Introduction: Responsibility and choice -- The idea of moral responsibility -- Complex choice situations -- Differing types of responsibility -- Hans Jonas' idea of "caring for beings" -- The moral experience of women -- Criticizing rational choice -- The rational choice model 5 -- Bounded rationality -- Myopic and deficient choices -- Violations of the axioms -- Rational fools -- The strategic role of emotions -- Social norms -- The communitarian challenge -- Duty, self-interest, and love -- Responsible decision (...) making -- Norms, goals, and stakeholders -- Choice as problem solving -- Ethical norms -- Who are the stakeholders? -- Co-evolving goals and alternatives -- Responsibility and the diversity of choices -- Rationality and respect -- Deontology -- Choices people can make -- The psychology of choice -- Prospect theory -- The "matching law" -- Incommensurability -- Modeling responsible decision making -- What is a responsible decision? -- Deontological payoffs -- Goal-achievement values -- Payoffs for the stakeholders -- Evaluation from multiple perspectives -- The maximin rule -- A geometric representation -- The procedural model -- Real world cases -- Donna's case -- The Ford Pinto case -- The World Bank environmental policy -- Applications in economics and public policy -- Responsibility and social justice -- The paradox of a paretian liberal -- Res ponsible agency in prisoner's dilemma situations -- Multidimensional cost-benefit analysis -- Ethical and social performance of business -- Nature, society, and future generations -- Epilogue: The responsible person. (shrink)

This essay investigates, via the concepts of the philosophy of orientation, Annie Duke’s decision-making theory in "Thinking in Bets" and scrutinizes as to what extent one can universalize the 'orientation skill' of decision-making with regard to our everyday and professional life.

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)

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 (“gaming the system” in particular), 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)

Decision-making Capacity 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)

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 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)

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)

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)

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)

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)

A wide range of decision-making models have been offered to assist in making ethical decisions in the workplace. Those that are based on normative moral frameworks typically include elements of traditional moral philosophy such as consequentialist and/or deontological␣ethics. This paper suggests an alternative model drawing on Jean-Paul Sartre’s existentialism. Accordingly, the model focuses on making decisions in full awareness of one’s freedom and responsibility. The steps of the model are intended to encourage reflection of one’s (...) projects and one’s situation and the possibility of refusing the expectations of others. A case study involving affirmative action in South Africa is used to demonstrate the workings of the model and a number of strengths and weaknesses are identified. Despite several weaknesses that can be raised regarding existential ethics, the model’s success lies in the way that it reframes ethical dilemmas in terms of individual freedom and responsibility, and in its acceptance and analysis of subjective experiences and personal situations. (shrink)

Decision-making capacity (DMC) is normally taken to include (1) understanding (and appreciation); (2) the ability to deliberate or weigh up; and (3) the ability to express a choice. In an article published recently in PPP, Jacinta Tan and her colleagues (2006) suggest that DMC requires also (4) the absence of 'pathological values' (i.e., values that arise from mental disorder). In this paper, I argue that although (1)–(3) might be necessary for DMC, (4) is not necessary (barring cases where (...) pathological values interfere with (1)–(3)). My argument will simply be that (4) fails to be supported by the empirical data provided by Tan et al., which I claim supports the view that people with pathological values do often have DMC. I also consider but reject the claim that pathological values entail incapacity because they are not 'authentic' to the person. I conclude that the absence of pathological values does not constitute an additional element of DMC and that we cannot justify compulsory treatment of people who have (1)–(3), but not (4), on the grounds they lack DMC. (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)

This book clarifies the meaning of the most important and pervasive concepts and tools in bioethical argumentation and assesses the methodological suitability of the main methods for clinical decision-making and argumentation. The first part of the book is devoted to the most developed or promising approaches regarding bioethical argumentation, namely those based on principles, values and human rights. The authors then continue to deal with the contributions and shortcomings of these approaches and suggest further developments by means of (...) substantive and procedural elements and concepts from practical philosophy, normative systems theory, theory of action, human rights and legal argumentation. Furthermore, new models of biomedical and health care decision-making, which overcome the aforementioned criticism and stress the relevance of the argumentative responsibility, are included. (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)

