It has been argued by disability advocates that supported decision-making must replace surrogate, or substituted, decision-making for people with cognitive disabilities. From a moral perspective surrogate decision-making it is said to be an indefensible form of paternalism. At the heart of this argument against surrogate decision-making is the belief that such paternalistic action expresses something fundamentally disrespectful about those upon whom it is imposed: that they are inferior, deficient or child-like in some way. Contrary to this widespread belief, I (...) will argue that surrogate decision-making sometimes expresses more respect for people with life-long, ‘severe’ or ‘profound’ cognitive disabilities than does the adoption of supported decision-making.. Specifically, I argue that in some cases supported decision-making can arguably express that people with severe or profound cognitive disabilities lack equal moral value. I also argue that supported decision-making for people with profound cognitive disabilities can arguably express that they lack complex and rich inner lives. If our aim is to ensure our behaviour and practices express respect for people with life-long ‘severe’ or ‘profound’ cognitive disabilities, then sometimes surrogate rather than supportive decision-making will be a better option. (shrink)

In their thoughtful and rigorous article, Peterson and colleagues extend an account of supported decision-making that was originally developed for people with static cognitive impairments, t...

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making (...) would be better understood as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the (...) necessary conditions of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research. (shrink)

Peterson, Karlawish, and Largent’s “Supported Decision Making with People at the Margins of Autonomy” brings welcome attention to the rights of people with cognitive impairment and provides...

The mental prosthesis model (Silvers and Francis 2009) suggests that interpersonal “prosthetic” thinking could support decision making for people with limited cognitive capacities, and positions th...

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Article 12 (Equal Recognition before the Law) of the UN Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities: the recognition of legal capacity. Legal capacity means recognizing the right to make decisions for oneself. Article 12 is also moving in the direction of supported decision-making, as an (...) alternative to substituted decision-making. The objective of this paper is to show conceptually the connection between supported decisionmaking and the preservation of personal autonomy for persons with intellectual disabilities. This paper discusses supported decision-making based on Bach and Kerzner's model: (a) legally independent status, (b) supported decision- making status, and (c) facilitated decision-making status. Arguments will be made based on John Stuart Mill's concept of autonomy and arguments against it using Sarah Conly's argument for paternalism. (shrink)

Peterson, Karlawish and Largent offer a defense of supported decision making in health care for people with dynamic and diminishing capacity. They are to be warmly commended for bringing sup...

People with cognitive impairments often have difficulties formulating, understanding, or articulating decisions that others judge reasonable. The frequent response shifts decision-making authority to substitutes through advance directives of the person or guardianship orders from a court. The Convention on the Rights of People with Disabilities defends supported decision-making as an alternative to such forms of supplanted decision-making. But supported decision-making raises both metaphysical questions—what is required for a decision to be the person’s own?—and epistemological questions: how do (...) we know what persons judge to be their good, when they have difficulty conceptualizing and articulating? It raises practical questions, too, such as protection against risks of exploitation. This article uses a non-discrimination account of legal personhood drawn from the CRPD to explore how common features of decisions employed by people without cognitive disabilities are important in supported decision-making too. These features include prostheses, guardrails, relationships, and social contexts. (shrink)

Supported decision-making, a process by which people who might otherwise be unable to make their own decisions do so with help from other people, is rapidly gaining attention as an alternative to g...

In their article, “Supported Decision Making with People at the Margins of Autonomy,” Peterson, Karlawish, and Largent point to the fact that the concept of ‘supported decision-making’ has recently...

In their article, Navin, Brummett, and Wasserman (2022) advance the idea that there are qualitatively different types of decision-making capacity (DMC) for treatment refusals. Departing from what t...

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Adults with intellectual disabilities are characterized by the limitations in their intellectual functioning and in their adaptive behavior, which compromises three skill types, and this starts before the age of 18. Though persons with intellectual disabilities are characterized by having these limitations, they are thought to face significant decisionmaking challenges due to their disability. Moving away from this (...) generalization, Article 12 of the United Nations Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities, recognizing the right to legal capacity. (shrink)

Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

Supported decision making is a model of decision making in which an adult with impaired capacity enters freely into an agreement with a closely trusted person or persons (the “s...

