In recent years, we have seen a new concern with ethics training for research and development professionals. Although ethics training has become more common, the effectiveness of the training being provided is open to question. In the present effort, a new ethics training course was developed that stresses the importance of the strategies people apply to make sense of ethical problems. The effectiveness of this training was assessed in a sample of 59 doctoral students working in the biological and social (...) sciences using a pre–post design with follow-up and a series of ethical decision-making measures serving as the outcome variable. Results showed not only that this training led to sizable gains in ethical decision making but also that these gains were maintained over time. The implications of these findings for ethics training in the sciences are discussed. (shrink)

This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion Tool—a (...) dialogical and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)

This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a (...) proper role for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated. (shrink)

This paper begins by reviewing dominant themes in current teaching of professional ethics in engineering education. In contrast to more traditional approaches that simulate ethical practice by using ethical theories to reason through micro-level ethical dilemmas, this paper proposes a pragmatic approach to ethics that places more emphasis on the practical plausibility of ethical decision-making. In addition to the quality of ethical justification, the value of a moral action also depends on its effectiveness in solving an ethical dilemma, (...) cultivating healthy working relationships, negotiating existing organizational cultures, and achieving contextual plausibility in everyday professional practice. This paper uses a cross-cultural ethics scenario to further elaborate how a pragmatic approach can help us rethink ethical reasoning, as well as ethics instruction and assessment. This paper is expected to be of interest to educators eager to improve the ability of engineers and other professional students to effectively and appropriately deal with the kinds of everyday ethical issues they will likely face in their careers. (shrink)

Dynamic Consent is both a model and a specific web-based tool that enables clear, granular communication and recording of participant consent choices over time. The DC model enables individuals to know and to decide how personal research information is being used and provides a way in which to exercise legal rights provided in privacy and data protection law. The DC tool is flexible and responsive, enabling legal and ethical requirements in research data sharing to be met and for online health (...) information to be maintained. DC has been used in rare diseases and genomics, to enable people to control and express their preferences regarding their own data. However, DC has never been explored in relationship to historical collections of bioscientific and genetic heritage or to contexts involving Aboriginal and Torres Strait Islander people.In response to the growing interest by First Peoples throughout Australia in genetic and genomic research, and the increasing number of invitations from researchers to participate in community health and wellbeing projects, this article examines the legal and ethical attributes and challenges of DC in these contexts. It also explores opportunities for including First Peoples' cultural perspectives, governance, and leadership as a method for defining DC on cultural terms that engage best practice research and data analysis as well as respect for meaningful and longitudinal individual and family participation. (shrink)

Experimental psychologists in the learning tradition stress the importance of three of the authors' four key variables of experimental design. We review research investigating the roles played by these variables in studies of choice from our laboratory. Supporting the authors' claims, these studies show that the effects of these variables are not fixed and should not be taken for granted.

Only in recent years have developmental psychologists begun advocating and exploring dual-process theories and their applicability to cognitive development. In this paper, a dual-process model of developments in two processing systems—an “analytic” and an “experiential” system—is discussed. We emphasise the importance of “metacognitive intercession” and developments in this ability to override experiential processing. In each of two studies of sunk cost decisions, age-related developments in normative decisions were observed, as were declines in the use of a “waste not” heuristic. In (...) the second study, children and adolescents were presented with arguments for normative and non-normative sunk cost decisions. Following argument evaluation, participants were re-presented the original problems and a set of novel, transfer problems. Results indicated that post-argument improvements were most apparent during adolescence. Age-related improvements were most noticeable on the transfer problems. In general, the findings suggest that the ability to metacognitively intercede (i.e., reflect on arguments; inhibit experientially produced responses) emerges towards middle adolescence. However, even by the end of adolescence, in the absence of significant contextual cues and motivation, this ability is infrequently utilised. (shrink)

