This is a new edition of a classic textbook in health care ethics, one that offers an alternative to the principle-based approach from Beauchamp and Childress (Principles of Biomedical Ethics, now in its seventh edition from OUP) and traditional Catholic approaches of Ashley and O'Rourke. In the early chapters Devettere spells out the meaning of ethics and the importance of prudential reasoning in seeking the good life. The rest of the book deals with issues and cases, including determinations of life (...) and death, reproduction and research and genetics, and the distribution of health care. In this fourth edition Devettere updates all chapters and adds new cases and new sections on the following: neuroscience, social psychology, overriding advance directives, studies on the fetus, the palliative care movement, cardiopulmonary resuscitation, pharmacists and reproductive issues, prenatal life and abortion, neonatal testing and mandatory vaccinations, the US governments' STD research in Guatemala, the emergence of biobanks, facial transplantations, genetic testing, legal issues around the Affordable Care Act, and more. This is an accessible and comprehensive textbook covering all aspects of the field. (shrink)

What kinds of things can we be morally responsible for? Andrew Khoury offers an answer that includes (i) an argument for the impossibility of blameworthiness for overt action, and (ii) the assertion that “willings are the proper object of responsibility in the context of action”. After presenting an argument for the inconsistency of Khoury’s answer to our focal question, I defend the following partial answer that resembles, but differs importantly from, Khoury’s answer: one can be blameworthy for a practical (...) decision—that is, an essentially intentional momentary mental action of forming an intention to do something that resolves prior felt unsettledness about what to do. (shrink)

Midwest Studies In Philosophy, EarlyView.

Say that a ‘practical decision’ is a momentary intentional mental action of intention formation. According to what I’ll call the ‘Decisional Prior Intention Thesis’, each practical decisio...

Say that a ‘practical decision’ is a momentary intentional mental action of intention formation. According to what I’ll call the ‘Decisional Prior Intention Thesis’ (‘DPIT’), each practical decision is intentional at least partly in virtue of the representational content of some previously acquired intention. DPIT is entailed by the following widely endorsed thesis that I’ll call the ‘General Prior Intention Thesis’ (‘GPIT’): each intentional action is intentional at least partly in virtue of the representational content of (...) some previously acquired intention. Alfred Mele argues that a certain kind of case impugns DPIT. I defend DPIT from Mele’s argument by showing that his focal case is impossible. I then develop a new argument for an important portion of DPIT – viz., the thesis that, necessarily, if at t you decide to A, then just before t you have an intention whose representational content enables it to play an intentionality-grounding role relative to an act of deciding to A. The defense of DPIT and argument for the indicated portion of it jointly foreground and shed new light on the phenomenon of practical unsettledness – i.e. the felt unsettledness about what to do that precedes a practical decision. (shrink)

_ Source: _Page Count 19 This paper offers an account of practical decisions. The author argues that decisions do not need to be conscious, nor do they need to be settled by deliberation. Agents can be mistaken about what they decided and agents can decide by doing some intentional action besides deliberating. The author argues that the functional role of a decision is to put an end to practical uncertainty. A mental event is a decision to (...) the extent that it ends practical uncertainty and to the extent that awareness of this causal role tends to reinforce that fact. This role is causal, but has systematic connections to consciousness. (shrink)

Presenting the most comprehensive and lucid account of the topic currently available, Robert Audi's "Practical Reasoning and Ethical Decision" is essential reading for anyone interested in the role of reason in ethics or the nature of human action. The first part of the book is a detailed critical overview of the influential theories of practical reasoning found in Aristotle, Hume and Kant, whilst the second part examines practical reasoning in the light of important topics in moral (...) psychology - weakness of will, self-deception, rationalization and others. In the third part, Audi describes the role of moral principles in practical reasoning and clarifies the way practical reasoning underlies ethical decisions. He formulates a comprehensive set of concrete ethical principles, explains how they apply to reasoning about what to do, and shows how practical reasoning guides moral conduct. (shrink)

Any theory of practical irrationality necessarily imposes a division of labour between an account of the agent's intentional states and how these are formed, and an account of how these intentional states get applied in particular circumstances to choose a particular action. Nevertheless, questions that concern the content of the agent's beliefs and desires are still routinely lumped together with questions that deal with the way the agent chooses in the light of these beliefs and desires. This generates a (...) number of pseudoproblems. Seeks to clarify some of them, by considering the internal structure of decision theory. (shrink)

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.

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well as (...) addressing current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

This book approaches ethical and legal issues in medicine from the patient's viewpoint and argues that many patients do not want the full burden of decision making that contemporary bioethics has thrust upon them.