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

It has recently been proposed to incorporate the use of a “Patient Preference Predictor” (PPP) into the process of making treatment decisions for incapacitated patients. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Including a PPP in the shared decision-making process between clinicians and surrogates has the potential to better realize important ethical goals for (...) making treatment decisions for incapacitated patients. However, developing and implementing a PPP poses significant practical challenges. The present paper discusses these practical challenges and considers ways to address them. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Decision-Making as a Broader ConceptJacinta O. A. Tan (bio), Anne Stewart (bio), and Tony Hope (bio)KeywordsCompetence, decision-making, capacity, anorexia nervosa, autonomy, values, identityWe thank Demian Whiting for the thoughtful critique of aspects of our paper (Tan et al. 2006a). A primary aim of our research was to provide empirical grounds on which to stimulate discussion about the nature of decision-making capacity (DMC). Whiting (...) criticizes in particular the concept of 'pathological values' that we suggested might be relevant in the assessment of DMC and in the related issue of deciding when a patient's refusal of beneficial treatment should be overridden.Whiting's central concern is with DMC. Whiting argues that the absence of pathological values should not be a criterion for DMC. We are unclear whether he is also arguing that pathological values do not provide a reason of any kind for overriding treatment refusal. At the end of the paper he writes: "we cannot justify compulsory treatment of patients who have pathological values... on the grounds that these patients lack DMC" (2009, XX). This seems to leave open the possibility that we may be able to justify compulsory treatment of patients who have pathological values on grounds other than that they lack DMC. As we wrote in our response to the discussants of our original paper, "The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests" (Tan et al. 2006b, 300).In deciding on whether to use compulsory treatment, there are other relevant factors that may need to be considered, such as the seriousness of the decision, which determines the threshold for competence. However, in this response we consider three issues. First, we argue that the current concept of DMC is by no means so clear cut or generally agreed upon as Whiting implies, and that some of the lack of clarity relates to pathological values. Second, that the concept of DMC is itself dependent on accounts of autonomy, and that it is plausible that pathological values can affect autonomy. Third, we directly consider the question of whether a coherent account of pathological values might be given based on a concept of authenticity.The Current Criteria for DMCWhiting argues that the current criteria for DMC are correct and that an additional criterion along the lines of absence of pathological values should not be added. This argument assumes that there is a clear and agreed understanding of the current criteria. We believe this is not the case for three reasons.(i) Whiting begins his account of DMC by saying that it is normally taken to include: "(1) [End Page 345] understanding (and appreciation)" (2009, 341). Already there is an area of dispute, and the use of parentheses reflects this. The concept of 'appreciation' was developed by Grisso and Applebaum (Grisso, Appelbaum, and Hill-Fotouhi 1997). It is not included in either English common law development, for example (ReC), nor in the criteria specified in the Mental Capacity Act 2005. More important, Grisso and Appelbaum in their comment on our original paper (2006) argue that our work advances thinking about 'appreciation' rather than requiring that we add new elements. The implication is that they believe that what we have called pathological values are relevant to the assessment of capacity and are already included in an account of capacity that incorporates the criterion of 'appreciation.' In our response, we argued that pathological values are not entirely captured within the account of appreciation that Grisso and Appelbaum had previously given. We do not want to revisit that issue here, but the point of relevance is that on one view (that of Grisso and Appelbaum) pathological values are already included in the current criteria for DMC as part of the concept of appreciation, whereas on Whiting's view they are not.(ii) Even if there were agreement over the wording and concepts relevant to DMC there is a further important issue: how are those concepts... (shrink)

This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this paper we will discuss the normative importance of vitality as a diagnostic cue and will argue that vitality, as a sign (...) perceived by doctors and nurses, has moral significance and represents a legitimate contribution to clinical decision-making in difficult cases where the child's life is at stake. We will argue that these clinical intuitions can be justified on a moral basis but only with certain qualifications that accounts for a certain objectivity and intersubjective reliability in the therapeutic judgements. (shrink)

