain experience. Furthermore, any expressions of pain from the child may be necessary for diagnosis. Just coercion criteria provide a means of evaluating when and to what extent pain in infants should be controlled under the authority of surrogate decision makers. (shrink)

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there (...) are fewer eligibility criteria for participants, in an... (shrink)