Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves, the potential loss of companies’ competitive edge, and the limited gains in answerability to be expected since sophisticated algorithms (...) usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante. (shrink)

The authors review the empirical literature in order to assess which variables are postulated as influencing ethical beliefs and decision making. The variables are divided into those unique to the individual decision maker and those considered situational in nature. Variables related to an individual decision maker examined in this review are nationality, religion, sex, age, education, employment, and personality. Situation specific variables examined in this review are referent groups, rewards and sanctions, codes of conduct, type of (...) ethical conflict, organization effects, industry, and business competitiveness. The review identifies the variables that have been empirically tested in an effort to uncover what is known and what we need to know about the variables that are hypothesized as determinants of ethical decision behavior. (shrink)

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves, the potential loss of companies’ competitive edge, and the limited gains in answerability to be expected since sophisticated algorithms (...) usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante. (shrink)

Ethical decision-making descriptive theoretical models often conflict with each other and typically lack comprehensiveness. To address this deficiency, a revised EDM model is proposed that consolidates and attempts to bridge together the varying and sometimes directly conflicting propositions and perspectives that have been advanced. To do so, the paper is organized as follows. First, a review of the various theoretical models of EDM is provided. These models can generally be divided into rationalist-based ; and non-rationalist-based. Second, the proposed (...) model, called ‘Integrated Ethical Decision Making,’ is introduced in order to fill the gaps and bridge the current divide in EDM theory. The individual and situational factors as well as the process of the proposed model are then described. Third, the academic and managerial implications of the proposed model are discussed. Finally, the limitations of the proposed model are presented. (shrink)

Decision-Making Capacity First published Tue Jan 15, 2008; substantive revision Fri Aug 14, 2020 In many Western jurisdictions the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own medical decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This question has to (...) do with what is commonly called “decisional capacity”, a central concept in health care law and ethics, and increasingly an independent topic of philosophical inquiry. -/- Decisional capacity can be defined as the ability of subjects to make their own medical decisions. Somewhat similar questions of capacity arise in other contexts, such as capacity to stand trial in a court of law and the ability to make decisions that relate to personal care and finances. However, the history behind the more general legal notions of capacity to stand trial and capacity to manage one’s life is different and operates somewhat differently in law (Roth, Meisel, & Litz 1977; Zapf & Roesch 2005). For the purposes of this discussion the notion of decisional capacity will be limited to medical contexts only; most notably, those where decisions to consent or to refuse treatment or participation in clinical research are concerned. (shrink)

In response to the lack of empirical studies examining the internal disclosure behavior in the Chinese context, this study tested a whistleblowing -decision-making process among employees in the Chinese banking industry. For would-be whistleblowers, positive affect and organizational ethical culture were hypothesized to enhance the expected efficacy of their whistleblowing intention, by providing collective norms concerning legitimate, management-sanctioned behavior. Questionnaire surveys were collected from 364 employees in 10 banks in the Hangzhou City, China. By and large, the findings (...) supported the hypotheses. Issues of whistleblowing in the Chinese context and implications were discussed. (shrink)

The danger of human operators devolving responsibility to machines and failing to detect cases where they fail has been recognised for many years by industrial psychologists and engineers studying the human operators of complex machines. We call it “the control problem”, understood as the tendency of the human within a human–machine control loop to become complacent, over-reliant or unduly diffident when faced with the outputs of a reliable autonomous system. While the control problem has been investigated for some time, up (...) to this point its manifestation in machine learning contexts has not received serious attention. This paper aims to fill that gap. We argue that, except in certain special circumstances, algorithmic decision tools should not be used in high-stakes or safety-critical decisions unless the systems concerned are significantly “better than human” in the relevant domain or subdomain of decision-making. More concretely, we recommend three strategies to address the control problem, the most promising of which involves a complementary coupling between highly proficient algorithmic tools and human agents working alongside one another. We also identify six key principles which all such human–machine systems should reflect in their design. These can serve as a framework both for assessing the viability of any such human–machine system as well as guiding the design and implementation of such systems generally. (shrink)