This paper analyses managers'' moral decision-making, and studies the role of ethical theories in it by following the research tradition using the multidimensional ethics scale. The research question is: what kinds of ethical dimensions do Finnish business managers reveal when they are making moral decisions, and how have these dimensions changed in the 1990s? This question is answered by examining what kinds of factors emerge when the multidimensional ethics scale is used to analyse Finnish managers'' attitudes toward moral dilemmas. (...) The results show that Finnish managers'' decision-making reflects a variety of ethical theories. Teleological thinking is strongly emphasised by Finnish managers, and relativist thinking is used as well, but often combined with either deontology or justice thinking. In addition, a strong moralistic dimension emerged in Finnish managers'' decision-making. The analysis was carried out in two different surveys in years 1994 and 1999, and the results show that the ways of decision-making were more complex at the end of the 1990s than almost six years earlier. (shrink)

This essay seeks to link management action with business ethics. It utilizes two conceptual models of decision making to examine the important processes of information gathering and information processing. This analysis is then related to the ethical aspects of a business decision to help explain differences in the selection of ethical criteria.

This paper aims to contribute to the goal of finding influential legal precedents by quantitative methods. A lot of work has been made in this direction worldwide, especially in the context of common law jurisdictions. However, this type of work is extremely scarce in the Brazilian literature. In addition, our work also contributes to the research of network analysis and the law by applying these methods to unprecedented amount of data and narrowing our inquiry to a single law area, corporate (...) law. Furthermore, whereas most of the literature applying network analysis to judicial decisions had access to readily available data on the citations to precedent within each ruling, our raw data was nothing but the full text of decisions. We focus on data produced by the Superior Court of Justice, the highest court in Brazil for matters of federal law, including statutory interpretation of civil, criminal and corporate law. The Court issued an astonishing 282040 opinions tagged as related to corporate law between 2008 and 2018. This amount of cases is unparalleled internationally for superior courts and for studies in network analysis and law. In our results, we rank precedents quantitatively based on the citations they receive and make. We also qualitatively analyze some of the results, especially related to groups identified in the network with the Modularity algorithm. Our findings also reveal that corporate law jurisprudence in the STJ is quantitatively dominated by a few legal issues around one single theme that is only tangentially related to corporate law. That is, a type of contract used for the expansion of telephone landlines, which also allowed the consumer to become a shareholder of the telecommunication company. This comparison is especially pertinent because the utter lack of data on the quantitative weight of STJ precedents means the national literature has been operating in a void of objective measurements, one which has been filled with cherry-picked rulings and subjective ranking criteria. (shrink)

A new approach to environmental policy analysis is introduced that is designed to mitigate the exacerbation of environmental problems, which can result from the application of traditional approaches in environmental decision making. These approaches are problematic because they tend to rely on technical fixes, a single-discipline focus, and optimality. When such traditional approaches are applied, complex environmental problems are simplified beyond recognition, and the solution produced no longer matches the original problem. An alternative approach has been developed (...) at the U.S. Environmental Protection Agency (EPA) that is designed to improve the utilization of scientific research results and data (social, physical, and biological) through a more inclusive problem-solving process aimed particularly at difficult and complex environmental issues. Using a policy application pertaining to the EPA’s 1995 decision to approve a fuel additive, the authors illustrate how integrated environmental policy decision analysis can be made operational using this new approach. (shrink)

Decisions related to animal welfare standards depend on farmer’s multiple goals and values and are constrained by a wide range of external and internal forces. The aim of this paper is twofold, i.e., to develop a theoretical framework for farmers’ AW decisions that incorporates farmers’ goals, use and non-use values and to present an approach to empirically implement the theoretical framework. The farmer as a head of the farm household makes choices regarding production to maximize the utility of the (...) household. The overall utility of the farmer is determined by his multiple objectives. For the analysis of multi-objective problems, the multiple criteria decision - making paradigm provides an appropriate theoretical framework. However, theories from the field of social-psychology are needed to facilitate the identification of all relevant aspects in the decision making. The practical use of the conceptual framework is demonstrated using a simple numerical application of a multi-objective programming model. Two workshops were devoted to examining the scientific consistency and the practical usefulness of the approach. Implementing this approach will increase knowledge of the main factors and barriers that determine farmers’ decisions with regard to AW standards. This knowledge is relevant during the development of new AW concepts that aims to supply products that comply with above-legal AW standards for middle-market segments. (shrink)

The prevailing case study approach to teaching biomedical ethics is compared with a new methodology using short written exercises designed to develop decision making skills. Course content of this new approach and its adaptability to computer assisted instruction with student-faculty interactive software are outlined.