Integrated approaches in the ethical decision-making (EDM) and practically wise decision-making literature are emerging as alternative perspectives to management theories that conceptualize decision-making in a rationalist and value-free manner. However, more dialogue between both perspectives and qualitative research that applies them is required. In addition, there is a need for empirical analysis on business engagement in the face of grand challenges in developing countries. This paper proposes an integrated practically wise EDM framework to study how Colombian councilors (...) who, in 2013, voted for or against the merger between the Colombian state-owned company UNE and the Swedish multinational Millicom interpret this decision and its public impact. Qualitative semi-structured interviews were conducted with a voluntary sample of 18 of 21 councilors. Supporters of the UNE-Millicom merger expressed open-mindedness, seeing the merger as a means to achieve justice. On the contrary, the merger’s opponents expressed circumspection, doubting that Millicom’s intentions really leaned toward justice. We conclude that practical wisdom—embodied by both supporters and detractors—fosters an understanding of EDM beyond what leaders should not do. It also includes a democratic and balanced deliberation on what leaders think they should do to promote the common good. (shrink)

Decision-making is a complex action requiring efficient information processing. Specifically, in movement in which performance efficiency depends on reaction time, e.g., open-loop controlled movements, these processes may play a crucial role. Information processing includes three distinct stages, stimulus identification, response selection, and response programming. Mainly, response selection may play a substantial contribution to the reaction time and appropriate decision making. The duration of this stage depends on the number of possible choices an individual has to “screen” to make (...) a proper decision. Given that reaction time is crucial in many sports, the possibilities of reducing it through practice are very tempting. The information processing and its relationship to the manner an individual is practicing are discussed. Especially the variability of practice issues will be explored. In variable practice conditions, an individual has to react to one or more stimuli and has to produce one of the many variations of the same movement or different movements they learned. One has to identify a stimulus appropriately and has to select a response optimally, i.e., choosing from as few choices as possible to reduce the reaction time. On the other hand, in constant practice conditions, an individual can be exposed to one or many stimuli. Still, there is only one variation of the movement that can be executed in the presence of a learned stimulus. Based on the information processing theory and the results of the research focusing on variability of practice, I discuss how the practice conditions may affect reaction time and, as a result, the decision-making process. I conceptually frame the possible implications of practice conditions on decision making related to information processing. In this review, a possible mechanism and relationship between practice conditions and decision-making are presented. Future research directions are presented. (shrink)

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.

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues (...) for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

The best interests principle is commonly utilized in acute care settings to assist with decision making about life-saving and life-sustaining treatment. This ethical principle demands that the decision maker refers to some conception of quality of life that is relevant to the individual patient. The aim of this article is to describe the factors that are required to be incorporated into an account of quality of life that will provide a morally justifiable basis for making a judgement about (...) the future quality of life, and therefore the best interests, of critically ill patients who are mentally incompetent. This account consists of three major components - pain and suffering, body functioning, and autonomy - and is applicable in situations where very limited information is available to guide decision making. This framework helps to make decisions about the provision of life-saving treatment that are as consistent as possible in all patient situations. (shrink)

BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care (...) in an acute hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)

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.

Regulatory science, which generates knowledge relevant for regulatory decision?making, is different from standard academic science in that it is oriented mainly towards the attainment of non?epistemic (practical) aims. The role of uncertainty and the limits to the relevance of academic science are being recognized more and more explicitly in regulatory decision?making. This has led to the introduction of regulation?specific scientific methodologies in order to generate decision?relevant data. However, recent practical experience with such non?standard methodologies indicates (...) that they, too, may be subject to important limitations. We argue that the attainment of non?epistemic values and aims (like the protection of human health and the environment) requires not only control of the quality of the data and the methodologies, but also the selection of the level of regulation deemed adequate in each specific case (including a decision about which of the two, under?regulation or over?regulation, would be more acceptable). (shrink)

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the (...) context of DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations. (shrink)

The conference entitled ‘Best Practices in Clinical Ethics Consultation and Decision-Making’, held in London 8–9 July 2010, was the first of its kind dedicated to identifying best practices in clinical ethics consultation and decision-making. Academics, health and social care professionals, clinical ethics committee members, lawyers, service users and carers from the UK, USA, Europe, Canada, Australia and Asia attended lectures, workshops, parallel paper sessions and clinical ethics case discussions across adult, maternity, children's, older persons, mental health and learning (...) disabilities settings. Seventy-eight best-practice points impacting on the quality of clinical ethics consultations and subsequent decisions were identified and grouped into eight themes: who tells the story; how the story is told; how the analysis, discussion and subsequent decisions are made; how values are weighted and balanced against one another; who decides; how the decision is made; how group dynamics and conflict are handled; how decisions are recorded. (shrink)

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 paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main problems usually keep us form acting and judging in a morally decent way: firstly, we make mistakes in moral reasoning. Secondly, even when we know how to act (...) and judge, we still fail to meet the requirements due to personal weaknesses. This discussion naturally leads us to another question: can we narrow the gap between what people are morally required to do and what they actually do? We discuss findings from neuroscience, economics, and psychology, considering how we might bring our moral behavior better in line with moral theory. Potentially fruitful means include nudging, training, pharmacological enhancement, and brain stimulation. We conclude by raising the question of whether such methods could and should be implemented. (shrink)