Algorithm Decision Making (ADM) systems designed to augment or automate human decision-making have the potential to produce better decisions while also freeing up human time and attention for other pursuits. For this potential to be realised, however, algorithmic decisions must be sufficiently aligned with human goals and interests. We take a Principal-Agent (P-A) approach to the questions of ADM alignment and trust. In a broad sense, ADM is beneficial if and only if human principals can trust (...) algorithmic agents to act faithfully on their behalf. This mirrors the challenge of facilitating P-A relationships among humans, but the peculiar nature of human-machine interaction also raises unique issues. The problem of asymmetric information is omnipresent but takes a different form in the context of ADM. Although the decision-making machinery of an algorithmic agent can in principle be laid bare for all to see, the sheer complexity of ADM systems based on deep learning models prevents straightforward monitoring. We draw on literature from economics and political science to argue that the problem of trust in ADM systems should be addressed at the level of institutions. Although the dyadic relationship between human principals and algorithmic agents is our ultimate concern, cooperation at this level must rest against an institutional environment which allows humans to effectively evaluate and choose among algorithmic alternatives. (shrink)

The rapidly increasing role of automation throughout the economy, culture and our personal lives has generated a large literature on the risks of algorithmic decision-making, particularly in high-stakes legal settings. Algorithmic tools are charged with bias, shrouded in secrecy, and frequently difficult to interpret. However, these criticisms have tended to focus on particular implementations, specific predictive techniques, and the idiosyncrasies of the American legal-regulatory regime. They do not address the more fundamental unease about the prospect that we might (...) one day replace judges with algorithms, no matter how fair, transparent, and intelligible they become. The aim of this paper is to propose an account of the source of that unease, and to evaluate its plausibility. I trace foundational unease with algorithmic decision-making in the law to the powerful intuition that there is a basic moral and legal difference between showing that something is true of many people just like you and showing that it is true of you. Human judgment attends to the exception; automation insists on blindly applying the rule. I show how this intuitive thought is connected to both epistemological arguments about the value of statistical evidence, as well as to court-centered conceptions of the rule of law. Unease with algorithmic decision-making in the law thus draws on an intuitive principle that underpins a disparate range of views in legal philosophy. This suggests the principle is deeply ingrained. Nonetheless, I argue that the powerful intuition is not as decisive as it may seem, and indeed runs into significant epistemological and normative challenges. At an epistemological level, I show how concerns about statistical evidence's ability to track the truth can be resolved by adopting a probabilistic, rather than modal, conception of truth-tracking. At a normative level, commitment to highly individualized decision-making co-exists with equally ingrained and competing principles, such as consistent application of law. This suggests that the “rule of law” may not identify a discrete set of institutional arrangements, as proponents of a court-centric conception would have it, but rather a more loosely defined set of values that could potentially be operationalized in multiple ways, including through some level of algorithmic adjudication. Although the prospect of replacing judges with algorithms is indeed unsettling, it does not necessarily entail unreasonable verdicts or an attack on the rule of law. (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)

This paper attempts to build on the contribution to moral imagination theory by Patricia Werhane by further integrating moral imagination with new theoretical developments that have taken place in the business ethics field. To accomplish this objective, part one will review the concept of moral imagination, from its definitional origins to its full theoretical conceptualization. Part two will provide a brief literature review of how moral imagination has been applied in empirical research. Part three will analyze and apply the construct (...) of moral imagination as it relates to the key process stages of ethical decision making including awareness, judgment, intention, and behavior. Immoral imagination is then discussed, along with other behavioral ethics concepts as they relate to moral imagination. The paper concludes with potential future research directions, as well as teaching and managerial implications for the moral imagination construct. (shrink)

This article focuses on patients' participation in decision‐making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision‐making meetings within a Foucauldian perspective. Patients' participation in decision‐making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From (...) the perspective of patients, there is a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a ‘customer’ in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision‐making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision‐making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A ‘projectification’ of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de‐professionalization. In that light, participation of patients in decision‐making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own situations from a humanistic perspective. (shrink)