This book is about the ethical issues that clinicians encounter as they care for patients and is written to assist those who serve on hospital ethics committees as they deliberate about appropriate action in difficult ethical cases.

Book reviewed in this article: Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. By Albert R. Jonsen, Mark Siegler, and William J. Winslade.

Abstract A general framework is proposed for accommodating the recent results of studies into ?natural? decision making. A crucial element of this framework is the notion of a ?partial structure?, recently introduced into the semantic approach to scientific theories. It is through the introduction of this element that connections can be made with certain problems regarding inconsistency and rationality in general.

While there is much in Paul's letters that is hard to understand, his approach to ethical decision-making consistently reflects three characteristics It is God-centered, reality-bounded, and love-impelled, and all three are rooted in the trustworthy character and purposes of God.

The aim of this paper is to analyze an Intensive Care Unit case that required ethics consultation at a University Hospital in Northern Italy. After the case was resolved, a retrospective ethical analysis was performed by four clinical ethicists who work in different healthcare contexts. Each ethicist used a different method to analyze the case; the four general approaches provide insight into how these ethicists conduct ethics consultations at their respective hospitals. Concluding remarks examine the similarities and differences among the (...) various approaches and offer a reflection concerning the possibility of a shared resolution to the case. The authors’ efforts to come to a tentative consensus may serve as an example for professionals working in medical contexts that reflect an increasing pluralism of values. This article aims to respond to some of these concerns by illustrating how different methods in clinical ethics would be used when considering a real case. The goal is not to establish the best model on a theoretical level, but to learn from actual practice in order to see if there are common elements in the different methods, and to validate their pertinence to clinical ethics consultation. (shrink)

Multiprofessional teams have become in recent years one of the distinguishing features of services, where professionals with different competences work together. The core of our interest is addressed to the équipe of a palliative care ward; in particular, to that series of working activities that consists of communicative acts, as équipe meetings, for instance. Our research focuses on the analysis of the process by which the development of knowledge in multiprofessional practice is built to establish more information on recurrent patterns (...) in the interaction and connect them to the specific context that these are shaped by. In this sense we will underline how components of knowing are shared among team members in constructing medical prognosis and we will analyse the connection among language processes, cognitive activities and social structures. More specifically, we will study the role of language and the context in the definition of linguistic acts in cognitive activities and in hierarchies involved in decision-making processes by exploring and pointing out how it is organised and structured. In particular through the study of talk-in-interaction where interchange of information is realised, we will emphasise how, in the multiprofessional équipe meeting, the realisation of practices and the knowledge useful to collaborative management of ward working life are established. To reach this aim, we adopted an ethnographic approach connected to the analysis of the situated interaction. (shrink)

