My topic is a problem with our practice of surrogate decision-making in health care, namely, the problem of the surrogate who is not doing her job—the surrogate who cannot be reached or the surrogate who seems to refuse to understand or to be unable to understand the clinical situation. The analysis raises a question about the surrogate who simply disagrees with the medical team. One might think that such a surrogate is doing her job—the team just doesn't like (...) how she is doing it. My analysis raises the question of whether she should be overridden. In approaching this problem, I focus not on the range of difficulties in practice but on the underlying moral conceptual issue. My concern will be to show that the moral values that underpin patient decision-making are fundamentally different from those that underpin surrogate decision-making. Identifying the distinctions will set parameters for any successful solution to the “Who should decide?” question. A patient has a specific kind of moral right to make her own medical decisions. A surrogate has no analogous moral right to decide for someone else. We want the surrogate to make the decision because we believe that she has a relevant epistemological advantage over anyone else on the scene. If and when she has no such advantage or if she refuses or is unable to use it, then there might not be sufficient reason to let her be the decision-maker. (shrink)

We present the interval-valued intuitionistic fuzzy ordered weighted cosine similarity measure in this paper, which combines the interval-valued intuitionistic fuzzy cosine similarity measure with the generalized ordered weighted averaging operator. The main advantage of the IVIFOWCS measure provides a parameterized family of similarity measures, and the decision maker can use the IVIFOWCS measure to consider a lot of possibilities and select the aggregation operator in accordance with his interests. We have studied some of its main properties and particular cases (...) such as the interval-valued intuitionistic fuzzy ordered weighted arithmetic cosine similarity measure and the interval-valued intuitionistic fuzzy maximum cosine similarity measure. The IVIFOWCS measure not only is a generalization of some similarity measure, but also it can deal with the correlation of different decision matrices for interval-valued intuitionistic fuzzy values. Furthermore, we present an application of IVIFOWCS measure to the group decision-making problem. Finally the existing similarity measures are compared with the IVIFOWCS measure by an illustrative example. (shrink)

Ethical decision making measures are widely applied as the principal dependent variable used in studies of research integrity. However, evidence bearing on the internal and external validity of these measures is not available. In this study, ethical decision making measures were administered to 102 graduate students in the biological, health, and social sciences, along with measures examining exposure to ethical breaches and the severity of punishments recommended. The ethical decision making measure was found to (...) be related to exposure to ethical events and the severity of punishments awarded. The implications of these findings for the application of ethical decision making measures are discussed. (shrink)

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

Objectives: to assess physicians’ and patients’ views in Saudi Arabia towards involving the patient versus the family in the process of diagnosis disclosure and decision-making, and to compare them with views from the USA and Japan.Design: A self-completion questionnaire was translated to Arabic and validated.Participants: Physicians from different specialties and ranks and patients in a hospital or attending outpatient clinics from 6 different regions in KSA.Results: In the case of a patient with incurable cancer, 67% of doctors and (...) 51% of patients indicated that they would inform the patient in preference to the family of the diagnosis . Assuming the family already knew, 56% of doctors and 49% of patients would tell the patient even if family objected . However, in the case of HIV infection, 59% of physicians and 81% of patients would inform the family about HIV status without the patient’s consent . With regards to withholding ventilatory support, about 50% of doctors and over 60% of patients supported the use of mechanical ventilation in a patient with advanced cancer, regardless of the wishes of the patient or the family. Finally, the majority of doctors and patients were against assisted suicide.Conclusions: Although there was more recognition for a patient’s autonomy amongst physicians, most patients preferred a family centred model of care. Views towards information disclosure were midway between those of the USA and Japan. Distinctively, however, decisions regarding life prolonging therapy and assisted suicide were not influenced to a great extent by wishes of the patient or family, but more likely by religious beliefs. (shrink)

Decision making is an area of profound importance to a wide range of specialities - for psychologists, economists, lawyers, clinicians, managers, and of course philosophers. Only relatively recently, though, have we begun to really understand how decision making processes are implemented in the brain, and how they might interact with our emotions. 'Emotion and Reason' presents a groundbreaking new approach to understanding decision making processes and their neural bases. The book presents a sweeping survey (...) of the science of decision making. It examines the brain mechanisms involved in making decisions, and controversially proposes that many of our perceptual actions are essentially decision making processes. Whether looking, listening, hearing, or moving, we choose to attend to certain stimuli, at the expense of others. In some psychiatric disorders the inability to respond selectively to certain stimuli can be harmful - such pathologies of decision making are additionally considered. Berthoz also considers how many decision making processes involve an internal dialogue with our other self, and how this dialogue with our "doppelganger" might be represented in the brain. He considers the important implications that a neuroscience of decision making can have for the judiciary - how we apportion blame and responsibility; for economics - with discussion of the growing field of neuroeconomics; and for theories of management. Lastly he examines decision making and creativity - if perception relies in part on decision making processes, how might this alter our view of the artistic process. Written by a neuroscientist of international fame and accessible for both scientists and non-scientists, this book is the most exhaustive examination of the science of decision making yet. (shrink)

