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)

An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease, involving dialysis or conservative care. Shared decision-making is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs (...) further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD. (shrink)

This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater (...) strategy use. Likewise, a positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed. (shrink)

Past research showed that the ability to focus on one’s internal states positively correlates with the self-regulation of behavior in situations that are accompanied by somatic and/or physiological changes, such as emotions, physical workload, and decision-making. The analysis of moral oriented decision-making can be the first step for better understanding the legal reasoning carried on by the main players in the field, as lawyers are. For this reason, this study investigated the influence of the decision (...) context and interoceptive manipulation on the moral decision-making process in the legal field gathering the responses of two groups of lawyers. A total of 20 lawyers were randomly divided into an experimental group, which was explicitly required to focus the attention on its interoceptive correlates, and a control group, which only received the general instruction to perform the task. Both groups underwent a modified version of the Ultimatum Game, where are presented three different moral conditions and three different offers. Results highlighted a significant increase of Acceptance Rate in those offers that should be considered more equal than fair or unfair ones, associated with a general increase of Reaction Times in the equal offers. Furthermore, the interoceptive manipulation oriented the Lawyers toward a more self-centered decision. This study shows how individual, situational, contextual, and interoceptive factors may influence the moral decision-making of lawyers. Future research in the so-called Neurolaw field is needed to replicate and expand current findings. (shrink)

In this paper, we theorize that the anticipation of guilt plays an important role in ethically questionable consumer situations. We propose an ethical decision-making framework incorporating anticipated guilt as partial mediator between consumers’ ethical beliefs (anteceded by ethical ideology) and intentions. In the first study, we compared several models using structural equation modeling and found empirical support for our research model. A second experiment was set up to illustrate how these new insights may be applied to prevent consumers (...) from taking advantage of the seller. Results showed that enhancing the anticipation of guilt (by making the interpersonal consequences of the unethical act more salient) increased consumers’ ethical intentions, controlling for ethical beliefs. Together these two studies might have important theoretical and managerial contributions. (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)

This paper explores, in the light of recent empirical results from neurobiology, some issues having to do with the contrast between “emotion” and “cognition” and the ways in which these figure in moral judgment and decision-making. The role of reward learning in emotional processing and the implications of this for "rationalist" moral theories is emphasized.

Whether anorexic patients should be able to refuse treatment when this potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of ‘terminal anorexia’ suggests criteria when a move to palliative care or even physician assisted suicide might be justified. I argue that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is in (...) conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision making capacity. It should therefore be rejected. (shrink)

The multiobjective optimization on the basis of ratio analysis method captures diverse features such as the criteria and alternatives of appraising a multiple criteria decision-making problem. At the same time, the multiple criteria problem includes a set of decision makers with diverse expertise and preferences. In fact, the literature lists numerous approaches to aid in this problematic task of choosing the best alternative. Nevertheless, in the MCDM field, there is a challenge regarding intangible information which is commonly (...) involved in multiple criteria decision-making problem; hence, it is substantial in order to advance beyond the research related to this field. Thus, the objective of this paper is to present a fused method between multiobjective optimization on the basis of ratio analysis and Pythagorean fuzzy sets for the choice of an alternative. Besides, multiobjective optimization on the basis of ratio analysis is utilized to choose the best alternatives. Finally, two decision-making problems are applied to illustrate the feasibility and practicality of the proposed method. (shrink)

Background Ethical decision-making education in nursing can be taught effectively by combining different teaching models that support the visualisation of taught concepts and integrating theory into practice. Objectives The study aims to examine the effect of flipped and jigsaw learning models on ethical decision-making and ethical sensitivity in nursing. Research design We used a nested mixed design. A pretest-posttest single-group quasi-experimental design was used in the quantitative part, and a case study method was used in the (...) qualitative part. Participants and research context This study was conducted in fall semester with second-year nursing students who studied an ethics course for the first time, using two different collaborative learning models. In the quantitative part, ethical dilemma and ethical sensitivity scales were made as pre-test with 117 and post-test with 128 students. In the qualitative part, a semi-structured three focus group interviews was conducted with 16 students. Ethical considerations After obtaining the approval of the University’s ethics committee, the study was carried out after obtaining participants’ informed written and verbal consent. Findings Students’ perspectives changed positively after training. This was related to six cases in section A of the Ethical Dilemma Scale. In part B, Practical Consideration (PC) and Principled Thinking (PT) mean scores were similar, showing no significant difference. For Familiarity in section C, it was determined that 68.4% of students in the pre-test and 77.3% in the post-test were familiar with similar dilemmas. The ethical sensitivity scale’s total scores were in a similar range. In the qualitative stage, ethical decision-making, ethical sensitivity, ethical dilemma and the improvement process were obtained as a theme. Conclusions There was an increase in the level of ethical sensitivity and familiarity with ethical dilemmas of nursing students after education. Flipped and jigsaw learning models can be used for nursing ethics courses. (shrink)