BackgroundWhether and how to disclose genomic findings obtained in the course of genomic clinical practice and medical research has been a controversial global bioethical issue over the past two decades. Although several recommendations and judgment tools for the disclosure of genomic findings have been proposed, none are sufficiently systematic or inclusive or even consistent with each other. In order to approach the disclosure/non-disclosure practice in an ethical manner, optimal and easy-to-use tools for supporting the judgment of physicians/researchers in genomic (...) medicine are necessary.MethodsThe bioethics literature on this topic was analyzed to parse and deconstruct the somewhat overlapping and therefore ill-defined key concepts of genomic findings, such as incidental, primary, secondary, and other findings. Based on the deconstruction and conceptual analyses of these findings, we then defined key parameters from which to identify the strength of duty to disclose (SDD) for a genomic finding. These analyses were then applied to develop a framework with the SDD matrix and systematic decision-making pathways for the disclosure of genomic findings.ResultsThe following six major parameters (axes), along with sub-axes, were identified: Axis 1 (settings and institutions where findings emerge); Axis 2 (presence or absence of intention and anticipatability in discovery); Axis 3 (maximal actionability at the time of discovery); Axis 4 (net medical importance); Axis 5 (expertise of treating physician/researcher); and Axis 6 (preferences of individual patients/research subjects for disclosure). For Axes 1 to 4, a colored SDD matrix for genomic findings was developed in which levels of obligation for disclosing a finding can be categorized. For Axes 5 and 6, systematic decision-making pathways were developed via the SDD matrix.ConclusionWe analyzed the SDD of genomic findings and developed subsequent systematic decision-making pathways of whether and how to disclose genomic findings to patients/research subjects and their relatives in an ethical manner. Our comprehensive framework may help physicians and researchers in genomic medicine make consistent ethical judgments regarding the disclosure of genomic findings. (shrink)

For those with advanced life-limiting illness, the optimization of quality of life and avoidance of nonbeneficial treatments at the end of life are key ethical concerns. This article evaluates the efficacy of an Interdisciplinary Ethics Panel (IEP) approach to decision making at the end of life for unbefriended nursing home residents who lack decisional capacity and have advanced life-limiting illness, through the use of a ninestep algorithm developed for this purpose. We reviewed the outcomes of three quality-of-care phased (...) initiatives conducted in our facility, a large public nursing home in New York City, between June 2016 and February 2020, which indicated that this IEP approach promoted advance-care planning, as palliative measures were endorsed to optimize quality of life for this vulnerable population at the end of life. We also examined another quality-of-care initiative when this IEP approach was applied to end-of-life decision making for nursing home residents who had a surrogate during the COVID-19 pandemic. This application appeared to be beneficial in adding more residents to our Palliative Care Program while it improved rates of advance-care planning. When all of the above findings are considered, we believe this novel IEP approach and algorithm have the potential to be applied elsewhere after appropriate assessment. (shrink)

The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient’s preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients’ treatment preferences. Hence, shared decision making leaves families with the stressful challenge of (...) identifying the patient’s preferred treatment option. To address this concern, the present paper proposes to incorporate the use of a “Patient Preference Predictor” (PPP) into the shared decision-making process between surrogates and clinicians. 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. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. (shrink)

Although machine intelligence is increasingly employed in healthcare, the realm of decision-making in medical ethics remains largely unexplored from a technical perspective. We propose an approach based on fuzzy cognitive maps (FCMs), which builds on Beauchamp and Childress’ prima-facie principles. The FCM’s weights are optimized using a genetic algorithm to provide recommendations regarding the initiation, continuation, or withdrawal of medical treatment. The resulting model approximates the answers provided by our team of medical ethicists fairly well and offers a (...) high degree of interpretability. Possible applications of such a system include informal guidance on medical ethics dilemmas as well as educational purposes. (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)

Recent work has shown that memory for various types of information associated with social targets (impressions based on behaviours and political ideology) influences decisions to approach or avoid those same targets. The current study was intended to better understand the extent that memory for other types of details associated with targets (beliefs and behaviours) affects subsequent approach/avoidance decisions. In this investigation, participants formed impressions of social targets represented by a picture and a sentence (a belief in Experiment 1; (...) either a belief or behaviour in Experiment 2). Later, memory for the impressions and sentences associated with each target was tested. Finally, participants decided whether they would want to approach or avoid each target. Results demonstrated that accurate memory strongly influenced approach/avoidance decisions for targets associated with different types of information (beliefs; behaviours), although there was no difference in the effect of memory between beliefs and behaviours. Overall, results suggest an important role of memory in decisions to approach or avoid others. (shrink)