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)

The aim of the present research is studying the relationship between the salespersons’ ethical philosophy and their ethical decision-making process and seeks to answer two fundamental questions: first, what is the ethical philosophy of salespersons? And second, how does the salespersons’ ethical philosophy affect their ethical decision-making process? Statistical population of this research is salespersons who have passed the sales training course at the Department of Commerce Research Centre. One hundred thirty-seven questionnaires of total 300 accessible (...) populations were analyzed through path analysis method. The findings indicate that most salespersons are idealists. Although this idealism affects the ethical judgment directly, but the effect of relativism on ethical intention is more considerable. (shrink)

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics (...) consultation. In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

In decision-making the first step is to get knowledge about alternatives which can deliver "a" required objective. The second step is to choose one from the many options using a suitable "criterion". The third is to recognise the famous lesson from Bhagabad Gita that one can control his actions but not the result and be prepared with a "coping strategy" in case of a failure. The two central aspects in decision making are knowledge and choice. Choice (...) is based on certain cost-benefit; which entail an intangible part where religion assumes importance in resolving moral conflicts. The religious principles of decision making according to four religions will be briefly documented and analysed. A "universal" decision making process consistent with the religious principles as well as applicable to the present day socio-economic panorama will be identified. (shrink)

Decision analysts sometimes use the results of clinical trials in order to evaluate treatment alternatives. I discuss some problems associated with this, and in particular I point out that it is not valid to use the estimates from clinical trials as the probabilities of events which are needed for decision analysis. I also attempt to show that an approach based on objective statistical theory may have advantages over commonly used methods based on decision theory. These advantages include (...) the recognition of uncertain data, the introduction of a third alternative, namely suspension of judgement, and the possibility of modifying the choice of probabilities based on a clinical trial with reference to other available knowledge. I have not, however, shown in detail how this modification is done, but I think the concept is sufficiently promising to be applied to an actual clinical decision problem. (shrink)

Bayesianism is the predominant philosophy of science in North-America, the most important school of statistics world-wide, and the general version of the rational-choice approach in the social sciences. Although often rejected as a theory of actual behavior, it is still the benchmark case of perfect rationality. The paper reviews the development of Bayesianism in philosophy, statistics and decision making and questions its status as an account of perfect rationality. Bayesians, who otherwise are squarely in the empiricist camp, invoke (...) a priori reasoning when they recommend Bayesian methods - a recommendation that is not justified by their own standards. (shrink)

Integrated pest management (IPM) has been widely promoted in the developing world, but in many regions its adoption rates have been variable. Experience has shown that to ensure IPM adoption, the complexities of local agro-production systems and context-specific folk knowledge need to be appreciated. Our research explored the linkages between farmer knowledge, pest management decision making, and ecological attributes of subsistence maize agriculture. We report a case study from four rural communities in the highlands of southeast Honduras. Communities (...) were typified by their agro-environments, IPM training history, and levels of infestation by a key maize pest, the fall armyworm (Spodoptera frugiperda Smith). Although variable, infestation levels generally did not justify pest management intervention. Consequently, crop losses from this pest were considered of low importance and most farmers proceeded in a rational fashion by refraining from action in their fields. Farmers attributed the low degree of pest infestation predominantly to abiotic causal factors (rainfall, temperature). The role of natural enemies in controlling this pest (i.e., biological control) was deemed of low importance by farmers; nevertheless, a broad array of such organisms was mentioned by farmers as operating in their maize crop. Farmers’ knowledge of natural enemies only partially matched scientific knowledge and was associated with the ecological features of their respective field settings. Local knowledge about natural enemies was mainly restricted to abundant and easily observable predatory species. Farmers who were knowledgeable about biological control were also familiar with a larger variety of pest management alternatives than uninformed farmers. Management options covered a wide range of curative techniques, including conservation biological control. Farmers who relied on insecticides to manage pest outbreaks knew less about biological control and pesticide alternatives. In contrast, farmers who received IPM training mentioned more types of natural enemies and were familiar with a broader range of alternative pest management tactics. Our research suggests that IPM training modifies local knowledge to better fit its environmental context. This paper provides insights in the environmental context of local agro-ecological knowledge and its linkage with pest management decision making. It also constitutes a basis for modifying IPM extension programs to deliver locality-specific technologies while strengthening the local knowledge base. (shrink)