Decisions are made under uncertainty when there are distinct outcomes of a given action, and one is uncertain to which the act will lead. Decisions are made under indeterminacy when there are distinct outcomes of a given action, and it is indeterminate to which the act will lead. This paper develops a theory of (synchronic and diachronic) decision-making under indeterminacy that portrays the rational response to such situations as inconstant. Rational agents have to capriciously and randomly choose how (...) to resolve the indeterminacy relevant to a given choice-situation, but such capricious choices once made constrain how they will choose in the future. The account is illustrated by the case of self-interested action in situations where it is indeterminate whether you yourself will survive to benefit or suffer the consequences. The conclusion emphasizes some distinctive anti-hedging predictions of the account. (shrink)

Across two studies the hypotheses were tested that stressful situations affect both leadership ethical acting and leaders' recognition of ethical dilemmas. In the studies, decision makers recruited from 3 sites of a Swedish multinational civil engineering company provided personal data on stressful situations, made ethical decisions, and answered to stress-outcome questions. Stressful situations were observed to have a greater impact on ethical acting than on the recognition of ethical dilemmas. This was particularly true for situations involving punishment and lack (...) of rewards. The results are important for the Corporate Social Responsibility (CSR) of an organization, especially with regard to the analysis of the Stressors influencing managerial work and its implications for ethical behavior. (shrink)

In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, (...) different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship. (shrink)

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making (...) are analysed in relation to five different aspects of autonomy: (1) self-realisation; (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice. (shrink)

The danger of human operators devolving responsibility to machines and failing to detect cases where they fail has been recognised for many years by industrial psychologists and engineers studying the human operators of complex machines. We call it “the control problem”, understood as the tendency of the human within a human–machine control loop to become complacent, over-reliant or unduly diffident when faced with the outputs of a reliable autonomous system. While the control problem has been investigated for some time, up (...) to this point its manifestation in machine learning contexts has not received serious attention. This paper aims to fill that gap. We argue that, except in certain special circumstances, algorithmic decision tools should not be used in high-stakes or safety-critical decisions unless the systems concerned are significantly “better than human” in the relevant domain or subdomain of decision-making. More concretely, we recommend three strategies to address the control problem, the most promising of which involves a complementary coupling between highly proficient algorithmic tools and human agents working alongside one another. We also identify six key principles which all such human–machine systems should reflect in their design. These can serve as a framework both for assessing the viability of any such human–machine system as well as guiding the design and implementation of such systems generally. (shrink)

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves, the potential loss of companies’ competitive edge, and the limited gains in answerability to be expected since sophisticated algorithms (...) usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante. (shrink)

Our research’s aim is to assess the effect of cultural factors on business ethical decision-making process in a Western cultural context and in a non-Western cultural context. Specifically, this study investigates ethical perceptions, religiosity, personal moral philosophies, corporate ethical values, gender, and ethical intentions of U.S. and Moroccan business managers. The findings demonstrate that significant differences do exist between the two countries in idealism and relativism. Moroccan managers tend to be more idealistic than the U.S. managers. There is (...) a strong positive relationship between religiosity and idealism. There were mixed findings in examining the correlates of religiosity and various components of ethical intentions. Moroccan managers were more homogenous in their corporate ethical values than were the U.S. managers. The results demonstrate that (in general) idealism is a good predictor of ethical intentions and behaviors. Additionally, managers from the two countries differed in the degree of relationship between perceptions and intentions in three of the four scenarios. This study’s results confirm other research findings that, in general, female business managers have higher ethical sensitivity in terms of their ethical judgment than their male counterparts. Managerial implications are also discussed. (shrink)

Using artificial intelligence (AI) to make decisions in human resource management (HRM) raises questions of how fair employees perceive these decisions to be and whether they experience respectful treatment (i.e., interactional justice). In this experimental survey study with open-ended qualitative questions, we examine decision making in six HRM functions and manipulate the decision maker (AI or human) and decision valence (positive or negative) to determine their impact on individuals’ experiences of interactional justice, trust, dehumanization, and perceptions (...) of decision-maker role appropriate- ness. In terms of decision makers, the use of human decision makers over AIs generally resulted in better perceptions of respectful treatment. In terms of decision valence, people experiencing positive over negative decisions generally resulted in better perceptions of respectful treatment. In instances where these cases conflict, on some indicators people preferred positive AI decisions over negative human decisions. Qualitative responses show how people identify justice concerns with both AI and human decision making. We outline implications for theory, practice, and future research. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We report (...) on the difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