This book is an accessible, research-based introduction to behavioral ethics. Often ethics education is incomplete because it ignores how and why people make moral decisions. But using exciting new research from fields such as behavioral psychology, cognitive science, and evolutionary biology, the study of behavioral ethics uncovers the common reasons why good people often screw up. Chapters coordinate with free online teaching resources from The University of Texas at Austin. Scientists have long studied the ways human beings make decisions, but (...) only recently have researchers begun to focus specifically on ethical decision making. Unlike philosophy and religion, which aim to tell people how to think and act about various moral issues, behavioral ethics research reveals the factors that influence how people really make moral decisions. Most people get into ethical trouble for doing obviously wrong things. Aristotle cannot help, but learning about behavioral ethics can. By supplementing traditional approaches to teaching ethics with a clear, accessible, detailed, and research-based introduction to behavioral ethics, beginners can quickly become familiar with the important elements of this new field. This book includes the bonus of being coordinated with Ethics Unwrapped-a free, online, educational resource featuring award-winning videos and teaching materials on a variety of behavioral ethics (and general ethics) topics. This book is a useful supplement for virtually every ethics course, and important in any course where incorporating practical ethics in an engaging manner is paramount. The content applies to every discipline-journalism, business ethics, medicine, legal ethics, and others-because its chief subject is the nature of moral decision making. Because the book is research-based yet accessibly written with interesting studies, it could be used in high schools, colleges, graduate schools, and industry. (shrink)

This paper explores the relationship between thinking and decision-making. In the first part, the paper analyzes the process of thinking from three aspects – language, psychology, and behavior. It then proceeds to investigate the implications of different kinds of thinking ondecision-making. The final section of the paper raises some questions and concerns about the role of the scientific method in making decisions under conditions of uncertainty. The author offers specific examples from the book publishing business and the movie industry.

Business Ethics: A European Review, EarlyView.

Critical care nurses are key providers in a high acuity environment. This qualitative research study explored ethical decision making in a critical care practice setting. Fifteen critical care nurses with varying experience and education levels were purposively sampled to assure the representativeness of the data. The theoretical concepts of experiential learning, perspective transformation, reflection-in-action and principle-based ethics were used as a framework for eliciting information from the participants. A new model of focused reflection in ethical decision making was (...) developed. Findings showed that having a role model or mentor to help guide the ethical decision-making process was critical for focused ethical discourse and the decision making. (shrink)

The aim of this study is to examine the factors influencing ethical business decision-making on environmental issues, among employees of SMEs. To do so, a survey study was performed with 394 top managers of SMEs in the UAE using a questionnaire, and the data was statistically evaluated using SmartPLS 3.0. The results suggest that prior technology use has significant positive relationships with ethical decision-making and the level of risk acceptance. Furthermore, perceived competitive pressure has significant positive relationships with (...) ethical decision-making and confidence level. In comparison, the level of risk acceptance and confidence level have significant positive relationships with ethical decision-making. Results also demonstrate that the level of risk acceptance mediates the relationship between prior technology use and ethical decision-making. There is also a significant and positive association between perceived competitive pressure and ethical decision-making with a mediating impact of the confidence level. (shrink)

In general, the technical apparatus of decision theory is well developed. It has loads of theorems, and they can be proved from axioms. Many of the theorems are interesting, and useful both from a philosophical and a practical perspective. But decision theory does not have a well agreed upon interpretation. Its technical terms, in particular, ‘utility’ and ‘preference’ do not have a single clear and uncontroversial meaning. How to interpret these terms depends, of course, on what purposes (...) in pursuit of which one wants to put decision theory to use. One might want to use it as a model of economic decision-making, in order to predict the behavior of corporations or of the stock market. In that case, it might be useful to interpret the technical term ‘utility’ as meaning money profit. Decision theory would then be an empirical theory. I want to look into the question of what ‘utility’ could mean, if we want decision theory to function as a theory of practical rationality. I want to know whether it makes good sense to think of practical rationality as fully or even partly accounted for by decision theory. I shall lay my cards on the table: I hope it does make good sense to think of it that way. For, I think, if Humeans are right about practical rationality, then decision theory must play a very large part in their account. And I think Humeanism has very strong attractions. (shrink)

Objectives: To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end-of-life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies.Design and participants: Cross-sectional postal survey of doctors in Victoria.Results: 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the (...) definition of euthanasia.Conclusions: Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. (shrink)

Zur patientenorientierten Behandlung bei nichteinwilligungsfähigen Patienten werden aktuell der Einbezug oder auch die Entscheidung durch ein Ethikkonsil oder klinisches Ethikkomitee (KEK) gefordert. Damit die Entscheidung des Entscheidungsträgers durch das KEK unterstützt werden kann, müssen Zuständigkeiten, Besetzung und Arbeitsweise des Gremiums klar umschrieben sein.