Background:The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied.Purpose:This study examined the moral experiences of caregivers related to challenging behaviours’ management and alternatives to control measures.Research design:Using Charles Taylor’s hermeneutic framework, a 2-month focused ethnography with a participatory (...) approach was used.Participants and research context:Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity.Ethical considerations:The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants.Findings:By accounting for caregivers’ moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver’s vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures.Discussion:A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability.Conclusion:The recognition of caregiver’s vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers’ self-concern can be understood as fostering mutual respect. (shrink)

The classical theory of preference among monetary bets represents people as expected utility maximizers with concave utility functions. Critics of this account often rely on assumptions about preferences over wide ranges of total wealth. We derive a prediction of the theory that bears on bets at any fixed level of wealth, and test the prediction behaviorally. Our results are discrepant with the classical account. Competing theories are also examined in light of our data.

“Futility” is a word which means the absence of benefit. It has been used to describe an absence of utility in resuscitation endeavours but it fails to do this. Futility does not consider the harms of resuscitation and we should consider the balance of benefit and harm that results from our resuscitation endeavours. If a resuscitation is futile then any harm that ensues will bring about an unfavourable benefit/harm balance. However, even if the endeavour is not futile, by any definition, (...) the benefit/harm balance may still be unfavourable if the harms that ensue are great.It is unlikely that we will ever achieve a consensus definition of futility and certainly not one that is applicable to every patient undergoing resuscitation. In the meantime our use of the term “futile”, in the mistaken belief that it tells us whether it is worth resuscitating or not, has no utility as it will never succeed in telling us this. Furthermore we risk causing offence by use of the term and we risk harming the patient's autonomy by using futility as an overriding force. Instead we should consider the utility of our endeavours, for which an assessment of the harms of resuscitation should be added to our considerations of its benefit. This balance of benefit and harm should then be evaluated as best it can be from the patient's perspective. The words futile and futility should be abandoned by resuscitationists. (shrink)

This paper axiomatizes a recursive utility model that captures both intertemporal utility smoothing defined across time and ambiguity aversion defined over states. The resulting representation adapts Wakai model of intertemporal utility smoothing as an aggregator function, where the utility of the certainty equivalent of future uncertainty is computed by Gilboa and Schmeidler multiple-priors utility. The model also permits the separation of intertemporal utility smoothing from ambiguity aversion.

A principal source of interest in behavioral economics has been its advertised contributions to policies aimed at ‘nudging’ people away from allegedly natural but self-defeating behavior toward patterns of response thought more likely to improve their welfare. This has occasioned controversies among economists and philosophers around the normative limits of paternalism, especially by technical policy advisors. One recent suggestion has been that ‘boosting,’ in which interventions aim to enhance people’s general cognitive skills and representational repertoires instead of manipulating their choice (...) environments behind their backs, avoids the main normative challenges. A limitation in most of this literature is that it has focused on relatively sweeping policy recommendations and consequently on strong polar alternatives of general paternalism and strict laissez faire. We review a real instance, drawn from a consulting project we conducted for an investment bank, of a proposed intervention that is more typical of the kind that economists are more often actually called upon to offer. In this example, the sophistication of current tools for preference attribution, combined with philosophical externalism about the semantics of preferences that makes it less plausible to attribute their literal self-conscious representation to people as propositional attitude content becomes more tightly refined, blocks applicability of the distinction between nudging and boosting. This seems to call for irreducible, context-specific ethical judgment in assessing the appropriateness of the forms of paternalism that economists must actually wrestle with in going about their everyday business. (shrink)

In recent years, several authors have called to ground descriptive and normative decision theory on neuro-psychological measures of utility. In this paper, I combine insights from the best available neuro-psychological findings, leading philosophical conceptions of welfare and contemporary decision theory to rebut these prominent calls. I argue for two claims of general interest to philosophers, choice modellers and policy makers. First, severe conceptual, epistemic and evidential problems plague ongoing attempts to develop accurate and reliable neuro-psychological measures of utility. And second, (...) even if these problems are solved, neuro-psychological measures of utility lack the potential to inform welfare analyses and policy evaluations. (shrink)