McCarthy and Howard (2023) advocate for supported decision making for patients with intellectual and developmental disabilities (IDD). Departing from the “mental prosthesis” model of supported deci...

In a compelling article, Peterson, Karlawish and Largent argue that supported decision-making is preferable to substitute decision-making for people with dynamic impairments. We fully...

Discussion of supported decision making has been dominated by legal scholars, philosophers, and advocates for persons with disabilities. Peterson et al.’s primary contribution is introducing...

Peterson, Karlawish, and Largent’s “Supported Decision Making with People at the Margins of Autonomy” not only elucidates the conceptual framework but also the practical importance of suppor...

Volume 20, Issue 8, August 2020, Page 88-90.

A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict (Not...

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on (...) class='Hi'>supported decision-making. Thirty-six interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on (...) class='Hi'>supported decision-making. Thirty-six interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

In their fine overview of supported decision making for persons with dynamic cognitive and functional impairments “at the margins of autonomy,” Peterson, Karlawish, and Largent query whether...

The United Nations Convention on the Rights of Persons with Disabilities urges and requires changes to how signatories discharge their duties to people with intellectual disabilities, in the direction of their greater recognition as legal persons with expanded decision-making rights. Australian jurisdictions are currently undertaking inquiries and pilot projects that explore how these imperatives should be implemented. One of the important changes advocated is to move from guardianship models to supported or assisted models of decision-making. A driving force behind (...) these developments is a strong allegiance to the social model of disability, in the formulation of the Convention, in inquiries and pilot projects, in implementation and in the related academic literature. Many of these instances suffer from confusing and misleading statements and conceptual misinterpretations of certain elements such as legal capacity, decision-making capacity, and support for decision-making. This paper analyses some of these confusions and their possible negative implications for supported decision-making instruments and those whose interests these instruments would serve, and advises a more incremental development of existing guardianship regimes. This provides a more realistic balance between neglecting the real limits of those with mental disabilities and thereby ignoring their identity and particularity, and continuing to bring them equally and fully into society. (shrink)

We join McCarthy and Howard (2023) in advocating supported decision-making for patients with diminished mental capacity that meaningfully expands the role of trustees beyond merely channeling the i...

Methodological strategies for the identification and synthesis of ‘evidence’ to support decision‐making in relation to complex healthcare systems and practices This paper addresses the limitations of current methods supporting ‘evidence‐based health‐care’ in relation to complex aspects of care, including those questions that are best supported by descriptive or non‐empirical evidence. The paper identifies some new methods, which may be useful in aiding the synthesis of data in these areas. The methods detailed are broadly divided into those that facilitate the (...) identification of evidence and those that enable the interpretation of the data retrieved. To illustrate some of the issues involved, reference is made to a multimethod review recently completed by the authors, which aimed to identify factors that promote continuity in the transition from child to adult health and social care. It is argued that as healthcare organisations are becoming increasingly preoccupied with the evidence base of practice, such methods may help ensure that aspects of care and approaches that are outside the dominant pharmaco‐medical domain maintain a prominent position on the healthcare agenda while remaining open to external scrutiny. Healthcare professionals who use such approaches need to know their relative utility and benefits to inform clinical decisions, so as to ensure that best practice is observed. (shrink)

McCarthy and Howard (2023) present a “Non-Domination” approach to supported decision-making, specially to help intellectually and developmentally disabled (IDD) patients rather than “Mental Prosthe...