This paper reports on a study of ethical decision-making in a fair trade company. This can be seen to be a crucial arena for investigation since fair trade firms not only have a specific ethical mission in terms of helping growers out of poverty, but they tend to be perceived as (and are often marketed on the basis of) having an "ethical" image. Eschewing a straightforward test of extant ethical decision models, we adopt Thompson''s proposal for a (...) more contextualist understanding rooted in ethnographic data. Our findings suggest that the fair trade mission of the firm is experienced as an over-riding ethical claim, which is often invoked to justify potentially ethically questionable decisions. Moreover, decision precedents emerge which can mean that the decision process is bypassed or hurried through. Finally we provide evidence that the significance of these precedents, and indeed, even moral intensity itself, could be actively shaped and constructed by organization members to support different, even shifting, conceptions of what is a morally acceptable decision for a fair trade company to make. (shrink)

In recent years, increasing attention has been given to virtue ethics in business. Aristotle's thought is often seen as the basis of the virtue ethics tradition. For Aristotle, the idea of phronësis, or 'practical wisdom', lies at the foundation of ethics. Confucian ethics has notable similarities to Aristotelian virtue ethics, and may embody some similar ideas of practical wisdom. This article considers how ideas of moral judgment in these traditions are consistent with modern ideas about intuition in management decision (...) making. A hypothetical case is considered where the complexity of ethical decision making in a group context illustrates the importance of intuitive, phronësis-like judgment. It is then noted that both Aristotelian and Confucian virtue ethics include suggestions about support for moral decision making that are also consistent with modern theory. (shrink)

Shared decision‐making involves health professionals and patients/clients working together to achieve true person‐centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision‐making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence (...) in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision‐making for caesarean section. The team concluded that shared decision‐making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision‐making (defeaters) are disclosed. Informed consent is not shared decision‐making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision‐making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

PREVIOUS WORK Theoretical discussion of the interval measurement of utility based upon theories of decision making under conditions of risk has been voluminous and will not be reviewed here. Those interested will find extensive ...

In today's global marketplace, the Philippines provide a unique example of an Asian culture with established economic ties to the West. In this study, Philippine and United States undergraduate business students responded to 13 vignettes describing questionable ethical actions in business situations. Results reveal significant differences between groups for 9 of the 13 vignettes. For 4 vignettes, Philippine participants were more disapproving of the actions, and for another 5, United States participants were more disapproving. The study suggests that cultural differences (...) continue and the implications of these differences should be considered in today's global economy. (shrink)

Decision-making capacity is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally (...) differs from existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in (...) philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

This paper discusses the philosophical argument and the application of the Triple Font Theory for moral evaluation of human acts and attempts to integrate the conceptual components of major moral theories into a systematic internally consistent decision-making model that is theoretically driven. The paper incorporates concepts such as formal and material cooperation and the Principle of Double Effect into the theoretical framework. It also advances the thesis that virtue theory ought to be included in any adequate justification of (...) morality and the need to integrate or coordinate notions of virtue into various act-oriented or principles-based ethics. The TFT offers a comprehensive and practical approach to ethical decision-making and is a useful alternative embedded in traditional wisdom. This paper provides a more general framework of the TFT than traditionally presented. Practical judgment is shown to play a constitute role in providing a guide for right action and is the “glue” that integrates the various components of the TFT. (shrink)

This study uses judgment and decision-making (JDM) perspective with the help of framing and schema literature from cognitive psychology to evaluate how managers behave when problems with unethical overtones are presented to them in a managerial frame rather than an ethical frame. In the proposed managerial model, moral judgment of the situation is one of the inputs to managerial judgment, among several other inputs regarding costs and benefits of various alternatives. Managerial judgment results in managerial intent leading to (...) managerial action. The model and the effects of taking an ethics course on ethical and managerial judgment and managerial intent were then indirectly tested in this study, wherein subjects judged the ethical wrongness, managerial badness, and the managerial intent regarding decisions made in a case. Forty-nine MBA students analyzed a case involving budget-based bonuses and production, in which the ethical issue evolved over three stages. It appears from the Path-analysis results that managerial judgment mediated between moral judgment and the judgment of managerial intent as suggested by the proposed model, and that taking an ethics course directly affected managerial judgment but did not affect the moral judgment. Additionally, in the first stage of decision-making (early stage of a developing “ethical slippery slope”), moral judgment did not significantly influence managerial judgment. However, students with ethics course still were more inclined to judge the decision as managerially bad as compared to others, indicating that they were more aware or sensitive to the moral issues involved. (shrink)