Recent evaluation of the practice of euthanasia and related medical decisions at the end of life in the Netherlands has shown a slight decrease in the frequency of physician-assisted death since the enactment of the Euthanasia Law in 2002. This paper focuses on the absence of euthanasia cases concerning patients with dementia and a written advance euthanasia directive, despite the fact that the only real innovation of the Euthanasia Law consisted precisely in allowing physicians to act upon such directives. The (...) author discusses two principal reasons for this absence. One relates to the uncertainty about whether patients with advanced dementia truly experience the suffering they formerly feared. There is reason to assume that they don’t, as a consequence of psychological adaptation and progressive unawareness (anosognosia). The second, more fundamental reason touches upon the ethical relevance of shared understanding and reciprocity. The author argues that, next to autonomy and mercifulness, “reciprocity” is a condition sine qua non for euthanasia. The absence thereof in advanced dementia renders euthanasia morally inconceivable, even if there are signs of suffering and notwithstanding the presence of an advance euthanasia directive. This does not mean, however, that advance euthanasia directives of patients with dementia are worthless. They might very well have a role in the earlier stages of certain subtypes of the disease. To illustrate this point the author presents a case in which the advance directive helped to create a window of opportunity for reciprocity and shared decision-making. (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)

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

Ethics consultation, while often a process of negotiation between diverse opinions, sometimes requires deeper moral inquiry. The form of such inquiry is suggested by classical casuistry and its attendant doctrine of probabilism.

Salespeople have long been considered unique employees. They tend to work apart from each other and experience little daily contact with supervisors and other organizational employees. Additionally, salespeople interact with customers in an increasingly complex and multifunctional environment. This provides numerous opportunities for unethical behavior which has been chronicled in the popular press as well as academic research. Much of the research in sales ethics has relied on conceptual foundations which focus on individual and organizational influencers on ethical decision (...) making. While significant, contributors to this research suggest that alternative theoretical perspectives and methods of investigation should be utilized and call for more research on the status of professional selling as a whole. We answer this call by exploring an alternative and complementary perspective based on the theory of occupational choice, social learning, and work groups to gain insight on how the sales profession evolves as its own subculture that extends beyond individual and organizational boundaries. First, we discuss the characteristics of the sales profession and empirically examine the relationship between typical individual and organizational factors and sales professionals’ perceptions of ethical behavior. Second, we offer a theoretical explanation that our findings may be due to how salespeople choose and are socialized into the subculture of the sales profession. Third, we examine this theoretical perspective via qualitative in-depth interviews with experienced sales professionals. Results and implications are discussed in terms of a sales profession code of ethics and future research directions. (shrink)

A recent qualitative study published in Neuroethics by Schembs and colleagues explores how functional neurodiagnostics of consciousness inform surrogate decision making in cases of disorders of consciousness. In this commentary, we argue that the chosen methodology significantly limits the scope of the potential conclusions and suggest an embedded ethnographic approach of co-presence as an alternative.

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow (...) physicians and internal medicine attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

The purpose of this paper is to develop an approach to multiattribute group decision making under interval-valued hesitant fuzzy environment. To do this, this paper defines some new operations on interval-valued hesitant fuzzy elements, which eliminate the disadvantages of the existing operations. Considering the fact that elements in a set may be interdependent, two generalized interval-valued hesitant fuzzy operators based on the generalized Shapley function and the Choquet integral are defined. Then, some models for calculating the optimal fuzzy (...) measures on the expert set and the ordered position set are established. Because fuzzy measures are defined on the power set, it makes the problem exponentially complex. To simplify the complexity of solving a fuzzy measure, models for the optimal 2-additive measures are constructed. Finally, an investment problem is offered to show the practicality and efficiency of the new method. (shrink)