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way and used (...) to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis. (shrink)

It is widely held that under ordinal utility, utility differences are ill-defined. Allegedly, for these to be well-defined (without turning to choice under risk or the like), one should adopt as a new kind of primitive quaternary relations, instead of the traditional binary relations underlying ordinal utility functions. Correlatively, it is also widely held that the key structural properties of quaternary relations are entirely arbitrary from an ordinal point of view. These properties would be, in a nutshell, the hallmark of (...) cardinal utility. While much is obviously true in these two tenets, this note explains why, as stated, they should be abandoned. Any ordinal utility function induces a rich quaternary relation. There is such a thing as ordinal utility differences. Furthermore, this induced quaternary relation respects, apart from completeness, the most standard structural properties of quaternary relations. These properties are, from an ordinal point of view, anything but arbitrary; from a quaternary perspective only completeness should be considered the hallmark—if any—of cardinal utility. These facts are explained to be especially relevant to the critical appreciation of the ordinalist methodology. (shrink)

Utility discounting in intertemporal economic modelling has been viewed as problematic, both for descriptive and normative reasons. However, positive utility discount rates can be defended normatively; in particular, it is rational for future utility to be discounted to take into account model-independent outcomes when decision-making under risk. The resultant values will tend to be smaller than descriptive rates under most probability assignments. This also allows us to address some objections that intertemporal considerations will be overdemanding. A principle for utility discount (...) rates is suggested which is rooted in probability discounting. Utility discounting is defended against objections from Parfit (1984) and Broome (2005); Broome (2012). A sample utility discount rate is estimated. [Open access]. (shrink)

How should rational believers pursue the aim of truth? Epistemic utility theorists have argued that by combining the tools of decision theory with an epistemic form of value—gradational accuracy, proximity to the truth—we can justify various epistemological norms. I argue that deriving these results requires using decision rules that are different in important respects from those used in standard (practical) decision theory. If we use the more familiar decision rules, we can’t justify the epistemic coherence norms that epistemic utility theory (...) had hoped to justify. In short, those of us who are attracted to the project of epistemic utility theory face a dilemma. If we choose “consequentialist” rules, then we can vindicate the idea that rational belief has the aim of accuracy—but at the cost of giving up attractive epistemic norms. (shrink)

The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in (...) health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times. (shrink)

Utilitarianism is a “consequentialist” doctrine: that actions are right or wrong in proportion as they produce good or bad consequences. Mill’s version is also a “hedonistic” doctrine. Consequences are good insofar as they have more happiness or less unhappiness; bad, as they have more unhap- piness or less happiness; and by happiness and unhappiness, Mill means pleasure and pain. In English, the words “happiness” and “unhappiness” do not have the same connotations as “pleasure” and “pain.” “Happiness” implies feeling good about (...) one’s life as well as feeling good. “Happiness” is found in relationships with friends and loved ones and in a sense of accomplishment. “Pleasure” seems to be something that is momentary and more sensational. But according to Mill’s psy- chology, a happy life consists in many pleasures and few pains. The happiness of relationships with friends and loved ones is reducible to the joys and satisfactions in the moments of one’s life that arise from these relationships. The happiness of a sense of accomplishment consists of the pleasurable states of consciousness that arise from a sense of accomplishment. The happiness of self-respect and the unhap- piness of self-disrespect consist of the pleasurable and painful states of conscious- ness that these involve. This reduction of happiness and unhappiness to pleasures and pains is a controversial element in Mill’s philosophy. I leave it to the reader to think about that reduction. In what follows, it will be assumed. (shrink)

According to epistemic utility theory, epistemic rationality is teleological: epistemic norms are instrumental norms that have the aim of acquiring accuracy. What’s definitive of these norms is that they can be expected to lead to the acquisition of accuracy when followed. While there’s much to be said in favor of this approach, it turns out that it faces a couple of worrisome extensional problems involving the future. The first problem involves credences about the future, and the second problem involves future (...) credences. Examining prominent solutions to a different extensional problem for this approach reinforces the severity of the two problems involving the future. Reflecting on these problems reveals the source: the teleological assumption that epistemic rationality aims at acquiring accuracy. (shrink)