It is a commonplace that in making decisions agents often have to juggle competing values, and that no choice will maximise satisfaction of them all. However, the prevailing account of these cases assumes that there is always a single ranking of the agent's values, and therefore no unresolvable conflict between them. Isaac Levi denies this assumption, arguing that agents often must choose without having balanced their different values and that to be rational, an act does not have to be (...) optimal, only what Levi terms 'admissible'. This book explores the consequences of denying the assumption and develops a general approach to decision-making under unresolved conflict. Professor Levi discusses conflicts of value in several domains - those arising in moral dilemmas, the drawing of scientific inferences, decisions taken under uncertainty, and in social choice. In each of these he adapts his theoretical framework, showing how conflict may often be reduced though not always altogether eliminated. (shrink)

Higher courts sometimes assess the constitutionality of law by working through a concrete case, other times by reasoning about the underlying question in a more abstract way. Prior research has found that the degree of concreteness or abstraction with which an issue is formulated can influence people's prescriptive views: For instance, people often endorse punishment for concrete misdeeds that they would oppose if the circumstances were described abstractly. We sought to understand whether the so-called ‘abstract/concrete paradox’ also jeopardizes the consistency (...) of judicial reasoning. In a series of experiments, both lay and professional judges sometimes reached opposite conclusions when reasoning about concrete cases versus the underlying issues formulated in abstract terms. This effect emerged whether participants reasoned with broad principles, such as human dignity, or narrow rules, and was largest among individuals high in trait empathy. Finally, to understand whether people reflectively endorse the discrepancy between abstract and concrete resolutions, we examined their reactions when evaluating both, either simultaneously or sequentially. These approaches revealed no single pattern across lay and expert populations, or exploratory and confirmatory studies. Taken together, our studies suggest that empathic concern plays a greater role in guiding the judicial resolution of concrete cases than in illuminating judges' professed standards—which may result in concrete decisions in violation of their own abstract principles. (shrink)

Much discussion of decision-making processes in medicine has been patient-centred. It has been assumed that there is, most often, one patient. Less attention has been given to shared decision-making processes where two or more patients are involved. This article aims to contribute to this special area. What conditions need to be met if decision-making can be said to be shared? What is a shared decision-making process and what is a shared autonomous (...) class='Hi'>decision-making process? Why make the distinction? Examples are drawn from the area of new reproductive medicine and clinical genetics. Possible gender-differences in shared decision-making are discussed. (shrink)

Abstract: This paper defends a constraint that any satisfactory decision theory must satisfy. I show how this constraint is violated by all of the decision theories that have been endorsed in the literature that are designed to deal with cases in which opinions or values are represented by a set of functions rather than a single one. Such a decision theory is necessary to account for the existence of what Ruth Chang has called “parity” (as well as (...) for cases in which agents have incomplete preferences or imprecise credences). The problem with the all of the decision theories that have been defended to account for parity is that they are committed to a claim I call unanimity: when all of the functions in the set agree that an agent ought to do A, then an agent ought to do A. A decision theory committed to unanimity violates the constraint I defend in this paper. Thus, if parity exists, a new approach to decision theory is necessary. (shrink)

Providing a vibrant four-color design, market-leading BUSINESS ETHICS: ETHICAL DECISION MAKING AND CASES, Ninth Edition, thoroughly covers the complex environment in which managers confront ethical decision making. Using a proven managerial framework, this accessible, applied text addresses the overall concepts, processes, and best practices associated with successful business ethics programs--helping readers see how ethics can be integrated into key strategic business decisions. Thoroughly revised, the new ninth edition incorporates coverage of new legislation affecting business ethics, the (...) most up-to-date examples, and the best practices of high-profile organizations. It also includes 20 all-new or updated original case studies. (shrink)

To tackle zoonotic disease threats, a One Health approach is currently commonplace and generally understood as an integrated effort of multiple disciplines to promote the health of humans, animals and the environment. To implement One Health strategies in zoonotic disease control, many countries set up early warning systems, in which human and veterinary health professionals cooperate. These systems, like the Dutch Zoonoses Structure, can be successful to detect emerging disease threats. However, these systems are not well equipped to handle moral (...) dilemmas that can arise in zoonotic disease control, like the culling of healthy animals. This research studies the role of normative presuppositions of professionals involved in zoonotic disease control policies in the Netherlands. We found that these professionals in general adhered to a holistic view of the One Health concept, however, in practice an anthropocentric approach was dominant. Public health was identified as the trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. The lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle which is frequently evoked to justify disease control measures. (shrink)