This study investigates the relationship among ethical philosophy, thinking style, and managerial ethical decision-making. Based on the premise that business ethics is a function of culture and time, we attempt to explore two important questions as to whether the national differences in managerial ethical philosophies remain over time and whether the relationship between thinking style and ethical decision-making is consistent across different national contexts. We conducted a survey on Korean managers’ ethical decision-making and (...) thinking style and made a cross-cultural, cross-temporal comparison with the results presented by previous studies that surveyed Korean and US managers with the same questionnaire at different points in time. Our analysis revealed that Korean managers have become more reliant on rule utilitarianism for ethical decision-making over the last two decades, which is dominantly used by US managers, corroborating our convergence hypothesis built on social contracts theory. However, as opposed to previous research, we found that managers with a balanced linear and nonlinear thinking style do not necessarily make more ethical decisions compared to those with a predominantly linear or nonlinear thinking style. This study contributes to international business ethics literature by presenting a theoretical framework that may explain the convergence of ethical philosophies employed by managers in different national contexts over time, and that the relationship between thinking style and managerial ethical decision-making may not be universal, but contingent on contextual factors. (shrink)

It can be assumed that value judgements, which are needed to judge what is ‘good’ or ‘better’ and what is ‘bad’ or ‘worse’, are involved in every decision-making process. The theoretical understanding and analysis of value judgements is, therefore, important in the context of bioethics, for example, to be able to ethically assess real decision-making processes in biomedical practice and make recommendations for improvements. However, real decision-making processes and the value judgements inherent in them (...) must first be investigated empirically (‘empirical bioethics’). For this to succeed, what exactly a ‘value judgement’ is and of what components it might consist must initially be theoretically clarified. A corresponding conceptual model can then support or even enable empirical data collection and analysis and, above all, subsequent ethical analysis and evaluation. This paper, therefore, presents a value judgement model with its theoretical derivation. It also illustrates its application in an interview study of decision-making between animal experimentation and alternative methods in the context of biomedical research. Though the model itself can be theoretically deepened and extended, the application of the model works in general and helps to uncover what value judgements can enter into decision-making. However, the empirical methods, for example, qualitative interviews, can also be better oriented towards eliciting value judgements (as understood according to the model). Further applications of the model to other topics or by means of other empirical methods are conceivable. (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)

The state of the art of contemporary philosophy and psychiatry is reviewed. Section 1 describes the new field as an international open society of ideas. Section 2 introduces values-based practice. Although originally a philosophy-into-practice initiative, values-based practice is now developing more strongly in areas of bodily medicine such as surgery. An example from surgery illustrates how values-based practice has been implemented as a partner to evidence-based practice in supporting shared clinical decision-making as the basis of best (...) practice in contemporary person-centered clinical care. Section 3 explores the difficulties presented by implementing values-based practice in mental health as illustrated by a case example of anorexia. This shows that these difficulties derive from the particularly intense challenges of values pluralism presented by anorexia. The resources of phenomenology provide the basis for an effective response to these challenges. Section 4 generalizes the argument of Section 3 showing that an effective response to the wider range of challenges of values pluralism arising across the board in mental health is available from the resources of the international open society of ideas of contemporary philosophy and psychiatry. The article concludes with a promissory note on values and a cautionary note on science. (shrink)

This paper will examine the effects of gender, age, work experience, academic status and legality on certain ethical decisions. Six scenarios representing ethical dilemmas were presented to both undergraduate and MBA students in an attempt to determine if various demographic factors influenced ethical decision making. While some past studies have suggested that gender has an important effect on ethical decision making, this study does not completely support this conclusion and suggests that age and/or length of work (...) experience should be included in any study of ethical decision making.The legality of the decisions was determined and compared to the reason given by the students for their decisions. In some cases the choice made by a majority of the students was not the one that was supported by the legal authorities which suggests that there may be conflicts between the ethical system of the respondents and the behavior expected of them by society. (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 order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights (...) hinges on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)

Rationality in decision making is commonly assessed by comparing choice performance against normative standards. We argue that such a performance-centered approach blurs the distinction between rational choice and adaptive behavior. Instead, rational choice should be assessed with regard to the way individuals make analytic decisions. We suggest that analytic decisions can be made in two different modes in which control processes are directed at different levels. In a RUN mode, thought is directed at controlling the operation of a (...) decision strategy. In the JUMP mode, the individual analyses the interpretation of the decision situation as well as the appropriateness of alternative strategies. We suggest that a decision should be considered “rational” when an individual is able to switch between these modes and balance their interaction. (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)