What are the relations among wisdom, virtue, and expertise? Wisdom can be defined broadly as knowledge about how to live well. At the least, the task of living well requires some conception of what it means for a life to be _good_ as well as the knowledge and skill needed to actualize the good in one’s spheres of life. While this idea is easy to assert, it is difficult to examine empirically. This is because the scientific study of wisdom immediately (...) runs up against the challenge of the fact/value dichotomy. While psychological science seeks to study “what is”, the “wisdom” of any given decision, act or person is something that can only be assessed against some conception of the good. Thus, the study of wisdom calls on us to seek ways to bridge the fact/value dichotomy. In this paper, we pursue this goal. We suggest that the study of wisdom requires the integration of at least two forms of inquiry: psychological-empirical analyses of the development of knowledge and skills, and philosophical-conceptual inquiries into what it means to live a good life. In elaborating this approach, we first differentiate the concepts of _wisdom_, _wise decision-making_, and _wisdom-supporting skills_. Then we describe conceptual and _empirical_ tools for assessing the development of wisdom-supporting skills as well as an _evaluative_ framework for assessing the “wisdom” of any given act of decision-making. To illustrate these ideas, we report the results of a study demonstrating how the capacity for wise decision-making can be cultivated through participation in a program devoted to fostering the development of wisdom-supported skills. (shrink)

Building on research and measures on solitude, ethical leadership theories, and decision making literatures, we propose a conceptual model to better understand processes enabling ethical leadership neglected in the literature. The role of solitude as antecedent is explored in this model, whereby its selective utilization focuses inner directionality toward growing authentic executive awareness as a moral person and a moral manager and allows an integration between inner and outer directionality toward ethical leadership and resulting decision-making processes (...) that will have an impact on others’ perceptions of leader authentic ethical leadership. Thus it is proposed that utilization of solitude positively predicts executive-level authentic ethical leadership action and in turn, ethical decision making perceived fairness and integrity. We also propose two moderators, strengthening the hypothesized (positive) association between solitude and ethical leadership; these are the executive’s ability for moral reasoning and a motivation for socialized (as opposed to personalized) power. (shrink)

The aim of this paper is to define some new operation laws for the trapezoidal linguistic cubic fuzzy number and Hamming distance. Furthermore, we define and use the trapezoidal linguistic cubic fuzzy TOPSIS method to solve the multi criteria decision making (MCDM) method. The new ranking method for trapezoidal linguistic cubic fuzzy numbers (TrLCFNs) are used to rank the alternatives. Finally, an illustrative example is given to verify and prove the practicality and effectiveness of the proposed method.

Background The principle of respect for autonomy (PRA) is a central tenet of bioethics. In the quest for a global bioethics, it is pertinent to ask whether this principle can be applied as it is to cultures and societies that are devoid of the Western sociopolitical historical pressures that led to its emergence. Relational autonomists have argued for a more inclusive approach to patient autonomy which takes into account factors such as interdependency and social relations. However, at the outset of (...) any relational approach, it is necessary to identify underlying factors that influence patient autonomy in non-Western cultures. Objective To conduct a review of the literature to uncover the mechanisms through which social, cultural, and religious factors influence and impact the application of the PRA in healthcare decision-making in non-Western cultures and societies. Methods We conducted a systematic review through a comprehensive search of three major electronic databases of biomedical sciences. Returned citations were imported to Covidence, full texts were assessed for eligibility, included articles were thoroughly reviewed and data was synthesized. PRISMA guidelines were followed. Results Our search retrieved 590 non-duplicate results, 50 of which were included after screening and full-text eligibility checks. The included studies were predominantly qualitative in nature, with few quantitative, mixed-methods, and review studies included. Our synthesis of data identified nine key factors that influenced patients’ autonomous decision-making through cultural, social, religious, or intersectional pathways. Conclusion Two main conclusions emerge from this review. Firstly, there is a notable dearth of bioethical research examining the influence of diverse factors on patients’ inclination towards different conceptions of autonomy. Secondly, the analysis of prevalent collectivist cultures and deference of autonomy adds value to the solution-oriented relational autonomy debate. This raises questions regarding how decision-making can be truly autonomous in the presence of such large-scale factors, warranting further attention. (shrink)