The ethics of autonomous vehicles has received a great amount of attention in recent years, specifically in regard to their decisional policies in accident situations in which human harm is a likely consequence. Starting from the assumption that human harm is unavoidable, many authors have developed differing accounts of what morality requires in these situations. In this article, a strategy for AV decision-making is proposed, the Ethical Valence Theory, which paints AV decision-making as a type of (...) claim mitigation: different road users hold different moral claims on the vehicle’s behavior, and the vehicle must mitigate these claims as it makes decisions about its environment. Using the context of autonomous vehicles, the harm produced by an action and the uncertainties connected to it are quantified and accounted for through deliberation, resulting in an ethical implementation coherent with reality. The goal of this approach is not to define how moral theory requires vehicles to behave, but rather to provide a computational approach that is flexible enough to accommodate a number of ‘moral positions’ concerning what morality demands and what road users may expect, offering an evaluation tool for the social acceptability of an autonomous vehicle’s ethical decision making. (shrink)

The purpose of this paper is to analyze the relationship between national culture and ethical decision making. Established theories of ethics and moral development are reviewed and a culture-based model of ethical decision making in organizations is derived. Although the body of knowledge in both cross-cultural management and ethics is well documented, researchers have failed to integrate the influence of cultural values into the ethical decision-making paradigm. A conceptual understanding of how managers from different (...) nations make decisions about highly ethical issues will provide business ethics researchers with a sound theoretical foundation upon which future empirical inquiry can be based. (shrink)

The study of decision making has multiple implications for business ethics. This paper outlines some commonly used frameworks for understanding choice in business. It characterises the dominant model for business decision making as rational choice theory (RCT) and contrasts this with a more recent, naturalistic theory of decision-making, image theory. The implications of using RCT and image theory to model decision making are discussed with reference to three ethical systems. RCT is shown (...) to be consistent with Utilitarian ethics, but not with Kantian or Virtue-based ethics. Image theory is shown to be consistent with each. The paper identifies a number of implications following from this analysis. (shrink)

Decision-making Capacity (DMC) matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that DMC matters because autonomy matters. And this is thought to justify DMC as a gatekeeper for autonomy—whereby autonomy concerns arise if but only if a patient has DMC. But appeals to autonomy invoke two distinct concerns: concern for authenticity—concern that a choice is consistent with an individual’s commitments; and concern for (...) sovereignty—concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why DMC matters. Instead, DMC matters because it indicates a harmony between the two concerns—the demands of each concern are more likely to agree if a patient has DMC. This vindicates the standard story, but also makes clear that DMC is an inappropriate gatekeeper for autonomy. (shrink)

Neuroscience has illuminated the neural basis of decision-making, providing evidence that supports specific models of decision-processes. These models typically are quite mechanical, the realization of abstract mathematical “diffusion to bound” models. While effective decision-making seems to be essential for sophisticated behavior, central to an account of freedom, and a necessary characteristic of self-governing systems, it is not clear how the simple models neuroscience inspires can underlie the notion of self-governance. Drawing from both philosophy and neuroscience (...) I explore ways in which the proposed decision-making architectures can play a role in systems that can reasonably be thought of as “self-governing”. (shrink)

In their article, “Supported Decision Making with People at the Margins of Autonomy,” Peterson, Karlawish, and Largent point to the fact that the concept of ‘supported decision-making’ has recently...

Theories of ethical decision making assume it is a process that is special, or different in some regard, from typical individual decision making. Empirical results of the most widely known theories in the field of business ethics contain numerous inconsistencies and contradictions. In an attempt to assess why we continue to lack understanding of how individuals make ethical decisions at work, an inductive study of ethical decision making was conducted. The results of this preliminary (...) study suggest that ethical decision making might not be meaningfully “special” or different from other decision making processes. The implications of this research are potentially significant in that they challenge the fundamental assumption of existing ethical decision making research. This research could serve as an impetus for further examination of whether ethical decision making is meaningfully different from other decision making processes. Such studies could create new directions for the field of business ethics. (shrink)

This paper focuses on the question of how to resolve disagreement and uses the Lehrer-Wagner model as a formal tool for investigating consensual decision-making. The main result consists in a general definition of when agents treat each other as epistemic peers (Kelly 2005; Elga 2007), and a theorem vindicating the “equal weight view” to resolve disagreement among epistemic peers. We apply our findings to an analysis of the impact of social network structures on group deliberation processes, and we (...) demonstrate their stability with the help of numerical simulations. (shrink)