This paper aims to identify the decision support systems and their role on the strategic management development in the Universities- Case Study: Islamic University of Gaza. The descriptive approach was used where a questionnaire was developed and distributed to a stratified random sample. (230) questionnaires were distributed and (204) were returned with response rate (88.7%). The most important findings of the study: The presence of a statistically significant positive correlation between the decision support systems and strategic management in the Islamic (...) University in Gaza, and this shows that there is a role for decision support systems in strategic management development. The senior management is convinced of the importance of strategic management of the organization, and this conviction paid to clearly understand the process of the development of strategic management and thus led to a commitment to this process to improve its performance. There is an impact on the strategic management of the capabilities available for the use of decision support systems, and the type of decision support systems used, while there is little effect of top management support for the use of decision support systems. Also, the results showed that there were no statistically significant differences between the averages of the respondents answers attributed to personal data. The research also concluded a series of recommendations: The Islamic University of Gaza need to develop its infrastructure of decision support systems when it develops the strategic management. It should increase its interest in organizational potential through the necessity of a separate unit for decision support systems. As well as increased interest in the physical and technical capabilities available to decision support systems through continuity in keeping pace with technological means and techniques, continued support of senior management in the organization of strategic management for its positive role on decision support systems, that senior management will continue in the organization in creating a culture of strategic management, and it should encourage employees to participate in the strategic management process. (shrink)

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision-making (...) around cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

Pickering et al. argue that judgments of competence should in part be based on the harm that could result from the decision. The centerpiece of their reasoning is that it is inconsistent...

With the rise and public accessibility of AI-enabled decision-support systems, individuals outsource increasingly more of their decisions, even those that carry ethical dimensions. Considering this trend, scholars have highlighted that uncritical deference to these systems would be problematic and consequently called for investigations of the impact of pertinent technology on humans’ ethical decision-making. To this end, this article conducts a systematic review of existing scholarship and derives an integrated framework that demonstrates how intelligent decision-support systems (IDSSs) shape humans’ ethical (...) decision-making. In particular, we identify resulting consequences on an individual level (i.e., deliberation enhancement, motivation enhancement, autonomy enhancement and action enhancement) and on a societal level (i.e., moral deskilling, restricted moral progress and moral responsibility gaps). We carve out two distinct methods/operation types (i.e., processoriented and outcome-oriented navigation) that decision-support systems can deploy and postulate that these determine to what extent the previously stated consequences materialize. Overall, this study holds important theoretical and practical implications by establishing clarity in the conceptions, underlying mechanisms and (directions of) influences that can be expected when using particular IDSSs for ethical decisions. (shrink)

Machine learning-driven clinical decision support systems (ML-CDSSs) seem impressively promising for future routine and emergency care. However, reflection on their clinical implementation reveals a wide array of ethical challenges. The preferences, concerns and expectations of professional stakeholders remain largely unexplored. Empirical research, however, may help to clarify the conceptual debate and its aspects in terms of their relevance for clinical practice. This study explores, from an ethical point of view, future healthcare professionals’ attitudes to potential changes of responsibility and decision-making (...) authority when using ML-CDSS. Twenty-seven semistructured interviews were conducted with German medical students and nursing trainees. The data were analysed based on qualitative content analysis according to Kuckartz. Interviewees’ reflections are presented under three themes the interviewees describe as closely related: (self-)attribution of responsibility, decision-making authority and need of (professional) experience. The results illustrate the conceptual interconnectedness of professional responsibility and its structural and epistemic preconditions to be able to fulfil clinicians’ responsibility in a meaningful manner. The study also sheds light on the four relata of responsibility understood as a relational concept. The article closes with concrete suggestions for the ethically sound clinical implementation of ML-CDSS. (shrink)

Freedom of information laws promote transparency by permitting individuals and organizations to obtain government documents. However, exemptions from disclosure are necessary to protect privacy and to permit government officials to deliberate freely. Deliberative language is often the most challenging and burdensome exemption to detect, leading to high processing costs and delays in responding to open-records requests. This paper describes a novel deliberative-language detection model trained on a new annotated training set. The deliberative-language detection model is a component of a decision-support (...) system for open-records requests under the US Freedom of Information Act, the FOIA Assistant, that ingests documents responsive to an open-records requests, suggests passages likely to be subject to deliberative language, privacy, or other exemptions, and assists analysts in rapidly redacting suggested passages. The tool’s interface is based on extensive human-factors and usability studies with analysts and is currently in operational testing by multiple US federal agencies. (shrink)

