Ethicists, regulators and researchers have struggled with the question of whether incidental findings in genomics studies should be disclosed to participants. In the ethical debate, a general consensus is that disclosed information should benefit participants. However, there is no agreement that genetic information will benefit participants, rather it may cause problems such as anxiety. One could get past this disagreement about disclosure of incidental findings by letting participants express their preferences in the consent form. We argue that this freedom of (...) choice is problematic. In transferring the decision to participants, it is assumed that participants will understand what they decide about and that they will express what they truly want. However, psychological findings about people's reaction to probabilities and risk have been shown to involve both cognitive and emotional challenges. People change their attitude to risk depending on what is at stake. Their mood affects judgments and choices, and they over- and underestimate probabilities depending on whether they are low or high. Moreover, different framing of the options can steer people to a specific choice. Although it seems attractive to let participants express their preferences to incidental findings in the consent form, it is uncertain if this choice enables people to express what they truly prefer. In order to better understand the participants' preferences, we argue that future empirical work needs to confront the participant with the complexity of the uncertainty and the trade-offs that are connected with the uncertain predictive value of genetic risk information. (shrink)

In 2004, prenatal risk assessment (PRA) was implemented as a routine offer in Denmark, in order to give all pregnant women an informed choice about whether to undergo prenatal testing. PRA is a non-invasive intervention performed in the first trimester of pregnancy and measures the risk of a fetus having Down's syndrome or other chromosomal disorders. The risk figure provides the basis for action, i.e. the decision about whether or not to undergo invasive fetal testing via (...) the maternal route (amniocentesis or chorionic villus sampling), which, however, involves the risk of inducing a miscarriage. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, this paper investigates how ideals such as autonomy and non-directiveness are practised in processes of decision-making. We view such ideals as forming social practice rather than neutral instruments to reach a certain goal. Focusing on one couple's trajectory through the clinical practices of PRA and the process through which a decision is reached, we call into question the assumption that more choice and more objective information is a source of empowerment and control. We make evident how decisions are made through a complicated process of meaning-making, which emerges through the relationship between professionals, the clinical setting and the social life of the couples. In the face of complex risk knowledge, PRA users are reluctant to make choices and seek to re-install authority in the health professionals. However, when assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the fetus. It is argued that PRA performs a form of government that works not through compulsion or persuasion but through choice. An ethic of a shared responsibility for PRA and its outcome between pregnant women and health professionals would be more in agreement with how decisions are actually made. (shrink)

Parental decision making is necessary for contracting medical interventions that require personal risk–benefit evaluation, and for overseeing matters of education. In the nineteenth century, exemptions from obligatory vaccination were granted for religious and conscientious reasons. Then and today, religion and moral values play marginal roles in vaccine hesitancy and denialism. Rather, the key values invoked by vaccine hesitants and denialists are liberty and pluralism. Neither is compatible with limiting adolescents’ choice. Because vaccination does not require assessment of personal (...) medical risks, because it does not need to occur within the sphere of the doctor–patient relationship, and because the risk involved is within the range of their daily activities, adolescents have the right to free access to vaccination without legal requirement of parental involvement. Drawing on the development of Common Law, and on the development of respect for personal conscience in the history of ideas, this paper does not promote an argument that grants public health an overriding moral power. Rather, this paper rejects the presumption that vaccination of adolescents might involve a conflict between parental authority and public health. Free access to vaccination is compatible with the law and ethics of adolescents’ evolving autonomy in relation to healthcare. (shrink)

How can it be rational to work on a new theory that does not yet meet the standards for good or acceptable theories? If diversity of approaches is a condition for scientific progress, how can a scientific community achieve such progress when each member does what it is rational to do, namely work on the best theory? These two methodological problems, the problem of pursuit and the problem of diversity, can be solved by taking into account the cognitive risk (...) that is involved in theory choice. I compare this solution to other proposals, in particular T. S. Kuhn's and P. Kitcher's view that the two problems demonstrate the epistemic significance of the scientific community. (shrink)

Although there is clearly a need for evidenced‐based behavioral or biomedical prevention or treatment programs for suicide, substance abuse, and sexual health targeted to members of the LGBT population under the age of eighteen, few such programs exist, due in substantial part to limited research knowledge. Ambiguities in regulations that govern human subjects protections and the related inconsistencies in institutional review board (IRB) interpretations of regulatory language are the key reason for the lack of rigorous clinical trial evidence to support (...) treatment choices and prevention approaches to reducing health disparities for this population. Given the socially sensitive nature of suicide, substance abuse, and HIV and STI research in general and LGBT research specifically, in the absence of empirical data to guide their decisions, IRBs must often rely on subjective judgments of minimal risk, which can lead to overestimation of the magnitude and probability of psychological, social, and informational harms that might arise from LGBT youth participation in clinical trials. In addition, more than other youth, LGBT adolescents whose families are unaware of their sexual orientation or gender identity or whose families have victimized them on account of it may be reluctant to participate in studies that require guardian permission. This, in turn, intensifies problems of recruitment and unbiased sampling. However, many IRBs are reluctant to apply federal regulations permitting waiver of guardian permission under conditions in which such permission is clearly not “feasible” or “reasonable” to require. Consequently, many investigators have excluded LGBT individuals under eighteen years of age in health intervention research proposals because of anticipated or actual difficulties obtaining IRB approval. This situation is in conflict with current ethical discourse focusing on the right of youths to participate in trials that will protect them from receiving developmentally untested, inappropriate, and unsafe treatments. In this article, we describe these barriers and recommendations for providing LGBT youth safe and fair access to health research. (shrink)

Abstract Most discussions of risk are developed in broadly consequentialist terms, focusing on the outcomes of risks as such. This paper will provide an alternative account of risk from a virtue ethical perspective, shifting the focus to the decision to take the risk. Making ethical decisions about risk is, we will argue, not fundamentally about the actual chain of events that the decision sets in process, but about the reasonableness of the decision to take the (...) class='Hi'>risk in the first place. A virtue ethical account of risk is needed because the notion of the ‘reasonableness’ of the decision to take the risk is affected by the complexity of the moral status of particular instances of risk-taking and the risk-taker’s responsiveness to these contextual features. The very idea of ‘reasonable risk’ welcomes judgments about the nature of the risk itself, raises questions about complicity, culpability and responsibility, while at its heart, involves a judgement about the justification of risk which unavoidably focuses our attention on the character of the individuals involved in risk making decisions. Keywords: Risk; ethics; morality; responsibility; virtue; choice; reasons . (shrink)