Woiceshyn showed that leaders who exhibit rational egoistic behaviors not only make decisions that lead to organizational success, but that these decisions are also ethical. Woiceshyn’s ethical decision-making model consists of seven fundamental virtues associated with rational egoism: rationality, productiveness, justice, independence, honesty, integrity, and pride. In this paper, we define the rational egoism construct using a virtues-based ethical framework. We compare and contrast the seven virtues under rational egoism with alternative interpretations that arise under altruism, deontology, and teleology (...) in order to further refine the construct. Based on this analysis, we conceptualize rational egoism as a Type II second-order formative model and develop a scale based on the seven underlying virtues. Through the use of partial least squares path modelling, we validate this on a sample of 534 full-time American workers. We then demonstrate that this rational egoism construct has a strong, positive relationship to the transformational leadership construct. Implications for practice are discussed and areas for future study are suggested. (shrink)

In this paper we introduce a formalism for single-agent decision making that is based on Dynamic Argumentation Frameworks. The formalism can be used to justify a choice, which is based on the current situation the agent is involved. Taking advantage of the inference mechanism of the argumentation formalism, it is possible to consider preference relations, and conflicts among the available alternatives for that reasoning. With this formalization, given a particular set of evidence, the justified conclusions supported by warranted arguments (...) will be used by the agent’s decision rules to determine which alternatives will be selected. We also present an algorithm that implements a choice function based on our formalization. Finally, we complete our presentation by introducing formal results that relate the proposed framework with approaches of classical decision theory. (shrink)

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

In recent years, we have seen a new concern with ethics training for research and development professionals. Although ethics training has become more common, the effectiveness of the training being provided is open to question. In the present effort, a new ethics training course was developed that stresses the importance of the strategies people apply to make sense of ethical problems. The effectiveness of this training was assessed in a sample of 59 doctoral students working in the biological and social (...) sciences using a pre-post design with follow-up and a series of ethical decision-making measures serving as the outcome variable. Results showed not only that this training led to sizable gains in ethical decision making but also that these gains were maintained over time. The implications of these findings for ethics training in the sciences are discussed. (shrink)

Situations in which patients lack medical decision-making (MDM) capacity raise ethical challenges, especially when the patients decline care that their surrogate decision makers and/or clinicians agree is indicated. These patients are a vulnerable population and should receive treatment that is the standard of care, in line with their the values of their authentic self, just as any other patient would. But forcing treatment on patients who refuse it, even though they lack capacity, carries medical and psychological risks to (...) the patients and the hospital staff. It is also often impractical to force some treatments, especially in the long term. For example, independent of the ethical “should” question, how would one force hemodialysis for the rest of a patient’s life, or force a surgery that requires weeks of post-operative physical therapy? In this article we present a novel algorithm that can help clinicians with ethical and practical decision making, with the goals of achieving the best outcomes for patients and reducing moral distress for their caretakers and clinicians. (shrink)

A provocative Target Article in this issue of AJOB proposes a new approach to decision-making for babies born in the “gray-zone” at the margins of viability. Titled “Postponed Withholding: balanced...

This book is about the ethical issues that clinicians encounter as they care for patients and is written to assist those who serve on hospital ethics committees as they deliberate about appropriate action in difficult ethical cases.

New technologies and new ways of thinking have recently led to rapid expansions in the study of perceptual learning. We describe three themes shared by many of the nine articles included in this topic on Integrated Approaches to Perceptual Learning. First, perceptual learning cannot be studied on its own because it is closely linked to other aspects of cognition, such as attention, working memory, decision making, and conceptual knowledge. Second, perceptual learning is sensitive to both the stimulus properties of (...) the environment in which an observer exists and to the properties of the tasks that the observer needs to perform. Moreover, the environmental and task properties can be characterized through their statistical regularities. Finally, the study of perceptual learning has important implications for society, including implications for science education and medical rehabilitation. Contributed articles relevant to each theme are summarized. (shrink)