Background Non-invasive prenatal testing (NIPT), which can screen for aneuploidies such as trisomy 21, is being implemented in several public healthcare systems across Europe. Comprehensive communication and information have been highlighted in the literature as important elements in supporting women’s reproductive decision-making and addressing relevant ethical concerns such as routinisation. Countries such as England and France are adopting broadly similar implementation models, offering NIPT for pregnancies with high aneuploidy probability. However, we do not have a deeper understanding of how professionals’ (...) counselling values and practices may differ between these contexts. Methods In this paper, we explore how professionals in England and France support patient decision-making in the provision of NIPT and critically compare professional practices and values. We draw on data from semi-structured interviews with healthcare professionals. Results Both English and French professionals emphasised values relating to patient choice and consent. However, understandings and application of these values into the practice of NIPT provision differed. English interviewees placed a stronger emphasis on interpreting and describing the process of counselling patients and clinical care through a “principle” lens. Their focus was on non-directiveness, standardisation, and the healthcare professional as “decision-facilitator” for patients. French interviewees described their approach through a “procedural” lens. Their focus was on formal consent, information, and the healthcare professional as “information-giver”. Both English and French professionals indicated that insufficient resources were a key barrier in effectively translating their values into practice. Conclusion Our findings illustrate that supporting patient choice in the provision of NIPT may be held as an important value in common on a surface level, but can be understood and translated into practice in different ways. Our findings can guide further research and beneficially inform practice and policy around NIPT provision. (shrink)

Decision makers in banking, insurance or employment mitigate many of their risks by telling “good” individuals and “bad” individuals apart. Laws codify societal understandings of which factors are legitimate grounds for differential treatment —or are considered unfair discrimination, including gender, ethnicity or age. Discrimination-aware data mining implements the hope that information technology supporting the decision process can also keep it free from unjust grounds. However, constraining data mining to exclude a fixed enumeration of potentially discriminatory features is insufficient. We argue (...) for complementing it with exploratory DADM, where discriminatory patterns are discovered and flagged rather than suppressed. This article discusses the relative merits of constraint-oriented and exploratory DADM from a conceptual viewpoint. In addition, we consider the case of loan applications to empirically assess the fitness of both discrimination-aware data mining approaches for two of their typical usage scenarios: prevention and detection. Using Mechanical Turk, 215 US-based participants were randomly placed in the roles of a bank clerk or a citizen / policy advisor. They were tasked to recommend or predict the approval or denial of a loan, across three experimental conditions: discrimination-unaware data mining, exploratory, and constraint-oriented DADM. The discrimination-aware tool support in the eDADM and cDADM treatments led to significantly higher proportions of correct decisions, which were also motivated more accurately. There is significant evidence that the relative advantage of discrimination-aware techniques depends on their intended usage. For users focussed on making and motivating their decisions in non-discriminatory ways, cDADM resulted in more accurate and less discriminatory results than eDADM. For users focussed on monitoring for preventing discriminatory decisions and motivating these conclusions, eDADM yielded more accurate results than cDADM. (shrink)

Physicians and other healthcare professionals are increasingly finding ways to use artificial intelligent decision support systems in their work. IBM Watson Health, for example, is a commercially available technology that is providing AI-DDS services in genomics, oncology, healthcare management and more.1 AI’s ability to scan massive amounts of data, detect patterns, and derive solutions from data is vastly more superior than that of humans. AI technology is undeniably integral to the future of healthcare and public health, and thoughtful consideration of (...) the legal, ethical and moral issues surrounding this technology is a must. The authors of the article, Responsibility, Second Opinions, and Peer-Disagreement—Ethical and Epistemological Challenges of Using AI in Clinical Diagnostic Contexts, provide an informed discussion of how AI-DSS may be used, both practically and ethically, to assist healthcare professionals in cooperative diagnostic processes2. The authors propose a process, whereby AI-DSS would provide a physician a second opinion, and when there is a mismatch between opinions, another physician would provide a third opinion. This approach maintains a ‘physician-in-charge’ perspective, and suggests that decision-making must ultimately be made by a person. This approach is also consistent with the ‘physician in-the-loop’ concept, such that even when increasingly autonomous AI-DSSs are put to use, physicians will still be providing checks and overseeing clinical decisions. The authors conceptualise AI as a replacement of human cognitive labour. That is, AI is used to supplant a human professional in particular functions …. (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)