This paper describes the results of a field experiment involving 400 employees from ten financial institutions operating within the Shenzhen Special Economic Zone of the Peoples Republic of China. It was found that, when faced with an agency-based problem, employees indicated they would be less inclined to advise management of the existence of unethical work practices. Younger employees without supervisory experience displayed significant risk aversion. Traditional Chinese values associated with Confucian work dynamism, were shown to be poor predictors (...) of moral choice response. A parsimonious regression model was developed that provides evidence that the universal trait Masculinity/Femininity (Human-heartedness) acted to offset the negative influence of the agency problem. On the other hand, an operatives level of education attainment exerted a negative influence on moral response scores. (shrink)

This paper describes the results of a field experiment involving 400 employees from ten financial institutions operating within the Shenzhen Special Economic Zone of the People's Republic of China. It was found that, when faced with an agency-based problem, employees indicated they would be less inclined to advise management of the existence of unethical work practices. Younger employees without supervisory experience displayed significant risk aversion. Traditional Chinese values associated with Confucian work dynamism, were shown to be poor predictors (...) of moral choice response. A parsimonious regression model was developed that provides evidence that the universal trait Masculinity/Femininity acted to offset the negative influence of the agency problem. On the other hand, an operative's level of education attainment exerted a negative influence on moral response scores. (shrink)

The Argument from Inductive Risk (AIR) is taken to show that values are inevitably involved in making judgements or forming beliefs. After reviewing this conclusion, I pose cases which are prima facie counterexamples: the unreflective application of conventions, use of black-boxed instruments, reliance on opaque algorithms, and unskilled observation reports. These cases are counterexamples to the AIR posed in ethical terms as a matter of personal values. Nevertheless, it need not be understood in those terms. The values which load (...) a theory choice may be those of institutions or past actors. This means that the challenge of responsibly handling inductive risk is not merely an ethical issue, but is also social, political, and historical. (shrink)

This paper presents a personal view of the interaction between the analysis of choice under uncertainty and the analysis of production under uncertainty. Interest in the foundations of the theory of choice under uncertainty was stimulated by applications of expected utility theory such as the Sandmo model of production under uncertainty. This interest led to the development of generalized models including rank-dependent expected utility theory. In turn, the development of generalized expected utility models raised the question of whether (...) such models could be used in the analysis of applied problems such as those involving production under uncertainty. Finally, the revival of the state-contingent approach led to the recognition of a fundamental duality between choice problems and production problems. (shrink)

Describes and evaluates a number of existing criticisms of the formal theory of rationality and subjective expected utility theory. The author argues that rationality is not a behavioural entity, but rather has to do with the relation between an agent's preferences and his or her behaviour.

Objective: The objective of the current study was to maximise the amount of information children and adolescents understand about the risks and benefits associated with participation in a biomedical research study.Design: Participants were presented with one of six hypothetical research protocols describing how to fix a fractured thigh using either a “standard” cast or “new” pins procedure. Risks and benefits associated with each of the treatment options were manipulated so that for each one of the six protocols there was either (...) a correct or ambiguous choice.Participants and setting: Two hundred and fifty one children, ages 6–15 , and 237 adults were interviewed while waiting for a clinic appointment at the Hospital for Sick Children.Results: Using standardised procedures and questionnaires, it was determined that most participants, regardless of age group, were able to understand the basic purpose and procedures involved in the research, and most were able to choose the “correct” operation. The younger children, however, showed an overall preference for a cast operation, whereas the older participants were more likely to choose the pins.Conclusions: By creating age appropriate modules of information, children as young as six years can understand potentially difficult and complex concepts such as the risks and benefits associated with participation in biomedical research. It appears, however, that different criteria were used for treatment preference, regardless of associated risks; older participants tended to opt for mobility whereas younger participants stayed with the more familiar cast operation. (shrink)

Deontological theories face difficulties in accounting for situations involving risk; the most natural ways of extending deontological principles to such situations have unpalatable consequences. In extending ethical principles to decision under risk, theorists often assume the risk must be incorporated into the theory by means of a function from the product of probability assignments to certain values. Deontologists should reject this assumption; essentially different actions are available to the agent when she cannot know that a certain (...) act is in her power, so we cannot simply understand her choice situation as a “risk-weighted” version of choice under certainty. (shrink)

It is frequently argued that home birth is morally irresponsible because it involves the taking of risks on behalf of the fetus. Against this position, I argue three things. First, the fact that home birth involves risks does not necessarily entail that choosing or attending one is morally unacceptable, irresponsible or wrong. Second, parents have a prima facia prerogative to decide on behalf of their fetuses and children whether risks should be taken. While this prima facia prerogative can be overridden, (...) reasonable and widely accepted criteria for doing so are not met in the case of home birth. Third, since the current attitudes and behaviours of physicians with regard to home birth constitute a de facto morally and socially unjustifiable overriding of an informed parental decision, physician autonomy should be restricted so as to preserve the autonomy of the medical consumer. (shrink)

Many of the policy choices we face that have implications for the lives of future generations involve creating a risk that they will live lives that are significantly compromised. I argue that we can fruitfully make use of the resources of Scanlon’s contractualist account of moral reasoning to make sense of the intuitive idea that, in many cases, the objection to adopting a policy that puts the interest of future generations at risk is that doing so wrongs those (...) who will live in the further future. (shrink)

There are many risks involved in genetic engineering. The release of genetically altered organisms in the environment can increase human suffering, decrease animal welfare, and lead to ecological disasters. The containment of biotechnological material in laboratories and industrial plants contributes to the risk of accidental release, especially if the handling and storage are inadequate. The purely political dangers include intensified economic inequality, the possibility of large-scale eugenic programs, and totalitarian control over human lives. How should the acceptability of these (...) risks be determined? We argue that the assessment should be left to those who can be harmed by the decisions in question. Economic risks are acceptable, if they are condoned by the corporations and governments who take them. The risks imposed on laboratory personnel by the containment of dangerous materials ought to be evaluated by the laboratory personnel themselves. All other risks are more or less universal, and should therefore be assessed as democratically as possible. If risk-taking is based on the choices of those who can be harmed by the consequences, then, even if the undesired outcome is realized, the risk is acceptable, because it is embedded in their own system of ethical and epistemic values. (shrink)