Matthew Adler's Measuring Social Welfare is an introduction to the social welfare function (SWF) methodology. This essay questions some ideas at the core of the SWF methodology having to do with the relation between the SWF and the measure of well-being. The facts about individual well-being do not single out a particular scale on which well-being must be measured. As with physical quantities, there are multiple scales that can be used to represent the same information about well-being; no one scale (...) is special. Like physical laws, the SWF and its ranking of distributions cannot depend on exactly which of these scales we use. Adler and other theorists in the SWF tradition have used this idea to derive highly restrictive constraints on the shape of the SWF. These constraints rule out seemingly plausible views about distributive justice and population ethics. I argue, however, that these constraints stem from a simple but instructive mistake. The SWF should not be applied to vectors of numbers such as 1 and 2, but rather to vectors of dimensioned quantities such as 1 util and 2 utils. This seemingly pedantic suggestion turns out to have far-reaching consequences. Unlike the orthodox SWF approach, treating welfare levels as dimensioned quantities lets us distinguish between real changes in well-being and mere changes in the unit of measurement. It does this without making the SWF depend on the scale on which welfare is measured, and in a way that avoids the restrictive constraints on the shape of the SWF. (shrink)

Reprint of a chapter first appearing in African Values, Ethics, and Technology: Questions, Issues, and Approaches (2021).

Causal decision theory attends to probabilities used to obtain an option's expected utility but for completeness should also attend to utilities of possible outcomes. A suitable formula for an option's expected utility uses a certain type of conditional utility.

In recent years, a number of commentators have expressed dissatisfaction with Spinoza’s account of practical reason. In this paper, I defend his account against the most prominent objections, showing that the dictates of reason play an important role in guiding thought and action. However, against the standard interpretation, I propose that we view these rules not as exceptionless, instrumental prescriptions—hypothetical imperatives with necessary antecedents, as Curley memorable put it—but rather as adaptable guideposts that aid us in the complex, dynamic process (...) of acquiring a habit of virtue. The dictates of reason are best understood as defeasible policies that help to orient one in the ars vivendi. (shrink)

A mixture preorder is a preorder on a mixture space (such as a convex set) that is compatible with the mixing operation. In decision theoretic terms, it satisfies the central expected utility axiom of strong independence. We consider when a mixture preorder has a multi-representation that consists of real-valued, mixture-preserving functions. If it does, it must satisfy the mixture continuity axiom of Herstein and Milnor (1953). Mixture continuity is sufficient for a mixture-preserving multi-representation when the dimension of the mixture space (...) is countable, but not when it is uncountable. Our strongest positive result is that mixture continuity is sufficient in conjunction with a novel axiom we call countable domination, which constrains the order complexity of the mixture preorder in terms of its Archimedean structure. We also consider what happens when the mixture space is given its natural weak topology. Continuity (having closed upper and lower sets) and closedness (having a closed graph) are stronger than mixture continuity. We show that continuity is necessary but not sufficient for a mixture preorder to have a mixture-preserving multi-representation. Closedness is also necessary; we leave it as an open question whether it is sufficient. We end with results concerning the existence of mixture-preserving multi-representations that consist entirely of strictly increasing functions, and a uniqueness result. (shrink)

Epistemic utility theory seeks to establish epistemic norms by combining principles from decision theory and social choice theory with ways of determining the epistemic utility of agents’ attitudes. Recently, Moss, 1053–69, 2011) has applied this strategy to the problem of finding epistemic compromises between disagreeing agents. She shows that the norm “form compromises by maximizing average expected epistemic utility”, when applied to agents who share the same proper epistemic utility function, yields the result that agents must form compromises by splitting (...) the difference between their credence functions. However, this “split the difference” norm is in conflict with conditionalization, since applications of the two norms don’t commute. A common response in the literature seems to be to abandon the procedure of splitting the difference in favor of compromise strategies that avoid non-commutativity. This would also entail abandoning Moss’ norm. I explore whether a different response is feasible. If agents can use epistemic utility-based considerations to agree on an order in which they will apply the two norms, they might be able to avoid diachronic incoherence. I show that this response can’t save Moss’ norm, because the agreements concerning the order of compromising and updating it generates are not stable over time, and hence cannot avoid diachronic incoherence. I also show that a variant of Moss’ norm, which requires that the weights given to each agent’s epistemic utility change in a way that ensures commutativity, cannot be justified on epistemological grounds. (shrink)