This study compares computer-supported groups, i.e., groups using group support systems (GSS), and face-to-face groups using ethical decision-making tasks. A laboratory experiment was conducted using five-person groups of information systems professionals. Face-to-face (FTF) and GSS groups were compared in terms of their decision outcomes and group members' reactions. The results revealed that computer-supported and face-to-face groups showed no significant difference in terms of the decision outcomes of choice shift and decision polarity. However, FTF groups reached their decisions (...) more quickly and they were more successful in attaining group consensus than GSS groups. Subjects evaluated face-to-face communication more favorably than GSS interaction on most post-group measures related to perceived group processes and satisfaction. Despite these outcomes, some possibilities for using GSS technology in an ethical decision making context are examined. (shrink)

Regional planning has been regarded as a design activity. Usually planners focus on physical design rather than on societal issues. Nowadays, mass communication, environmental issues and social awareness lead to often complex and conflicting needs and interests of the public in regional planning. This paper focuses on the regional planning as a group problem solving process from the view of information processing. It offers an analysis of the causes of conflicts in the group decision process, and defines the characteristics of (...) group decision process support systems. (shrink)

The article presents an approach to the formation of a decision support system in the management of energy consumption of production technological systems. Such systems allow the company to detect and respond in a timely manner to the appearance of hidden energy losses, to carry out organizational measures aimed at energy saving and to optimize the timing and scope of repair and restoration work. The approach is based on the modeling of stationary sections of energy consumption, presented in the form (...) of precedents, their accumulation and subsequent analysis in the space of influential technological parameters. In addition to the base of precedents, the system includes software modules for assessment and formation of the profile of hidden energy losses, modules of technical condition, forecast and formation of precedents. The analysis of precedents consists in the selection of similar cases of energy consumption, the formation of efficient energy consumption functions and the calculation of energy losses with its help. Hidden energy losses can be calculated in real time for all technological systems of the enterprise. This allows you to build a profile of energy losses of the enterprise. The advantage of this approach in comparison with the known ones is that it allows to adapt to technological systems with different energy sources. The article emphasizes that the method can work with the energy manager with both linear and nonlinear dependence of energy consumption on process parameters. However, the limitations of this approach are noted. Thus, the determination of latent energy losses and technical condition of the equipment requires the participation of qualified specialists of the enterprise, who must be able to analyze the results and propose measures to eliminate energy losses. (shrink)

Human decisions are increasingly supported by decision support systems (DSS). Humans are required to remain “on the loop,” by monitoring and approving/rejecting machine recommendations. However, use of DSS can lead to overreliance on machines, reducing human oversight. This paper proposes “reflection machines” (RM) to increase meaningful human control. An RM provides a medical expert not with suggestions for a decision, but with questions that stimulate reflection about decisions. It can refer to data points or suggest counterarguments that (...) are less compatible with the planned decision. RMs think against the proposed decision in order to increase human resistance against automation complacency. Building on preliminary research, this paper will (1) make a case for deriving a set of design requirements for RMs from EU regulations, (2) suggest a way how RMs could support decision-making, (3) describe the possibility of how a prototype of an RM could apply to the medical domain of chronic low back pain, and (4) highlight the importance of exploring an RM’s functionality and the experiences of users working with it. (shrink)

Amy E. Caruso Brown (2022) considers situations in which a minor child’s parent or legal guardian (the “marginalized decision-maker (MDM)”) defers to another individual (the “primary decision-maker...