Background: Research involving adults lacking mental capacity relies on the involvement of a proxy or surrogate, although this raises a number of ethical concerns. Empirical studies have examined attitudes towards proxy decision-making, proxies’ authority as decision-makers, decision accuracy, and other relevant factors. However, a comprehensive evidence-based account of proxy decision-making is lacking. This systematic review provides a synthesis of the empirical data reporting the ethical issues surrounding decisions made by research proxies, and the development of a conceptual framework of (...) proxy decision-making for research. Methods: A systematic review was conducted according to PRISMA guidelines. Databases including MEDLINE, EMBASE, and CINAHL were searched using a combination of search terms, and empirical data from eligible studies were retrieved. The review followed the framework synthesis approach to refine and develop a conceptual framework. Results: Thirty-four studies were included in the review. Two dimensions of proxy decision-making emerged. The ethical framing criteria of decision-making used by proxies: use of a substituted judgement, use of a best interests approach, combination of substituted judgement and best interests, and ‘something else’, and the active elements of proxy decision-making: ‘knowing the person’, patient-proxy relationship, accuracy of the decision, and balancing risks, benefits and burdens, and attitudes towards proxy decision-making. Interactions between the framing criteria and the elements of decision-making are complex and contextually-situated. Conclusions: The findings from this systematic review challenge the accepted reductionist account of proxy decision-making. Decision-making by research proxies is highly contextualized and multifactorial in nature. The choice of proxy and the relational features of decision-making play a fundamental role: both in providing the proxy’s authority as decision-maker, and guiding the decision-making process. The conceptual framework describes the relationship between the framing criteria used by the proxy, and the active elements of decision-making. Further work to develop, and empirically test the proposed framework is needed. (shrink)

From the viewpoint of the independence axiom of expected utility theory, an interesting empirical dynamic choice problem involves the presence of a “global risk,” that is, a chance of losing everything whichever safe or risky option is chosen. In this experimental study, participants have to allocate real money between a safe and a risky project. Treatment variable is the particular decision stage at which a global risk is resolved: (i) before the investment decision; (ii) after the investment (...) decision, but before the resolution of the decision risk; (iii) after the resolution of the decision risk. The baseline treatment is without global risk. Our goal is to investigate the isolation effect and the principle of timing independence under the different timing options of the global risk. In addition, we examine the role played by anticipated and experienced emotions in the choice problem. Main findings are a violation of the isolation effect, and support for the principle of timing independence. Although behavior across the different global risk cases shows similarities, we observe clear differences in people’s affective responses. This may be responsible for the conflicting results observed in earlier experiments. Dependent on the timing of the global risk different combinations of anticipated and experienced emotions influence decision making. (shrink)

Modeling risk in a prescriptively plausible way represents a major issue in decision theory. The benchmarking procedure, being based on the satisficing principle and providing a probabilistic interpretation of expected utility (EU) theory, is prescriptive. Because it is a target-based language, the benchmarking procedure can be applied naturally to finance. In finance, the centrality of risk is widely recognized, but the risk measures that are commonly used to assess risk are too poor as a decision making (...) tool. In this paper we propose a two-stage decision criterion of choice under risk that provides an application of benchmarking to finance through a risk measure. We will analyze some nonexpected utility theories, in particular lottery dependent utility, as potential frameworks for our criterion. (shrink)

From the viewpoint of the independence axiom of expected utility theory, an interesting empirical dynamic choice problem involves the presence of a “global risk,” that is, a chance of losing everything whichever safe or risky option is chosen. In this experimental study, participants have to allocate real money between a safe and a risky project. Treatment variable is the particular decision stage at which a global risk is resolved: (i) before the investment decision; (ii) after the investment (...) decision, but before the resolution of the decision risk; (iii) after the resolution of the decision risk. The baseline treatment is without global risk. Our goal is to investigate the isolation effect and the principle of timing independence under the different timing options of the global risk. In addition, we examine the role played by anticipated and experienced emotions in the choice problem. Main findings are a violation of the isolation effect, and support for the principle of timing independence. Although behavior across the different global risk cases shows similarities, we observe clear differences in people’s affective responses. This may be responsible for the conflicting results observed in earlier experiments. Dependent on the timing of the global risk different combinations of anticipated and experienced emotions influence decision making. (shrink)

In the last decade, a number of studies in the behavioural sciences, particularly in psychology and economics, have explored the complexity of individual risk behaviour and its underlying factors. Most previous studies have examined the influences of various socio-economic, cognitive, biological and psychological factors on human decision-making however, the relationship between the decision-makers’ risk preferences and occupational background has not received much empirical attention. Accordingly, in the current study, we investigated how occupational background, together with decision-making framing (e.g., (...) variations in decision domain, context, presentation of risk and utility ratios), influence participants’ risk preferences for decision options with equivalent expected utility. Our novel findings indicate that risk preferences may vary among individuals from different occupational backgrounds. As such, when the task was framed in gain terms, participants who mostly deal with health/safety-related risks on a day-to-day basis (high-risk occupations) were predominantly risk-averse (avoiding risky options), while participants who mostly deal with financial/social risks (white-collar occupations) were prone to risk-seeking behaviour (avoiding certain options). Specifically, in “high-risk” occupations, participants’ pattern of choices changed from risk-averse in gain scenarios to risk-seeking in loss scenarios. However, the opposite pattern of risk preferences was found in participants with “white-collar” occupations. Our findings indicate that decision-makers’ occupational backgrounds influence risk preferences under some circumstances. (shrink)

If payoffs are tickets for binary lotteries, which involve only two money prizes, then rationality requires expected value maximization in tickets. This payoff scheme was increasingly used to induce risk neutrality in experiments. The experiment presented here involved lottery choice and evaluation tasks. One subject group was paid in binary lottery tickets, another directly in money. Significantly greater deviations from risk neutral behavior are observed with binary lottery payoffs. This discrepancy increases when subjects have easy access to (...) the alternatives' expected values and mean absolute deviations. Behavioral regularities are observed at least as often as with direct money payoffs. (shrink)