The purpose of this study is to expand our understanding of the factors that influence ethical behavioral intentions of public accountants. Recent scandals have dominated the news and have caused legislators, regulators and the public to question the role of the accounting profession. Legislative changes have brought about major structural changes in the profession and continued scrutiny will surely lead to further changes. Thus, developing an understanding of the personal and contextual factors that influence ethical decisions is critical. An extension (...) of the theory of planned behavior [Ajzen, I.: 1985, Action Control-From Cognition to Behavior ], the model used in this study examined the influence of personal, social and organizational factors on ethical intentions. Specifically, the individual level model tested direct eects of attitudes, subjective norms, perceived behavioral control, moral sensitivity and ethical climate. Professionals from five accounting firms completed a survey that measured responses to ethical dilemmas related to the public accounting domain. To minimize the potential impact of common method bias, the survey instrument was administered in two phases. Hypotheses were evaluated using a structural modeling technique, partial least squares. Results show strong support for a direct relationship between attitudes and ethical intentions. The proposed direct eect of subjective norms was not supported. However, a significant relationship between subjective norms and attitudes was found. Professionals' attitudes towards ethical issues clearly influence intentions. Moreover, this study illustrates the potential influence of social factors in attitude formation. Future research should explore the factors in the public accounting domain that most strongly influence attitude formation. This study suggests that the theory of reasoned action oers a useful framework for exploring these issues. (shrink)

Moral pragmatism has been largely ignored in Business Ethics, despite its natural attraction and the fact that it is prominent in philosophy and socio-economic theories. The main premise of the book is that the complexity of today's business world does not permit a grand ethical theory, notwithstanding the different attempts made by scientists. Moral pragmatism is the 'go-to' approach where the ethical decision-making of managers varies dependent on different circumstances but it always integrates moral considerations. Ethical (...) class='Hi'>decision-making is no longer based simply on known rules, but entails the constant dynamic interaction of circumstances, the development of new rules, managers' past experiences, their knowledge concerning ethics, and skills of moral reasoning. This book interweaves the postmodern approach to management studies and, based on its innovative research, reintroduces moral pragmatism in Business Ethics. The combination of decision-making theories, philosophy and postmodernism paves the way for future novel research in Business Ethics, making it an excellent resource for researchers, academics, and advanced students in the field of Business Ethics. Practitioners, on the other hand, will benefit by improving their skills in ethical decision-making and leadership. (shrink)

Key legislations in many countries emphasize the importance of involving children in decisions regarding their own health at a level commensurate with their age and capacities. Research is engaged in developing tools to assess capacity in children in order to facilitate their responsible involvement. These instruments, however, are usually based on the cognitive criteria for capacity assessment as defined by Appelbaum and Grisso and thus ill adapted to address the life-situation of children. The aim of this paper is to revisit (...) and critically reflect upon the current definitions of decision-making capacity. For this purpose, we propose to see capacity through the lens of essential contestability as it warns us against any reification of what it means to have capacity. Currently, capacity is often perceived of as a mental or cognitive ability which somehow resides within the person, obscuring the fact that capacity is not just an objective property which can be assessed, but always operates within a dominant cultural framework that “creates” that same capacity and defines the threshold between capable and incapable in a specific situation. Defining capacity as an essentially contested concept means using it in a questioning mode and giving space to alternative interpretations that might inform and advance the debate surrounding decision-making. (shrink)

Should decision-making algorithms be held to higher standards of transparency than human beings? The way we answer this question directly impacts what we demand from explainable algorithms, how we govern them via regulatory proposals, and how explainable algorithms may help resolve the social problems associated with decision making supported by artificial intelligence. Some argue that algorithms and humans should be held to the same standards of transparency and that a double standard of transparency is hardly justified. (...) We give two arguments to the contrary and specify two kinds of situations for which higher standards of transparency are required from algorithmic decisions as compared to humans. Our arguments have direct implications on the demands from explainable algorithms in decision-making contexts such as automated transportation. (shrink)