Goldstein and Gigerenzer (2002) [Models of ecological rationality: The recognition heuristic. Psychological Review, 109 (1), 75–90] found evidence for the use of the recognition heuristic. For example, if an individual recognizes only one of two cities, they tend to infer that the recognized city has a larger population. A prediction that follows is that of the less‐is‐more effect: Recognizing fewer cities leads, under certain conditions, to more accurate inferences than recognizing more cities. We extend the recognition heuristic to group (...) class='Hi'>decision‐making by developing majority and lexicographic models of how recognition information is used by groups. We formally show when the less‐is‐more effect is predicted in groups and we present a study where three‐member groups performed the population comparison task. Several aspects of our data indicate that members who can use the recognition heuristic are, not in all but in most cases, more influential in the group decision process than members who cannot use the heuristic. We also observed the less‐is‐more effect and found that models assuming that members who can use the recognition heuristic are more influential better predict when the effect occurs. (shrink)

The Brundtland Report popularized the concept of sustainable development as meeting “the needs of the present without compromising the ability for future generations to meet their own needs.” Twenty years later a United Nations report argued that current development strategies are inadequate for achieving sustainable development beyond 2015. Any approach to sustainability requires the negotiation and reconfiguration of resources, the consideration of the different stakeholder perceptions to uncertainty and its communication and the continuous recognition of potential threats. This paper aims (...) to enhance current frameworks on sustainability and contribute to management decision making by drawing upon the teachings of the Sikh Gurus. The paper begins with a summary of the main challenges in implementing the sustainability agenda; it then discusses a number of common sustainability frameworks and draws out a set of common limitations. The teachings of the Sikh Gurus are then introduced to provide unique insights into how their understanding of the universe might contribute to some general lessons that can support current sustainability frameworks and related decision making. Next, the paper considers System Archetypes, and in particular the “Limits to Growth”, as mechanisms for gaining insight into the patterns of behaviours that underpin the potential for less unsustainable futures. The paper combines the sustainability frameworks and Sikh teachings to suggest an integrated whole systems approach, across time and space that can throw a new light on the nexus of sustainable development. (shrink)

Roy Bhaskar's Social Cube model based on critical realist philosophy has not been dealt with in theory of decision-making at any length, nor has it raised any notable debate in social theory in general. The model demonstrates that decision-making is regulated and transformed by a constantly evolving complexity of mechanisms emerging from physical, mental, material, human and social levels of reality. With the help of this device, Graham Allison's argument against the Rational Actor Model that decisions (...) are not so much acts of unitary decision-makers but more outputs of large organisations can be elaborated and converted into a statement that decisions are products of a complexity of knowledge-producing mechanisms. The openness of social systems revealed by the Social Cube therefore requires methodological pluralism, for example the application of psychological theories in order to explain political phenomena. By applying the Social Cube model and by drawing new empirical evidence from the Linda Melvern Rwanda Genocide Archive, this article demonstrates that the Somalia effect on the UN's failure in Rwanda was more complicated than the existing literature claims; it was “multi-layered”, generated not only by intentional political calculations, as previous studies argue, but also by a multiplicity of other mechanisms operative at various levels, particularly cognitive dissonance in organisational learning at the unintentional or subconscious level. (shrink)

Recent accounts support the existence of two distinct feelings of guilt: altruistic guilt (AG), arising from the appraisal of not having been altruistic toward a victim and deontological guilt (DG), emerging from the appraisal of having violated an intuitive moral rule. Neuroimaging data has shown that the two guilt feelings trigger different neural networks, with DG selectively activating the insula, a brain area involved in the processing of disgust and self-reproach. Thus, insula activation could reflect the major involvement of self-reproach (...) in DG rather than in AG. However, only a few studies have empirically tested whether and how DG and AG differently affect decision making and none have compared enhanced self-worth. Here we asked three groups of participants, respectively, induced with either pride, DG or AG, to participate in a third-party version of the ultimatum game in which they were asked to decide on behalf of others to accept or reject economic offers with several degrees of fairness. Results revealed that only deontological participants had higher median acceptances of Moderately Unfair offers as compared to proud participants. However fairness judgments were not different between groups, suggesting that deontological participants’ moral standards had not decreased. Crucially, a higher increase in DG was associated with an increase in the odds of accepting 30:70 offers. The opposite effects that DG and pride exert on self-worth can account for these results. Specifically, proud participants felt entitled enough to take action in order to restore equity, while deontological participants followed the “Do not play God” principle, which limited their decisional autonomy, not allowing them to decide on behalf of others. (shrink)