Blood service organizations employ various ways to ensure transfusion blood safety, including the testing of all donations for transfusion-transmissible infections (TTI) and the exclusion of donors who are at increased risk of a recent infection. As some TTIs are more common among men who have sex with men (MSM), many jurisdictions (temporarily) defer the donation of blood by sexually active MSM. This boils down to a categorical exclusion of a large group solely on the basis of their sexual orientation, (...) which is seen as unduly discriminatory and stigmatizing. Blood service organizations in the U.K. and the Netherlands have recently changed their deferral policies for MSM. The problem of the MSM deferral involves a conflict between fundamental rights: the right of MSM to equal treatment and the right to health of the recipients of blood and blood products. We distinguish and discuss three broad alternative options to the current categorical deferral of MSM donations: (1) completely abandoning donor selection on the basis of sexual behavior, (2) individual risk assessment of the sexual activities of each potential donor, and (3) individual risk assessment of the sexual activities of MSM only. The new U.K. policy falls within the second category, and the new Dutch policy is in the third category. We argue that each approach comes with moral costs but that the most reasonable option is different from the policies of both the U.K. and the Netherlands. (shrink)

Blood service organizations employ various ways to ensure transfusion blood safety, including the testing of all donations for transfusion-transmissible infections (TTI) and the exclusion of donors who are at increased risk of a recent infection. As some TTIs are more common among men who have sex with men (MSM), many jurisdictions (temporarily) defer the donation of blood by sexually active MSM. This boils down to a categorical exclusion of a large group solely on the basis of their sexual orientation, (...) which is seen as unduly discriminatory and stigmatizing. Blood service organizations in the U.K. and the Netherlands have recently changed their deferral policies for MSM. The problem of the MSM deferral involves a conflict between fundamental rights: the right of MSM to equal treatment and the right to health of the recipients of blood and blood products. We distinguish and discuss three broad alternative options to the current categorical deferral of MSM donations: (1) completely abandoning donor selection on the basis of sexual behavior, (2) individual risk assessment of the sexual activities of each potential donor, and (3) individual risk assessment of the sexual activities of MSM only. The new U.K. policy falls within the second category, and the new Dutch policy is in the third category. We argue that each approach comes with moral costs but that the most reasonable option is different from the policies of both the U.K. and the Netherlands. (shrink)

Athletes who wish to compete in spite of high risk of injury can prove a challenge for sports doctors. Overriding an athlete's choices could be considered to be unnecessarily overbearing or paternalistic. However simply accepting all risk-taking as the voluntary choice of an individual fails to acknowledge the context of high-level sport and the circumstances in which an athlete may be being coerced or in some other way be making a less than voluntary choice. Restricting the (...) voluntary choices of an athlete may still be possible but under very limited circumstances. This article explores the ways a sports doctor might respond in ensuring a choice is indeed voluntary and, if so, under what circumstances limits might be placed. Responding to such risk-taking by, for example, limiting the actions of an athlete or assisting them to compete, involves attempting to balance the athlete's aims against some set of ideals of good health or medical ends. (shrink)

Decision-making competence reflects individual differences in the susceptibility to decision-making errors, measured using tasks common from behavioral decision research (e.g., framing effects, under/overconfidence, following decision rules). Prior research demonstrates that those with higher decision-making competence report lower incidence of health-risking and antisocial behaviors, but there has been less focus on intermediate mechanisms that may impact real-world decisions, and, in particular, those implicated by normative models. Here we test the associations between measures of youth decision-making competence (Y-DMC) and one such mechanism, (...) the degree to which individuals make choices consistent with maximizing expected value (EV). Using a task involving hypothetical gambles, we find that greater EV sensitivity is associated with greater Y-DMC. Higher Y-DMC scores are associated with (a) choosing risky options when expected value favors those options and (b) avoiding risky options when expected value favors a certain option. This relationship is stronger for gambles that involved potential losses. The results suggest that Y-DMC captures decision processes consistent with standard normative evaluations of risky decisions. (shrink)

It is frequently argued that home birth is morally irresponsible because it involves the taking of risks on behalf of the fetus. Against this position, I argue three things. First, the fact that home birth involves risks does not necessarily entail that choosing or attending one is morally unacceptable, irresponsible or wrong. Second, parents have a prima facia prerogative to decide on behalf of their fetuses and children whether risks should be taken. While this prima facia prerogative can be overridden, (...) reasonable and widely accepted criteria for doing so are not met in the case of home birth. Third, since the current attitudes and behaviours of physicians with regard to home birth constitute a de facto morally and socially unjustifiable overriding of an informed parental decision, physician autonomy should be restricted so as to preserve the autonomy of the medical consumer. (shrink)

Dignity of risk is a simple concept that is surprisingly hard to enact, honor, and prioritize in health care. The term was coined 50 years ago by Robert Perske in an article entitled "The Dignity of Risk and the Mentally Retarded". And as I have written in "Discharge Decisions and the Dignity of Risk", "the concept involves respect for persons, self-determination, and attempts to minimize paternalism or parentalism". Most simply, the dignity of risk embraces respecting or (...) honoring an individual's choices or decisions even in the face of potential harms.The central tension between safety/protection and autonomy/self-determination is at the core of the concept, but it also involves appraisals... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 30.1 (2006) 174-189 [Access article in PDF] Sophie's Choice: Letting Chance Decide Suzanne Dovi University of Arizona When, if ever, should individuals facing a genuine moral dilemma adopt a random decision procedure to determine the outcome of that dilemma? Or to put the question more metaphorically, is it ever morally preferable to determine the outcome of a moral dilemma by flipping a coin? In this (...) paper, I will argue that sometimes it is. To make this argument, I consider a particularly agonizing moral dilemma—the one found in William Styron's Sophie's Choice. Drawing on this famous example of a moral dilemma, I identify three salient features of a moral dilemma that make it morally permissible, and even morally preferable, for an agent to adopt a random decision procedure to determine its outcome. By 'morally preferable,' I do not mean to imply that an agent is morally required to adopt a random decision procedure to determine the outcome of a moral dilemma. As will be seen, I disagree with the view that humans must always pursue the most morally preferable course of action. Nevertheless, I contend that agents should adopt a random decision procedure when faced with a moral dilemma that possesses three salient features. These three features are: (1) when there is clearly no "better" outcome from the range of choices available to the agent; (2) when particular kinds of moral burdens (guilt burdens) can be alleviated by that agent adopting a random decision procedure; and (3) when the alternatives were given to, and not made by, the agent. The first two salient features are necessary for it to be morally permissible [End Page 174] to decide a moral dilemma using a random decision procedure. The third feature is not necessary since a person could, due to her morally permissible decisions, face a moral dilemma whose outcome could be legitimately determined by a random decision procedure. However, I maintain that all three features are jointly sufficient for determining when it is morally preferable to adopt a random decision procedure to decide the outcome of a moral dilemma. I Hard choices are decisions that require us to choose among conflicting goals, purposes, values, or goods that are very important to us. Such choices pervade our lives. According to David Schmidtz, to face such a hard choice can be "the price of the richness and complexity of a life well-lived. To have both ideals and loved ones is to run the risk of having to make decisions under unresolved conflicts of value."1 Although hard choices are often ordinary, some hard choices can also be genuine moral dilemmas.2For my purposes, hard choices become genuine moral dilemmas when an agent cannot avoid violating his or her deeply held moral beliefs. Moreover, genuine moral dilemmas are dilemmas that have no "right" answer. So, for example, genuine moral dilemmas occur when an agent faces a decision between outcomes that are, as far as the agent can reasonably determine, equally bad or incommensurable. Indeed, some genuine moral dilemmas can involve choices between such horrible outcomes that it does not make sense to use moral language to justify their decisions—that is, to provide reasons for thinking that one outcome is preferable to another. In these cases, genuine moral dilemmas do not offer any possibility for moral redemption: the agent cannot morally justify choosing one outcome over another. Thus, genuine moral dilemmas can impose serious (and potentially devastating) moral costs on the decision-maker.William Styron's Sophie's Choice presents an example of such a genuine moral dilemma. Sophie Zawistowska has been asked to choose which of her two children, Eva or Jan, will be sent to the gas chamber in Auschwitz. An SS doctor, Fritz Jemand von Niemand, will grant a dispensation to only one of Sophie's children. If she does not choose which one should live, Dr. von Niemand will send both to their death. Sophie chooses her daughter Eva to go to the gas chamber. Her son, Jan, is sent to the Children's Camp and she... (shrink)