This study investigates accounting students’ ethical decision-making judgments and behavioral intentions. The Multidimensional Ethics Scale (MES) was used to measure the extent to which a hypothetical behavior was consistent with three moral criteria (Moral Equity, Relativism and Contractualism). The study specifically tests the differences in ethical decision-making between students who have been exposed to a dedicated ethics unit of study compared with students who have not studied ethics. The influences of culture and gender on students’ ethical (...) decision-making are also addressed in the study. Ethical decision-making was assessed via three case studies describing moral dilemmas that an individual, business or professional person might face. The results provide support for the MES and the value added from incorporating a dedicated ethical decision-making unit in the accounting curriculum. The results also support prior evidence of gender bias and the impact of cultural differences on ethical decision-making. (shrink)

Teaching, irrespective of its geographical location, is fundamentally a relational practice in which unique ethically complex situations arise to which teachers need to respond at different levels of ethical decision-making. These range from ‘big’ abstract questions about whether or not what they teach is inherently good, through to seemingly trivial questions about everyday issues, for example whether or not it is right to silence children in classrooms. Hence, alongside a wide range of pedagogical skills, new teachers also need (...) to develop personal qualities, knowledge and understanding that will enable them to navigate successfully these professional ethical demands. ‘Philosophy for Teachers’, or ‘P4T’, is one promising approach to teachers’ pre-service professional preparation which has been piloted in England, adapted from the more familiar idea of ‘P4C’. Drawing on the model of learning through dialogue within a community of fellow enquirers, an ethical retreat was s... (shrink)

Ethical dilemmas require evaluation of alternatives in light of conflicting principles. Because of the difficulty of making and defending such complex decisions, we may compromise the quality of our ethical decisions and debates. We need a methodology that combines the weighted effects of multiple ethical guidelines on the issue at hand. This paper describes how the Analytic Hierarchy Process can help us improve ethical decision making.

Health care decision making for patients without decisional capacity is ethically and legally challenging. Advance directives (living wills) have proved to be of limited usefulness in clinical practice. Therefore, academic attention should focus more on substitute decision making by the next of kin. In this article, we comparatively analyse the legal approaches to substitute medical decision making in England and Germany. Based on the current ethico-legal discourse in both countries, three aspects of substitute (...) class='Hi'>decision making will be highlighted: (1) Should there be a legally predefined order of relatives who serve as health care proxies? (2) What should be the respective roles and decisional powers of patient-appointed versus court-appointed substitute decision-makers? (3) Which criteria should be determined by law to guide substitute decision-makers? (shrink)

This paper explores the practical consequences that Enlightenment ideals had on morality as it applies to clinical practice, using Alisdair MacIntyre's conceptualization and critique of the Enlightenment as its reference point. Taking the perspective of a practicing clinician, I critically examine the historical origins of ideas that made shared decision making (SDM) a necessary and ideal model of clinician-patient relationship. I then build on MacIntyre's critique of Enlightenment thought and examine its implications for conceptions of shared decision- (...) class='Hi'>making that use an Enlightenment justification, as well as examining contemporary threats to SDM that the Enlightenment made possible. I conclude by offering an alternative framing of SDM that fits with the clinician's duty to act on behalf of and along with patients but that avoids the tenuous Enlightenment assumptions that MacIntyre's work so vocally critiques. (shrink)

It is widely accepted in psychology and cognitive science that there are two “systems” in the mind: one system is characterized as quick, intuitive, perceptive, and perhaps more primitive, while the other is described as slower, more deliberative, and responsible for our higher-order cognition. I use the term “reflectivism” to capture the view that conscious reflection—in the “System 2” sense—is a necessary feature of good moral judgment and decision-making. This is not to suggest that System 2 must operate (...) alone in forming our moral decisions, but that it plays a normatively ineliminable role. In this paper, I discuss arguments that have been offered in defense of reflectivism. These arguments fit into two broad categories; let us think of them as two sides of a coin. On the first side are arguments about the efficaciousness of conscious reasoning—for example, without conscious deliberation we will make bad moral judgments and decisions. On the other side of the coin are arguments about the centrality of conscious deliberation to normative actions—for example, without conscious deliberation we are no more agential than animals or automatons. Despite their attractiveness, I argue that these arguments do not successfully establish that reflection is a necessary component of good moral judgment and decision-making. If I am right, the idea that good moral judgment and decision-making can result from entirely automatic and subconscious processes gains traction. My goal in this paper is to show that reflectivism fails to include the full range of cases of moral decision-making and that a theory of automaticity may do a better job. I briefly discuss at the end of the paper how an account of successful automatic moral judgment and decision-making might begin to take shape. (shrink)

