This article examines the ethical implications of Ian Mitroff's scholarly contribution to the study of Organizational Communication. Although Mitroff does not specifically ground his work in ethics, this article considers an ethic of choicemaking to be a significant interpretive key for understanding the contribution of his research. In addition, this article provides another conceptual key for understanding the considerable quantity of Mitroff's work by organizing it around three major themes: science, decision-making, and myth. The goal of this article is (...) to make explicit two conceptual keys to Mitroff's scholarship, an ethic of choice and a three-fold division of his work that exemplifies his commitment to maximizing choice in organizational settings. (shrink)

In this essay, we explore the various aspects of hermeneutic relativity that have rarely been explicitly discussed. Our notion of “hermeneutic relativity” can be seen as an extension, with significant revisions, of Gadamer’s notion of Vorurteil. It refers to various choices and constraints of the interpreter, including beliefs concerning the best way of doing philosophy, what criteria are to be used to evaluate competing interpretations, and so on. The interpreter cannot completely eliminate the guidance and constraint originating from his/her “background.” (...) However, in principle the interpreter can “choose” to be guided by other constraints. Hence, we speak of “choices” or “commitments.” Hermeneutic relativity is the major cause for the variation of competing interpretations. (shrink)

Religious dietary practices foster a sense of communal identity, certainly, but traditionally they are also regarded as pleasing to God (or the gods, or the ancestors) and spiritually beneficial. In other words, for many religious people, the effects of fasting go well beyond what is immediately observed or empirically measurable, and that is a large part of what motivates participation in the practice. The goal of this chapter is to develop that religious way of thinking into a response to a (...) motivational problem that arises from our awareness of the insensitivity of contemporary food supply chains. If someone can have faith, or at least tenacious hope, that the significance of her food choices goes well beyond what is immediately observed or empirically measurable, then she may be less demoralized by the apparent inefficacy of those choices. The chapter concludes by considering a way in which this broadly religious way of thinking might be available to secular people as well. (shrink)

In this essay, we explore the various aspects of hermeneutic relativity that have rarely been explicitly discussed. Our notion of “hermeneutic relativity” can be seen as an extension, with significant revisions, of Gadamer’s notion of Vorurteil. It refers to various choices and constraints of the interpreter, including beliefs concerning the best way of doing philosophy, what criteria are to be used to evaluate competing interpretations, and so on. The interpreter cannot completely eliminate the guidance and constraint originating from his/her “background.” (...) However, in principle the interpreter can “choose” to be guided by other constraints. Hence, we speak of “choices” or “commitments.” Hermeneutic relativity is the major cause for the variation of competing interpretations. (shrink)

Sometimes citizens disagree about political matters, but a decision must be made. We have two theoretical frameworks for resolving political disagreement. The first is the framework of social choice. In it, our goal is to treat parties to the dispute fairly, and there is no sense in which some are right and the others wrong. The second framework is that of collective decision-making. Here, we do believe that preferences are truth apt, and our moral consideration is owed not (...) to those who disagree but to the community that stands to benefit or suffer from the decision. In this chapter, I describe and explore these two frameworks. I conclude two things. First, analysis of real-world disagreement suggests that collective decision-making is the right way to model politics. In most, possibly even all, political disagreement, all parties believe (if implicitly) that there is an objective standard of correctness. Second, this matter is connected to the concept of pluralism. If pluralism is true, then collective decision-making cannot be applied to some political disagreements. More surprisingly, pluralism may rule out the applicability of social choice theory as well. (shrink)

This article is about the information relevant to decision-making capacity in refusal of life-prolonging medical treatment cases. We examine the degree to which the phenomenology of the options available to the agent—what the relevant states of affairs will feel like for them—forms part of the capacity-relevant information in the law of England and Wales, and how this informational basis varies across adolescent and adult medical treatment cases. We identify an important doctrinal phenomenon. In the leading authorities, the courts appear (...) to count the first-personal phenomenology of the available options among the information that adolescents seeking to refuse life-prolonging treatment must understand and appreciate in order to possess capacity; adults are not held to this (higher) standard. We evaluate this differential treatment in light of philosophical work on transformative choice—decisions involving options whose sensory character, and effect on our values and preferences, are grasped only through experience itself. (shrink)

Breaking down complex philosophical issues into a step-by-step self-help guide, the founder of the Institute for Global Ethics shows us how to grapple with everyday issues and problems: Should I take my family on a much-needed vacation or save money for my children's education? Should we protect the endangered owl or maintain jobs for loggers? This is a unique, anecdote-rich, and articulate program that teaches us to think for ourselves rather than supplying us with easy, definitive answers. Offering concrete guidelines (...) and principles, Kidder enables us to resolve ethical dilemmas and to make the tough choice between what are usually two "right" values. (shrink)

It is a commonplace that in making decisions agents often have to juggle competing values, and that no choice will maximise satisfaction of them all. However, the prevailing account of these cases assumes that there is always a single ranking of the agent's values, and therefore no unresolvable conflict between them. Isaac Levi denies this assumption, arguing that agents often must choose without having balanced their different values and that to be rational, an act does not have to (...) be optimal, only what Levi terms 'admissible'. This book explores the consequences of denying the assumption and develops a general approach to decision-making under unresolved conflict. Professor Levi discusses conflicts of value in several domains - those arising in moral dilemmas, the drawing of scientific inferences, decisions taken under uncertainty, and in social choice. In each of these he adapts his theoretical framework, showing how conflict may often be reduced though not always altogether eliminated. (shrink)