There has been a strong tendency in recent years, in countries such as Australia and the United States, for governmental and corporate spokespersons to present advice and information that comes from independent scientific sources as if it were no better grounded than that from any other source. Such a leveling out of all advice and information into mere “opinion” has been a key strategy in the assertion of corporate and governmental control over public debate and policy. In this paper, we (...) aim to explore some of the factors that diminish the credibility and reliability of information within organizational structures, effectively undermining the value of that information; we argue for the importance of processes like those of peer review in maintaining the credibility and reliability of information that is so important to effective action and decision; and we also provide an analysis of the rationale that underpins such processes. One of our conclusions will be that processes like those of peer review succeed largely because of the way in which they depend upon, but also support, the dispersal of information and authority within an organizational structure so as to ensure both that information is accessible within the structure and also remains open to challenge and scrutiny. (shrink)

The non-justificationist deductivism (or critical rationalism) of Karl Popper constitutes the only approach to human knowledge, including of course the natural and social sciences, that is capable of overcoming all the failings, and the plain contradictions, of the traditional doctrine of inductivism and of its modern incarnation, Bayesianism.

In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. (...) Because of ‘structural arbitrariness’ in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others. (shrink)

Often in insurance decision making, there are risk factors on which the insurer has an informational advantage over the consumer. But when the insurer sets and posts a premium for the consumer to consider, the consumer can potentially use the premium as an informational cue for the loss probability, and thereby to reduce the insurer’s informational advantage. We study, by means of a behavioral model, how consumers would use the premium as an informational cue in such contexts. The (...) belief formation process in our model assumes that both prior knowledge and the premium might have an impact on the consumer’s estimate of the loss probability. Moreover, the premium impacts the estimate through an anchoring-and-adjustment process. The model potentially leads to violations of rational expectations, with which the consumer overestimates the loss probability beyond what could be inferred from the premium, given the premise that the insurer must seek to break even or earn an expected profit. Our model analysis moreover implies that the frequency of such violations is non-increasing as the premium increases. Last, the model implies a generally inverted-U relationship between insurance demand and the premium so that the demand is upward sloping at low premium levels and downward sloping at high premium levels. A pilot field study and a laboratory experiment provide robust evidence for our model implications and calibrations for its parameters. (shrink)

Humans hunt and kill many different species of animals, but whales are our biggest prey. In the North Atlantic, a male long-fi nned pilot whale (Globiceph- ala melaena), a large relative of the dolphins, can grow as large as 6.5 meters and weigh as much as 2.5 tons. As whales go, these are not particularly large, but there are more than 750,000 pilot whales in the North Atlantic, traveling in groups, “pods,” that range from just a few individuals to a (...) thousand or more. Each pod is led by an individual known as the “pilot,” who appears to set the course of travel for the rest of the group. This pilot is both an asset and a weakness to the pod. The average pilot whale will yield about a half ton of meat and blubber, and North Atlantic societies including Ireland, Iceland, and the Shetlands used to manipulate the pilot to drive the entire pod ashore. In the Faroe Islands, a group of 18 grassy rocks due north of Scotland, pilot whale hunts have continued for the last 1200 years, at least. The permanent residents of these islands, the Faroese, previously killed an average of 900 whales each year, yielding about 500 tons of meat and fat that was consumed by local residents. Hunts have declined in recent years. From 2001 to 2005, about 3400 whales were killed, yielding about 890 metric tons of blubber and 990 metric tons of meat. The whale kill, or grindadráp in the Faroese language, begins when a fi shing boat spots a pod close enough to a suitable shore, on a suitably clear day. A single boat, or even a small group of fi shermen, is not suffi cient to trap a.. (shrink)

There are presently two leading foreign policy decision-making paradigms in vogue. The first is based on the classical or rational model originally posited by von Neumann and Morgenstern to explain microeconomic decisions. The second is based on the cybernetic perspective whose groundwork was laid by Herbert Simon in his early research on bounded rationality. In this paper we introduce a third perspective -- the poliheuristic theory of decision-making -- as an alternative to the rational actor and (...) cybernetic paradigms in international relations. This theory is drawn in large part from research on heuristics done in experimental cognitive psychology. According to the poliheuristic theory, policy makers use poly (many) heuristics while focusing on a very narrow range of options and dimensions when making decisions. Among them, the political dimension is noncompensatory. The paper also delineates the mathematical formulations of the three decision-making models. (shrink)