We argue that two long-term goals of AI research stand in tension with one another. The first involves creating AI that is safe, where this is understood as solving the problem of value alignment. The second involves creating artificial general intelligence, meaning AI that operates at or beyond human capacity across all or many intellectual domains. Our argument focuses on the human capacity to make what we call “existential choices”, choices that transform who we are as persons, including transforming what (...) we most deeply value or desire. It is a capacity for a kind of value misalignment, in that the values held prior to making such choices can be significantly different from (misaligned with) the values held after making them. Because of the connection to existentialist philosophers who highlight these choices, we call the resulting form of risk “existentialist risk.” It is, roughly, the risk that results from AI taking an active role in authoring its own values rather than passively going along with the values given to it. On our view, human-like intelligence requires a human-like capacity for value misalignment, which is in tension with the possibility of guaranteeing value alignment between AI and humans. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Jewish Choices, Jewish Voices: Body ed. by Elliot N. Dorff and Louis E. NewmanGeoffrey ClaussenJewish Choices, Jewish Voices: Body Edited by Elliot N. Dorff and Louis E. Newman Philadelphia: Jewish Publication Society, 2008. 134 pp. $16.00This volume, focused on Jewish attitudes toward the human body, is the first volume of the Jewish Choices, Jewish Voices series published by the Jewish Publication Society. Subsequent volumes focus on money, power, (...) sex and intimacy, war and national security, and social justice. Each volume in the series presents hypothetical case studies involving modern moral questions, a collection of classical and contemporary sources relevant to the case studies, and a collection of short essays by a range of contemporary American Jews reflecting on these materials or on other related issues. Elliot Dorff and Louis Newman, the preeminent scholars of Jewish ethics who edited this first volume in the series, explain in their introduction that they sought to gather together “a variety of authors with many different Jewish beliefs and approaches” (xvi). They do not claim to present “what Judaism says,” but, rather, to anthologize a variety of Jewish perspectives. In doing so, they seek to follow the approach of the Bible and the Talmud, both of which contain “many, many voices articulating often diverse points of view” (xvi).On the other hand, Dorff and Newman reject the idea that “anything goes” when it comes to Jewish views about the body. They indicate that modern American Jews may be tempted to endorse such a perspective, accustomed as they are to the American notion that “I own my body.” But, Dorff and Newman suggest, American Jews would do well to consider the contrary notions that animate much of classical Jewish thought on the body: that God is the true owner of every human body, and that God makes demands about how one should use one’s body. The case studies that follow challenge readers to keep these ideas in mind as they consider duties to limit one’s body weight, refrain from tattooing one’s body, and avoid high-risk behaviors.The essays that make up the heart of this book do by and large embrace Dorff and Newman’s challenge. A few do so quite confidently, such as the one Orthodox contributor to the volume, who declares God’s ownership of human bodies to be “the attitude of Torah Judaism.” But a similar view is also upheld by less traditionally inclined authors such as Adam Goodkind, a college student who expresses his doubts about conventional Jewish observance and theology but who sees the idea of not owning one’s body as reflecting the “common sense” of the Jewish tradition. [End Page 213]Many of the essays are also linked by their view of Judaism as a tradition that does not disparage bodily pleasures. Such pleasures should be greatly valued, a number of authors stress, at least within certain limits. Goodkind takes a stronger stance, opining that “part of being a good Jew is getting a maximum amount of enjoyment out of life” (43). Such talk is not surprising—it fits well with the this-worldly ethos of contemporary American Judaism. But it is worth noting that the more ascetic and otherworldly voices found in the tradition are largely absent from this volume.The volume may not showcase the full breadth of traditional Jewish perspectives, but it does demonstrate how thoughtful and generally liberally minded American Jews do think about key ethical questions when they are asked to consider them through a Jewish lens. And while the essays in the volume are somewhat uneven in quality, they tend to be marked by moral sensitivity and by the creative application of traditional Jewish ideas. This first book in the Jewish Choices, Jewish Voices series offers stimulating reflections about the human body, and it also offers a fine introduction to the patterns of moral reasoning found among many contemporary American Jews.Geoffrey ClaussenElon UniversityCopyright © 2013 Society of Christian Ethics... (shrink)

In this short response to Gray’s article Capacity and Decision Making we double down on our argument that risk-relativity is a nonsense. Risk relativity is the claim that we should set a higher standard of competence for a person to make a risky choice than to make a safe choice. Gray’s response largely involves calling attention to the complexities, ramifications and multiple value implications of decision-making, but we do not deny any of this. Using the notion (...) of quality of care mentioned by Gray, we construct an argument that might be used to support risk relativity. But it is no more persuasive than the arguments put forward by risk-relativists. (shrink)