The business landscape today is characterized by looming global challenges like natural disasters, war, and industrial accidents throughout the world. However, there is limited research on describing how businesses operate and cope in extreme environments and whether principles of ethical decision-making can be used as guidelines in such situations. To address this gap we describe and analyze organizational and business responses to three different extreme environments, namely the fall 2012 Gaza conflict, Hurricane Katrina in New Orleans, and the (...) so-called triple disasters in Japan on March 11, 2011. We discuss moral issues surrounding helping one another with specific reference to criteria called the Kew Garden Principles and strategic corporate social responsibility. We conclude the paper with managerial and leadership implications for ethical decision-making in extreme situations. (shrink)

Since its advent, predictive DNA testing has been perceived as a technology that may have considerable impact on the quality of people’s life. The decision whether or not to use this technology is up to the individual client. However, to enable well considered decision making both the negative as well as the positive freedom of the individual should be supported. In this paper, we argue that current professional and public discourse on predictive DNA-testing is lacking when it (...) comes to supporting positive freedom, because it is usually framed in terms of risk and risk management. We show how this ‘risk discourse’ steers thinking on the good life in a particular way. We go on to argue that empirical research into the actual deliberation and decision making processes of individuals and families may be used to enrich the environment of personal deliberation in three ways: (1) it points at a richer set of values that deliberators can take into account, (2) it acknowledges the shared nature of genes, and (3) it shows how one might frame decisions in a non-binary way. We argue that the public sharing and discussing of stories about personal deliberations offers valuable input for others who face similar choices: it fosters their positive freedom to shape their view of the good life in relation to DNA-diagnostics. We conclude by offering some suggestions as to how to realize such public sharing of personal stories. (shrink)

BackgroundHealth decisions occur in a context with omnipresent social influences. Information concerning what other patients decide may present certain interventions as more desirable than others.ObjectivesTo explore how physicians refer to what other people decide in conversations about the relevancy of cardio-pulmonary resuscitation or do-not-attempt-resuscitation orders.MethodsWe recorded forty-three physician–patient admission interviews taking place in a hospital in French-speaking Switzerland, during which CPR is discussed. Data was analysed with conversation analysis.ResultsReference to what other people decide in regards to CPR is used five (...) times, through reported speech. The reference is generic, and employed as a resource to deal with trouble encountered with the patient’s preference, either because it is absent or potentially incompatible with the medical recommendation. In our data, it is a way for physicians to present decisional paths and to steer towards the relevancy of DNAR orders. By calling out to a sense of membership, it builds towards the patient embracing norms that are associated with a desirable or relevant social group.ConclusionsIntroducing DNAR decisions in terms of what other people opt for is a way for physicians to bring up the eventuality of allowing natural death in a less overt way. Formulating treatment choices in terms of what other people do has implications in terms of supporting autonomous and informed decision making, since it nudges patients towards conformity with what is presented as the most preferable choice on the basis of social norms. (shrink)

Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and (...) with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be. (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)

Can findings from psychology and cognitive neuroscience about the neural mechanisms involved in decision-making can tell us anything useful about the commonly-understood mental phenomenon of making voluntary choices? Two philosophical objections are considered. First, that the neural data is subpersonal, and so cannot enter into illuminating explanations of personal level phenomena like voluntary action. Secondly, that mental properties are multiply realized in the brain in such a way as to make them insusceptible to neuroscientific study. The paper (...) argues that both objections would be weakened by the discovery of empirical generalisations connecting subpersonal properties with the personal level. It gives three case studies that furnish evidence to that effect. It argues that the existence of such interrelations are consistent with a plausible construal of the personal-subpersonal distinction. Furthermore, there is no reason to suppose that the notion subpersonal representation relied on in cognitive neuroscience illicitly imports personal-level phenomena like consciousness or normativity, or is otherwise explanatorily problematic. (shrink)