At a time when some are questioning the relevancy of business education in general, others are now asking whether MBA programs should be blamed for society’s declining trust in business and the numerous corporate ethical failures of recent decades. Whether the full blame lies with business schools or not, MBA instructors are actively seeking more effective ways to help students adopt more practical and ethical managerial paradigms. Because trust theory is simple and robust and outlines the basic mental processes that (...) drive economic exchange while simultaneously prioritizing ethical behavior, in this article, we argue that it is distinctively suited to operationalize stakeholder theory in the classroom, providing MBA students with both a principled and a practical foundation or thematic platform for their MBA coursework and subsequent careers. We also discuss potential challenges and limitations and provide recommendations for future research. (shrink)

In Reasons and Persons Derek Parfit defends the principle that it is not irrational to perform an action one believes to be morally right, even if it is no tin one’s self-interest. He calls this principle CP2 and formulates it as follows: -/- "There is at least one desire that is not irrational, and is no less rational than the bias in one’s own favor. This is a desire to do what is in the interests of other people, when this (...) is either morally admirable, or one’s moral duty." (Parfit 1984, 131) -/- I will examine his defense of this principle, which is essentially an invocation of a thought-experiment he labels My Heroic Death, with a view to clarifying its relationship to rational egoism and the principles of rational choice, as explained below. -/- . (shrink)

This paper is about the shaping of student workload preferences by educational institution design, and how this creates distrust by staff in those preferences when staff are asked to use those preferences in re-designing the courses they teach. It is a case study of the construction of student workload preferences by the context of a particular higher education institution. In more detail: Failures to standardize the work required to receive equal credit points from different courses make credit points unfit for (...) their official purposes. Moreover, increasingly, institutions are found where students are required to take a high number of courses simultaneously. This study aimed to identify plausible hypotheses about how high course-loads and standardization failure interact by examining credit point standardization failure at an Estonian university where students are required to take twice as many courses as their peers at better performing universities. The hypotheses supported by the study are: the high course-load both made standardization failure useful to students seeking to manage the high course-load and contributed toward standardization failure because it rendered students’ assessments of workload untrustworthy to lecturers who regulate that workload. Existing advice on standardization of workloads within the European Credit Transfer and Accumulation System is criticized for its insensitivity to the constructive effects of course-load on student workload preferences. (shrink)

The concept of psychophysiological arousal as a component of emotional behavior has a long history, but has not attracted the research attention paid to valence in the burgeoning field of affective neuroscience. The potency of emotional stimuli is often poorly balanced in studies designed to assess appetitive and aversive stimulus processing, and thus I applaud Picard and colleagues’ choice to highlight the arousal dimension of emotional behavior. Any attempt to understand the nature of human emotion must carefully balance the evocative (...) impact of appetitive and aversive processes. By focusing on the contribution of arousal to emotional processing, Picard advances this goal. In this comment I suggest methodological and conceptual refinements that may help to strengthen the multiple arousal theory perspective. (shrink)

Consider a subjective expected utility preference relation. It is usually held that the representations which this relation admits differ only in one respect, namely, the possible scales for the measurement of utility. In this paper, I discuss the fact that there are, metaphorically speaking, two additional dimensions along which infinitely many more admissible representations can be found. The first additional dimension is that of state-dependence. The second—and, in this context, much lesser-known—additional dimension is that of act-dependence. The simplest implication of (...) their usually neglected existence is that the standard axiomatizations of subjective expected utility fail to provide the measurement of subjective probability with satisfactory behavioral foundations. (shrink)