I focus my discussion on the well-known Ellsberg paradox. I find good normative reasons for incorporating non-precise belief, as represented by sets of probabilities, in an Ellsberg decision model. This amounts to forgoing the completeness axiom of expected utility theory. Provided that probability sets are interpreted as genuinely indeterminate belief, such a model can moreover make the “Ellsberg choices” rationally permissible. Without some further element to the story, however, the model does not explain how an agent may come to have (...) unique preferences for each of the Ellsberg options. Levi holds that the extra element amounts to innocuous secondary “risk” or security considerations that are used to break ties when more than one option is rationally permissible. While I think a lexical choice rule of this kind is very plausible, I argue that it involves a greater break with xpected utility theory than mere violation of the ordering axiom. (shrink)

In 2004 prenatal risk assessment was implemented as a routine offer to all pregnant women in Denmark. It was argued that primarily the new programme would give all pregnant women an informed choice about whether to undergo prenatal testing. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, we call into question the assumption underlying the new guidelines that more choice and more objective information is a (...) source of empowerment and control. We focus on one couple's experience of PRA. This case makes it evident how supposed choices in the context of PRA may not be experienced as such. Rather, they are experienced as complicated processes of meaning-making in the relational space between the clinical setting, professional authority and the social life of the couples. PRA users are reluctant to make choices and abandon health professionals as authoritative experts in the face of complex risk knowledge. When assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the foetus. It is argued that al-though the new programme of prenatal testing in Denmark presents itself in opposition to quasi-eugenic and paternalistic forms of governing couples' decisions it represents another form of government that works through the notion of choice. An ethics of a shared responsibility of PRA and its outcome would be more in agreement with how decisions are actually made. (shrink)

The shift to companionate marriage in South Asia and elsewhere is widely read as a move from ‘tradition’ to ‘modernity’ resulting in an expansion of individual agency, especially for women. This paper critically examines the narratives of urban middle-class women in Sri Lanka spanning three generations to illustrate that rather than indicating a radical shift in the way they negotiated between individual desires and social norms, the emphasis on ‘choice’ signals a shift in the narrative devices used in the (...) presentation of the ‘self’. The paper illustrates how young women's narratives about marriage appear to suggest ‘modernity’ as inevitable—that its processes are reconstituting the person who, less constrained by ‘tradition’ and collective expectations, is now experiencing greater freedom in the domain of marriage. However, it also shows how urban middle-class families in Sri Lanka have collectively invested in the narrative of choice through which ‘a choosing person’ is consciously created as a mark of the family's modernity and progress. Rather than signalling freedom, these narratives about choice reveal how women are often burdened with the risks and responsibility of agency. The paper illustrates that the ‘choosing person’ is produced through narratives that emphasise agency as a responsibility that must be exercised with caution because women are expected by and obligated to their families to make the ‘right’ choices. Hence, a closer look at the individualised ‘choosing person’ reveals a less unitary, relational self with permeable boundaries embedded within and accountable to family and kinship. (shrink)

How can one knowingly choose against one's best judgment? This is both a traditional philosophical puzzle and a realistic problem in our everyday life. This dissertation is an exposition and examination of a recent work, by George Ainslie, with regard to its innovative explanation as well as rational solution of such a problem. With the help of the new Ainsliean model, I have also sought to offer some analysis of a number of issues that I believe are important to the (...) understanding of the nature of practical rationality. ;The central question for Ainslie's approach to the dynamic problem of preference change is how to justify the "bundling" idea underlying his solution of the problem by adopting a "personal rule." The bundling idea is a belief in the relation between a series of similar choices as each predicting the direction of all the later choices. Being able to think in terms of this bundling idea is a powerful means of abstaining from defection, though it requires considerable cognitive effort. I try to defend the plausibility of such a personal-rule approach. But Ainslie's own account falls short of showing the ultimate necessity of the bundling idea, viz., why the collapse of the whole sequence of choices would necessarily follow from one defection. My argument hinges on demonstrating that neither a causal consideration about the links between similar choices, nor a prudential consideration about the possible risk involved in certain actions is sufficient for understanding the necessity: we need a normative perspective instead. ;This leads to my analysis of the conditions under which a normative solution can be justified. The analysis also delineates the type of dynamic choice situations Ainslie's approach may adequately fit, or have the greatest advantage. Some underlying hypothesis about the status and role of cognition in desire and higher-level motivation is carefully discussed; and the cognitive, deliberative, and affective aspects of the adoption of a rule is explored. During my discussions, I also compare Ainslie's approach with other theories in the domain of practical reasoning, such as that of Donald Davidson's, Jon Elster's, Michael Bratman's, Edward McClennen's, and David Gauthier's, in terms of their explanatory power, or their scope of application, limits, and complementarity. ;Ainslie's motivational model of mind has apparent as well as potential implications for a group of interesting philosophical issues. They include the nature of willpower, the nature of practical rationality as well as moral rules, personal identity, autonomy, and the existentialist theme on self-creation. My conclusion is that the clarification of the metaphysical underpinnings of the Ainsliean model can help to shed some light on these issues. (shrink)

Our understanding of the decisions made under scenarios where both descriptive and experience-based information are available is very limited. Underweighting of small probabilities was observed in the gain domain when both description and experience were provided. The divergence observed from the prospect theory suggests a need for a separate or modified theory of decision making under risk. Recent studies suggest a possible role of probability weighting in the choice behaviour under risk. We investigated both gain and loss (...) domains with and without feedback for small and large probability conditions. We characterized the shape of the probability weighting function by a two-parameter functional form representing discriminability (concave-convex shape) and attractiveness (level of absolute weights relative to objective probability). We replicated four-fold pattern of risk attitude on non-WEIRD population. We find that feedback leads to underweighting of small probabilities and overweighting of large probabilities in the gain domain and overall underweighting of probabilities in the loss domain. We find that underweighting of small probabilities is driven by changes in discriminability and attractiveness components in the gain domain and changes in the attractiveness component in the loss domain. We have interpreted the results by proposing an updated belief-based account of decisions under uncertainty in which feedback, when available, influences the probability weighting mediating the choice behaviour. (shrink)

In contrast to Di Nucci’s characterisation, my argument is not a technoapocalyptic one. The view I put forward is that systems like IBM’s Watson for Oncology create both risks and opportunities from the perspective of shared decision-making. In this response, I address the issues that Di Nucci raises and highlight the importance of bioethicists engaging critically with these developing technologies.