ABSTRACT:In this article, we review and build on intergenerational and behavioral ethics research to consider how the motive to build a lasting legacy can impact ethical behavior in intergenerational decision making. We discuss how people can utilize their relationships to organizations to craft their legacies. Further, we elucidate how the legacy motive can enhance business ethics, incorporating theory and empirical findings from research on intergenerational decision making, generativity, and terror management theory to develop the legacy construct (...) and to outline the psychological underpinnings of motivations to leave a positive legacy. We discuss the ways in which legacies can provide a link between life-meaning and pro-social motivation, and we consider the ways in which individuals’ social environments can moderate the intensity of the legacy motive and can impact legacy-building behavior by determining the types of legacies that are valued. Finally, we highlight the implications of these ideas for ethical behavior and sustainable decision making in business contexts. (shrink)

This experiment examined the effects of three elements comprising Jones' (1991) moral intensity construct, (social consensus, personal proximity, and magnitude of consequences) in a cross-cultural comparison of ethical decision making within a human resource management (HRM) context. Results indicated social consensus had the most potent effect on judgments of moral concern and judgments of immorality. An analysis of American, Eastern European, and Indonesian responses also indicted socio-cultural differences were moderated by the type of HRM ethical issue. In addition, (...) individual differences in personal ethical ideology (relativism and idealism) varied reliably with moral judgments after controlling for issue characteristics and socio-cultural background. (shrink)

Bioethical dilemmas can emerge in research and clinical settings, from end-of-life decision-making to experimental therapies. The COVID-19 pandemic raised serious ethical challenges for healthcare organizations, highlighting the need to conduct needs assessments of the bioethics infrastructures of healthcare organizations. Clinical ethics committees (CECs) also create equitable policies, train staff on ethics issues, and play a consultative role in resolving the difficulty of complex individual cases. The main objective of this project was to conduct a needs assessment of the (...) bioethics infrastructure within a comprehensive hospital system. A cross-sectional anonymous online survey, including quantitative and qualitative formatted questions. The survey was sent to five key leaders from the organization’s hospitals. Survey questions focused on the composition, structure, function, and effectiveness of their facilities’ bioethics infrastructure and ethics-related training and resources. Positive findings included that most facilities have active CECs with multidisciplinary membership; CECs address critical issues and encourage team members to express clinical ethics concerns. Areas of concern included uncertainty about how CECs function and the process for resolving clinical ethics dilemmas. Most reported no formal orientation process for CEC members, and many said there was no ongoing ethics education process. The authors conclude that if CECs are a critical institutional resource where the practice of medicine and mission intersect, having well-functioning ethics committees with trained and oriented members demonstrates an essential commitment to the mission. The survey revealed that more needs to be done to bolster the bioethics infrastructure of this institution. (shrink)

One of the interesting research questions in multi-attribute decision-making is what affects the consideration of shared information between two alternatives. Previous studies have suggested two approaches in finding what characteristics of common features affect their consideration. Two bottom-up factors were found, but no top-down factors were discovered. In the current study, we followed the top-down approach and investigated how subjective importance of a common feature affects its consideration. In two studies, we consistently found that, on both the general (...) and individual level, the level of consideration increased with the SI of the common feature. This result provided a new explanation for the effect of common feature consideration and its individual difference; it also provided insights in explaining the underlying process of multi-attribute decision making. (shrink)

The visual behaviour of consumers buying products in a supermarket was measured and used to analyse the stages of their decision process. Traditionally metrics used to trace decision-making processes are difficult to use in natural environments that often contain many options and unstructured information. Unlike previous attempts in this direction, our methodology reveals differences between a decision-making task and a search task. In particular the second stage of a decision task contains more re-dwells than (...) the second stage of a comparable search task. This study addresses the growing concern of taking eye movement research from the laboratory into the ‘real-world’, so findings can be better generalised to natural situations. (shrink)

Earp et al. (2024) sketch a thought-provoking potential use of generative AI to enhance supported decision-making for adults who have lost capacity/competence to make their own medical decisions. T...

This paper discusses strategic decision making in firms pursuing biotechnology innovation and the influence of risk regulation on firm strategy. Data from three research projects, involving interviews with over 60 managers from agricultural and food related biotechnology companies and also over 60 key participants in the regulatory process in the UK and EC, shows a diversity of strategy and opinion. While some industry representatives identified new risk regulations governing the release of genetically manipulated organisms (GMOs) as the primary (...) constraint on biotechnology innovation, the findings of the study painted a more complex picture. The controversies surrounding the issue of risk regulation and its impact on innovation are best understood if viewed in the context of other political and economic factors. We conclude that the actual impact of risk regulation on industry strategies is probably less than the rhetoric of industry lobbyists would suggest. At the same time, the very act of lobbying so forcefully could lead to a public backlash against industry that would be much more damaging than the regulation itself. (shrink)