Moral dissensus is a distinct feature of our time. This is not only true of our post-modern culture in general, but also of business culture specifically. In this paper I start by explaining how modernist rationality has produced moral dissensus without offering any hope of bringing an end to it in the foreseeable future. Opting for a form of post-modernist rationality as the only viable way of dealing with moral dissensus, I then make an analysis of a number of ways (...) proposed by both specialists in the field of business ethics, as well as philosophers to deal with moral decision-making in this situation of moral dissensus. The conclusion reached is that none of these attempts succeeds in coming to terms with moral dissensus. I then formulate an alternative approach to moral decision-making which I call: Rational interaction for moral sensitivity. After explaining this approach, I defend it against some of the most obvious objections that might be raised against it in a business environment. When you''re talking birth control, what blocks it and freezes it out is that it''s not a matter of more or fewer babies being argued. That''s just on the surface. What''s underneath is a conflict of faith, of faith in empirical social planning versus faith in the authority of God as revealed by the teachings of the Catholic Church. You can prove the practicality of planned parenthood till you get tired of listening to yourself and it''s going to get nowhere because your antagonist isn''t buying the assumption that anything socially practical is good per se. Goodness for him has other sources which he values as much as or more than social practicality. (Robert M. Pirsig, Zen and the Art of Motorcycle Maintenance.). (shrink)

Case studies and first-person stories about decision-making, written by professionals in the field, bring a uniquely personal touch to this valuable text.

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

One field in ethics that has been developed during recent decades is virtue ethics, represented most importantly by Alasdair MacIntyre's work After Virtue. Virtue ethics is not opposed to principle-based ethics, but rather complements its task and develops it more fully. In the field of US bioethics, this option has proved to be even more fruitful, especially in the work of Edmund Pellegrino and David Thomasma. Virtue ethics is also being reappraised in relation to the ethics of organisations and business. (...) It is considered that the best way of running a company does not depend solely on a group of ethical principles or agreed criteria, but on the effective exercise of certain qualities of character. Indeed, minimal ethics do not guarantee the excellence of organisations, or even their correct development. They guarantee certain standards of coexistence, but this is not sufficient to carry forward a collective enterprise in a creative way. It is impossible to achieve the aims of an organisation without ambition, magnanimity, humility, prudence, responsibility and courage. This group of intangible elements are virtues. This article explores the process of decision-making in the light of Aristotelian ethics, in particular his work _Nicomachean Ethics_. Making decisions is a common task on the managerial agenda. The decisions of a manager affect individuals, the future of the organisation and, of course, they have consequences for the organisation and its surroundings. Aristotle dedicates Book III of the work in question to studying the art of deliberation and examining which virtues must be taken into account when reaching the best decision. Aristotle tells us that we deliberate about things that are within our power and can be done. There can be no deliberation upon exact and sufficient knowledge; however, we deliberate upon the things that are brought about by our own efforts, although not always in the same way. Leading an organisation is not a mechanical matter, but rather a process that requires creativity and responsibility. There are many different ways of doing it. Following the Aristotelian doctrine, this article aims to examine the elements that must be taken into consideration for correct decisions to be made. The following virtues play a fundamental role in this process: prudence, fortitude, justice and temperance, referred to below as called cardinal virtues. (shrink)

BackgroundInformed consent is a key element of ethical clinical research. Addicted population may be at risk for impaired consent capacity. However, very little research has focused on their comprehension of consent forms. The aim of this study is to assess the capacity of addicted individuals to provide consent to research.Methods53 subjects with DSM-5 diagnoses of a Substance Use Disorder and 50 non psychiatric comparison subjects participated in the survey from December 2014 to March 2015. This cross-sectional study was carried out (...) at a community-based Outpatient Treatment Center and at an urban-located Health Centre in Spain. A binary judgment of capacity/incapacity was made guided by the MacArthur Competence Assessment Tool for Clinical Research and a clinical interview. Demographics and clinical characteristics were assessed by cases notes and the Mini-Mental State Examination, the Global Assessment Functional Scale and the Clinical Global Impression Scale.ResultsNPCs performed the best on the MacCAT–CR, and patients with SUD had the worst performance, particularly on the Understanding and Appreciation subscales. 32.7 % SUD people lacked research-related decisional capacity. There were no statistically significant differences between the groups in terms of capacity to consent to research.ConclusionsThe findings of our study provide evidence that a large proportion of individuals with SUD had decisional capacity for consent to research. It is therefore inappropriate to draw conclusions about capacity to make research decisions on the basis of a SUD diagnosis. In the absence of advanced cognitive impairment, acute withdrawal or intoxication, we should assume that addicted persons possess decision-making capacity. Thus, the view that people with SUD would ipso facto lose decision-making power for research consent is flawed and stigmatizing. (shrink)