Recently proposed models of risky choice imply systematic violations of transitivity of preference. This study explored whether people show the predicted intransitivity of the two models proposed to account for the certainty effect in Allais paradoxes. In order to distinguish “true” violations from those produced by “error,” a model was fit in which each choice can have a different error rate and each person can have a different pattern of preferences that need not be transitive. Error rate for (...) a choice is estimated from preference reversals between repeated presentations of the same choice. Results showed that few people repeated intransitive patterns. We can retain the hypothesis that all participants were transitive. (shrink)

The regulation of innovation reflects a specific imaginary of the role of governance that makes it external to the field it governs. It is argued that this decision and rule-based view of regulation is insufficient to deal with the inescapable uncertainties that are produced by innovation. In particular, relying on risk-based knowledge as the basis of regulation fails to deal sufficiently both with the problem that innovation ensures the future will not resemble the past, and with the problem that (...) the social priorities that underlie innovation often remain unquestioned. Recently, rights-based frameworks have been defended as principle-based approaches to innovation governance that address the gaps which trouble an understanding of regulation as guided by risk-based decision procedures. An alternative view of governance is defended, based on a concept of care drawn from feminist ethics and other traditions. Care aims, not at justifying punctual decisions, but at transforming institutions and practices, with the goal of creating specific institutional ‘virtues’, and requires the broad and deep participation of publics in shaping innovation. In this way, governance is made internal to innovation. (shrink)

After the US Supreme Court’s reversal of Roe v. Wade, a number of states have immediately banned abortion. Pro-choice activists are responding by promoting medication abortions – a do-it-yourself form of abortion. Women can take pills at home to induce an abortion in the first few weeks of pregnancy. -/- The Biden Administration [1] has backed the abortion pill, too. Attorney-General Merrick B. Garland and Health and Human Services Secretary Xavier Becerra both issued statements endorsing it. -/- “We stand (...) ready to work with other arms of the federal government that seek to use their lawful authorities to protect and preserve access to reproductive care,” said the Attorney-General. “In particular, the F.D.A. has approved the use of the medication mifepristone. States may not ban mifepristone based on disagreement with the F.D.A.’s expert judgment about its safety and efficacy.” -/- As the New York Times [1] has noted, this sets the scene for legal battles. The obvious one is: will anti-abortion states prosecute medication abortions? -/- But – based on experience in the United Kingdom - the use of the abortion pill could give pro-life doctors headaches as well. -/- In the past year, UK has witnessed the saga of two Catholic doctors who have been brought in front of the professional regulator, the General Medical Council, after accusations of professional misconduct. Their crime? They had supplied abortion pill reversal (APR) treatment to women. Accusations of this misconduct have been brought forward by pro-choice organisations [2]. -/- The problem is that some women might panic when they discover that they are pregnant or are pressured to make a rash decision. They obtain abortion pills, often without seeing a doctor faceto- face, and soon after taking the first pill, they regret their decision. -/- Is it too late for them to save their pregnancy? Not necessarily. -/- A treatment developed in the US works about half the time. It involves the woman taking progesterone after the first abortion pill to counteract the abortifacient action of the drug. -/- Seventy-three women in the UK are reported to have taken a full APR course, of whom, 38 – more than half — successfully remained pregnant. Admittedly, the procedure is controversial [3], with pro-choice writers denouncing it as unproven, unscientific, and unethical. This has triggered some healthcare practitioners and scholars to analyse the commitments of the pro-choice movement to APR. In a recently published paper in The New Bioethics [4], two colleagues, Dominic Whitehouse and Steven Bow, and I argue that those espousing a pro-choice worldview should actually support abortion pill reversal and that the current evidence indicates that they should actually be doing it. -/- While some pro-choice activists might be happy simply to expand women’s reproductive choices, some might also want to ensure that these choices are safe and effective at achieving the desired outcome, which in principle includes maintaining a pregnancy. -/- We then review the scientific evidence with respect to the ability of APR to halt an abortion, look at the potential impact of APR on mental health, as well as its procedural safety. While highlighting that gold-standard evidence is lacking, we note that APR is associated with about two times higher rate of embryo survival compared to not completing the full early medical abortion course, that there is large agreement in the literature that women who are ambiguous about abortion are at risk of poorer mental health outcomes after abortion (and argue that women who request APR fall into this category), and highlight that there is no evidence that APR is more dangerous than abandoning an initiated early medical abortion. -/- The latter fact is important, as the results of the only randomised-controlled trial of APR have been at times misrepresented in the media [5.6], creating the impression that APR is not safe while most of the adverse effects occurred in the study group that did not receive APR. As our paper argues, with respect to APR the two UK doctors were “champions of women’s choice and should be congratulated, not condemned, by pro-choice advocates”. -/- While the cases against the two doctors have now been dropped (and there have even been accusations against a member of one of these pro-choice organisations that they pressurised a patient into complaining about one of the doctors and twisted the patient’s experience of the treatment [7]), we argue that it is important to set-up systems to facilitate the future provision of APR to protect both patients and healthcare staff. -/- Our conclusion is that, while being open to any change in evidence, those espousing a pro-choice outlook should “support calls for an APR framework that will protect women and the healthcare professionals caring for them” “and certainly not oppose” APR. -/- The debate over abortion pill reversal will be heading to the United States soon. It is quite possible that it will be denounced as dangerous misinformation. It’s not. But pro-life defenders should be prepared to defend their ground. -/- This article was first published by Mercatornet. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Walking the Bodhisattva Path/Walking the Christ PathU.S. Conference of Catholic BishopsCatholics and Buddhists brought together by Dharma Realm Buddhist Association, the San Francisco Zen Center, and the United States Conference of Catholic Bishops (USCCB) met 20-23 March 2003 in the first of an anticipated series of four annual dialogues. Abbot Heng Lyu, the monks and nuns, and members of the Dharma Realm Buddhist Association hosted the dialogue at the (...) City of Ten Thousand Buddhas in Talmage, California. The community had transformed their Confucius Hall into a chapel, with a large, newly constructed wooden cross on a wall above an altar facing out from a raised platform, so the Catholic delegation would have a space for worship. A special poster announcing the theme of the conference, "Walking the Bodhisattva Path/Walking the Christ Path," showing a Buddhist dharma wheel at one foot of a bridge and a Celtic cross at the other foot, had been created by the hosting community.The daily schedule for the dialogue did not interfere with the monastic routine at the City of Ten Thousand Buddhas, which included early morning chanting (4:00-5:00 am), daily rituals in the Buddha Hall, and the single large meal for monastics before noon to which all participants were invited. Catholics and Buddhists meeting in the dialogue began each day with an optional forty-five minutes of quiet sitting together in the monastery meditation hall, each following their own form of meditation and prayer. There was a Eucharist on Friday and Saturday evenings for the Catholics and to which the Buddhists were invited, and additional meals of breakfast and supper throughout the meeting at the City's Jyun Kang Restaurant.Fourteen Buddhists and fourteen Catholics participated in the formal discussions. Each participant spoke on what it means to them to follow Christ or the way of the Bodhisattvas or enlightened beings. In addition to speaking, each participant distributed a short passage, usually from a traditional text, on this topic. Several passages from Master Dogen's Shobogenzo and the Gospel of John were among those shared by the group. Other passages shared were taken from the Avatamsaka Sutra and the Shurangama Sutra and from the other gospels and the writings of Zen master HakuinZenji, the Dalai Lama, Korean Zen Master I-sahn Hye-yeon, the teachings of Master [End Page 247] Hsuan Hua, Shantideva, Origen, St. Ignatius, St. Benedict, the author of The Cloud of Unknowing, St. John of the Cross, and Chiara Lubich. A minute of silence separated the fifteen-minute segments for each presentation. With so large a group, most of the time in the formal sessions involved listening to series of presentations; however, during discussion periods the participants asked several challenging questions of one another.Some participants noted the tension they felt between belonging to a particular religious group and the need to let go of any consequential narrowness. The goal of the discussion was to promote understanding of the differences and similarities between Christianity and Buddhism. At one point, the participants noted several concerns about mutual enrichment: whether Buddhist methods can be separated from Buddhism and Christian methods from Christianity, and what specific aspects of Christian practice truly enrich Buddhists and which Buddhist practices likewise enrich Christians. Several times participants discussed their understanding of terms such as transformation, grace, the incarnation and the passion of Jesus, discernment of spirits, prayer, Buddha-nature, and related terms. There was consensus that Buddhists and Catholics can practically help one another regarding mental cultivation and religious precepts. They expressed this consensus in their choice of the topic forthe next dialogue, "Transformation of Hearts and Minds: Chan/Zen-Catholic Approaches to Precepts."The group agreed to reconvene in 2004 to respond to six presentations, three from each side, on different aspects of this topic.Chairing the sessions were Rev. Heng Sure for the Dharma Realm Buddhist Association, Rev. Taigen Dan Leighton for the San Francisco Zen Center, and Bishop John Webster for the United States Conference of Catholic Bishops. Their three organizations are the sponsors of the Northern California Chan/Zen-Catholic Dialogue. Chan and Zen are respectively the Chinese and Japanese terms for the meditation school... (shrink)