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy (...) the triggering conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

Self-disclosures on online social networks have received increased attention in the last two decades. Researchers from different disciplines investigated manifold influencing variables, and studies applied different theories to explain why many users share very sensitive and personal information despite potential risks and negative consequences, whereas others do not. Oftentimes, it is argued that self-disclosure decisions result from a kind of rational “calculus” of risks and benefits. However, such an assumption of rationality can and has been criticized. Nevertheless, fundamental cognitive and (...) affective mechanisms that underlie self-disclosure decision making on social networks are still under-explored. By building upon previous self-disclosure theories and models, dual-and tripartite-system perspectives of decision making, and former empirical findings, we propose a Tripartite Self-Disclosure Decision model that conceptualizes inner processes of online self-disclosure decision making. Central to this model is the proposed interaction of three neural and cognitive/affective systems: a reflective, an impulsive, and an interoceptive system. We further highlight individual and environmental features, which can impact individuals’ online self-disclosure decisions by influencing the proposed inner decision-making processes targeting the aforementioned three systems. Possible short- and long-term consequences are also discussed, which in turn can affect certain model components in subsequent self-disclosure decision situations. By taking such a neurocognitive perspective, we expand current research and models, which helps to better understand potentially risky information sharing on online social networks and can support attempts to prevent users from incautious self-disclosures. (shrink)

Owen, Freyenhagen, and Martin present a novel discussion of the meaning of decision-making capacity. They frame their discussion in the context of deficits in executive function after traumatic brain injury, but their observations and suggestions for expansion of how DMC is appropriately assessed have potential implications for people with other disorders that can potentially affect executive functioning, including those with certain forms of neurodegenerative conditions and some of those with serious mental illnesses such as schizophrenia or bipolar disorder....

As business environments become more complex and reliant on information systems, the decisions made by managers affect a growing number of stakeholders. This paper proposes a framework based on the application of normative theories in business ethics to facilitate the evaluation of IS related ethical dilemmas and arrive at fair and consistent decisions. The framework is applied in the context of an information privacy dilemma to demonstrate the decision making process. The ethical dilemma is analyzed using each one (...) of the three normative theories—the stockholder theory, stakeholder theory, and social contract theory. The challenges associated with the application of these theories are also discussed. (shrink)

Transtheoretical integrative decision-making models help clinicians to use patient factors that are known to predict outcomes in order to inform individualized treatment. Patient factors with a strong evidence base include: functional impairment, social support and interpersonal functioning, complexity and comorbidity, coping style, level of resistance, and subjective distress. Among those with binge-eating disorder (BED), patient factors have not been extensively characterized relative to norms or other clinical samples. We used an integrative decision-making model of these six (...) domains of patient factors related to patient outcomes to characterize a sample of 424 adult treatment-seeking patients with BED. Data were from medical charts, a demographics questionnaire, and validated psychometric scales. We then compared these data to published data from normative and other eating disorder (ED) samples. Results showed that the average patient with BED: (1) was significantly more functionally impaired compared to non-clinical norms but somewhat less impaired than other patients with ED, (2) demonstrated clinically significant problems in social support and interpersonal functioning, (3) presented with complex comorbid pathology and high levels of chronicity, (4) used a more internalizing coping style compared to the norm and other ED samples, (5) had low levels of resistance to interventions, and (6) experienced a moderately high level of subjective distress indicating good motivation for treatment. Corresponding recommendations to these findings are that the average patient with BED should be provided higher intensity treatment that is longer in duration, interpersonally-focused, directive in nature, and emphasizing self-reflection and insight. Despite the nomothetic nature of the findings, clinicians are encouraged to assess these patient domains in order to come to an ideographic case conceptualization and to tailor precision treatment to the individual patient with BED. (shrink)

This study focused on the influence of American and Chinese cultures on consequentialism orientation in decision-making within the broader context of psychologists’ academic roles and responsibilities. In addition, this study hypothesized that educational level would affect culturally influenced ethical decision making in both cultures. Based on the American Psychological Association Ethics Code, 20 ethical scenarios in 5 domains in psychology were created and used to examine the influence of culturally ethical beliefs on psychologists’ decision (...) class='Hi'>making among 181 participants. The results indicated that significant cultural differences in consequentialism orientation differentiated Chinese and American participants and influenced their resolution of ethical issues. (shrink)