This study examined the relationship between nurses’ ethical decision-making levels and their professional behaviours. Data were collected from 225 nurses who were recruited from university hospitals in Ankara using proportionate sampling. Data were analysed using descriptive statistics and Pearson correlations. Most of the nurses were familiar with ethical dilemmas in nursing practice. The Nursing Principled Thinking level was above average, while the Practical Consideration level was average. Nurses’ professionalism level was low. There was a positive but weak correlation (...) between professional behaviours of the nurses and their ethical decision-making levels. Increasing nurses’ professionalism level can provide a positive contribution to the ethical decision-making level. (shrink)

BackgroundThis article is part of a study to gain insight into the decision-making process by looking at the views of the relatives of potential brain dead donors. Alongside a literature review, focus interviews were held with healthcare professionals about their role in the request and decision-making process when post-mortal donation is at stake. This article describes the perspectives of the relatives.MethodsA content-analysis of 22 semi-structured in-depth interviews with relatives involved in an organ donation decision.ResultsThree themes (...) were identified: ‘conditions’, ‘ethical considerations’ and ‘look back’. Conditions were: ‘sense of urgency’, ‘incompetence to decide’ and ‘agreement between relatives’. Ethical considerations result in a dilemma for non-donor families: aiding people or protecting the deceased’s body, especially when they do not know his/her preference. Donor families respect the deceased’s last will, generally confirmed in the National Donor Register. Looking back, the majority of non-donor families resolved their dilemma by justifying their decision with external arguments. Some non-donor families would like to be supported during decision-making.DiscussionThe discrepancy between general willingness to donate and the actual refusal of a donation request can be explained by multiple factors, with a cumulative effect. Firstly, half of the participants stated that they felt that they were not competent to decide in such a crisis and they seem to struggle with utilitarian considerations against their wish to protect the body. Secondly, non-donor families refused telling that they did not know the deceased’s wishes or contesting posthumous autonomy of the eligible. Thirdly, the findings emphasise the importance of Donor Registration, because it seems to prevent dilemmas in decision-making, at least for donor families.ConclusionDiscrepancies between willingness to consent to donate and refusal at the bedside can be attributed to an unresolved dilemma: aiding people or protect the body of the deceased. Non-donor families felt incompetent to decide. They refused consent for donation, since their deceased had not given any directive. When ethical considerations do not lead to an unambiguous answer, situational factors were pivotal. Relatives of unregistered eligible donors are more prone to unstable decisions. To overcome ambivalence, coaching during decision-making is worth investigation. (shrink)

BackgroundCommentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units. Our aim was twofold: to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and determine the association between the ethical climate, moral distress, and intention to leave.MethodsWe performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and physicians (...) in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire and the Measure of Moral Distress for Healthcare Professionals tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave.ResultsNurses perceived the ethical climate for decision-making as less favorable than physicians. They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units and also demonstrated lower moral distress scores and lower “intention to leave” scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated ; moral distress and "intention to leave" was positively correlated ; and ethical climate and “intention to leave” were negatively correlated.ConclusionsSignificant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care. (shrink)

The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent (...) for simple medical decisions but not for consequential medical decisions such as whether to refuse further life-sustaining therapy. Emerging technologies including computer-tracking assistance of retained partial motor function and brain-computer interfaces promise to improve the communication ability of LIS patients and, when better developed, will allow them to fully exercise their right to actively participate in consequential medical decisions about their own medical care. Although so-called “covert cognition” patients clinically diagnosed as vegetative state that are shown to be aware by functional neuroimaging maybe metaphorically considered locked-in, it is nosologically more coherent not to categorize them formally as LIS. (shrink)

This article is an attempt at a systematic account of decision making under greater uncertainty than what traditional, mathematically oriented decision theory can cope with. Four components of great uncertainty are distinguished: (1) the identity of the options is not well determined (uncertainty of demarcation) ; (2) the consequences of at least some option are unknown (uncertainty of consequences); (3) it is not clear whether information obtained from others, such as experts, can be relied on (uncertainty of (...) reliance); and (4) the values relevant for the decision are not determined with sufficient precision (uncertainty of values). Some possible strategy types are proposed for each of these components. Decisions related to environmental issues are used to illustrate the proposals. (shrink)