The ways in which the decisions we make for others differ from the ones we make for ourselves has received much attention in the literature, although less is known about their relationship to our p...

In public debate over agricultural biotechnology, at issue hasbeen its self-proclaimed aim of further industrializingagriculture. Using languages of ’risk‘, critics and proponentshave engaged in an implicit ethics debate on the direction oftechnoscientific development. Critics have challenged thebiotechnological R&D agenda for attributing socio-agronomicproblems to genetic deficiencies, while perpetuating the hazardsof intensive monoculture. They diagnosed ominous links betweentechnological dependency and tangible harm from biotechnologyproducts.In response to scientific and public concerns, theEuropean Community enacted precautionary legislation for theintentional release of genetically modified organisms (...) (GMOs). Inits implementation, choices for managing and investigatingbiotechnological risk involve an implicit environmental ethics.Yet the official policy language downplays the inherent valuejudgments, by portraying risk regulation as a matter of’objective‘ science.In parallel with safety regulation, thestate has devised an official bioethics that judges where to’draw the line‘ in applying biotechnological knowledge, as ifthe science itself were value-free. Bioethics may also judge howto ’balance‘ risks and benefits, as if their definition were notan issue. This form of ethics serves to compensate for theunacknowledged value-choices and institutional commitmentsalready embedded in R&D priorities.Thus the state separates’risk‘ and ’ethics‘, while assigning both realms to specialists.The risk/ethics boundary encourages public deference to theexpert assessments of both safety regulators and professionalethicists. Biotechnology embodies a contentious model of controlover nature and society, yet this issue becomes displaced andfragmented into various administrative controls. At stake arethe prospects for democratizing the problem-definitions thatguide R&D priorities. (shrink)

Background A significant number of women experience childbirth as traumatic. These experiences are often characterised by a loss of control coupled with a perceived lack of support and inadequate communication with health care professionals. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them. Methods A longitudinal Grounded Theory Methods (GTM) study involving 9 women was conducted. Over (...) half of the participants had a formal diagnosis of PTSD and/or PND related to the previous birth. Interviews were carried out at 3 timepoints perinatally. These findings are from the first interviews at 12-20 weeks. Results From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analysing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience, and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective caesareans to freebirth. Some women felt well supported by those around them, including health care professionals, partners, friends and family. Others did not, and were anticipating conflict in trying to assert their birth choices. Many early relationships with health care professionals were characterised by fear and mistrust. Discussion Women who have previously experienced a traumatic birth become pregnant again, have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with health care professionals at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control. (shrink)

In this paper I present an argument in favour of a parental duty to use preimplantation genetic diagnosis (PGD). I argue that if embryos created in vitro were able to decide for themselves in a rational manner, they would sometimes choose PGD as a method of selection. Couples, therefore, should respect their hypothetical choices on a principle similar to that of patient autonomy. My thesis shows that no matter which moral doctrine couples subscribe to, they ought to conduct the PGD (...) procedure in the situations when it is impossible to implant all of the created embryos and if there is a significant risk for giving birth to a child with a serious condition. (shrink)

The relevance to decision research of recent advances in the philosophy of social science is considered. The critical realism of Roy Bhaskar argues for the identification of contextually contingent explanatory mechanisms at multiple levels based on concepts grounded in intersubjectively shared reality. Using examples from the author’s and other’s research on the psychology of decisions involving risk and uncertainty, this paper explores the implications of taking a critical realist approach. It is argued that critical realism has the potential (...) to advance and unify disparate experimental and naturalistic lines of research. Furthermore, a diverse range of experimental, process-tracing and observational methods can play important complementary roles in developing fruitful critical realist explanations of decisions involving risk and uncertainty. (shrink)