Jeff Benedict has seen both good and bad in his career as a journalist. Some of the best are the extraordinary people he has met who have made deliberate choices to live happier lives despite the extreme hardship that each of them have faced. Although life will knock us down from time to time, this book is an important reminder that we all can make a choice to get back up, brush ourselves off, and keep pressing forward. Replace anger (...) with forgiveness through studying the real-life examples of seven inspiring mentors. Avoid discouragement by purposefully recognizing God's hand in your life. Diminish the heartache from tragedy through the concentrated act of serving others. Gain insights from parents who were deliberate in safeguarding their children against harmful influences. Stand strong through life's adversity through the examples of powerful prayer. (shrink)

This book is a unique introductory overview of decision theory. It is completely non-technical, without a single formula in the book. Written in a crisp and clear style it succinctly covers the full range of philosophical issues of rationality and decision theory, including game theory, social choice theory, prisoner's dilemma and much else. The book aims to expand the scope and enrich the foundations of decision theory. By addressing such issues as ambivalence, inner conflict, and the constraints imposed upon (...) us by our attachments to others, Frederic Schick reveals that our thinking is often more subtle than standard theories of rationality allow. Only a theory that respects that subtlety can illumine what is otherwise puzzling. The book contains many examples drawn from history and literature dealing with subjects such as love, war, friendship, and crime. (shrink)

This book teaches students how to make the difficult ethical decisions that journalists routinely face.

In this paper, we make the case that a person who is considering or has already made a decision that appears seriously harmful to that person should in some cases be judged incapable of making that...

The woman at the heart of Pearl Jam’s “Better Man” (Vitalogy, 1994) is trapped. She has committed herself to a relationship that makes her miserable, but she sees no viable alternative to staying in it. She mourns a past self who might have been able to leave and dreams of a dierent way things might be, but remains unable to move on. It is tempting to view her with a mixture of pity and frustration (reecting some of the personal circumstances (...) -- Eddie Vedder’s mother’s second marriage -- informing its composition). As a moral being, she appears to be hopelessly compromised by her situation, even as she is also doing her best to survive under conditions designed to undermine her autonomy and keep her trapped (as abusive relationships do). The song is not so much critical of her choice to stay as it is confused by and resigned to it. -/- What keeps a person where she so clearly does not want to be? -/- The song itself was, at least early in its recorded life for Pearl Jam, similarly compromised. Vedder appears to have thought of it as too “accessible”, too much of a pop hit for the kind of musical vision he had in mind either for Vs. (for which it had originally been intended) or for Vitalogy; by this point in the band’s career, he was ever more actively resisting success, accessibility, and everything that went with the version of rock star life imposed collectively on the band and on him as an individual. The form that resistance took was an exercise of artistic and other forms of control, sometimes exercised in ways that were destructive or damaging (to the band and its internal relationships, its fame or success, its image, its artistic identity, etc.). -/- What keeps an artist or a band where they so clearly do not want to be? In this chapter, I oer a loose exploration of some possible philosophical approaches to answering the question of what keeps us where we are, like it or not, worked out in parallel through the lyrics of “Better Man” and the circumstances of the song’s eventual arrival Vitalogy. My main interest is in examining the ethical dimensions of the question itself -- what, if anything, are we morally required or expected to do under compromised or compromising conditions? My main suggestion is that answering the question might require of us a messier, more ambivalent, and perhaps more compassionate notion of moral agency, inspired by Simone Weil’s work on affliction. (shrink)

In this paper, I use Kant’s theory of the aesthetic power of judgment to solve the problem of nonmoral value choice, which Kant himself did not deal with, and prove that my reconstruction can fit into Kant’s philosophy and function as a harmonization and unification of morality and happiness. First, I revisit Kant’s early view of intellectualized happiness to establish the feasibility of this project in Kant’s ethics. Second, by analogy with the contemplative judgment of taste and practical artistic (...) creation, I argue for the universal communicability of pleasure in value choice from the transcendental perspective, on the one hand, and explain the various choices by individuals in reality from the empirical perspective, on the other. Ultimately, I connect the pursuit of intellectual happiness with the fulfillment of the imperfect duty of one’s own perfection, through which a transition from nature to freedom can be accomplished in Kant’s philosophy. (shrink)

This article surveys the latest research on risky-choice framing effects, focusing on the implications for rational decision-making. An influential program of psychological research suggests that people's judgements and decisions depend on the way in which information is presented, or ‘framed’. In a central choice paradigm, decision-makers seem to adopt different preferences, and different attitudes to risk, depending on whether the options specify the number of people who will be saved or the corresponding number who will die. It (...) is standardly assumed that such responses violate a foundational tenet of rational decision-making, known as the principle of description invariance. We discuss recent theoretical and empirical research that challenges the dominant ‘irrationalist’ narrative. These approaches typically pay close attention to how decision-makers represent decision problems (including their interpretation of numerical quantifiers or predicate choice) and they highlight the need for a more robust characterization of the description invariance principle. We conclude by indicating avenues for future research that could bring us closer to a complete—and potentially rationalizing—explanation of framing effects. (shrink)

In the morning -- After school -- Time for bed -- My smart choices -- Glossary -- Index -- About the author.

With advice that combines ancient spiritual traditions with the common sense of the 21st century, this book offers soothing and practical guidance to the frazzled decision-maker. Those concerned about making the best choices can find techniques for broadening their way of thinking and effectively solving problems that also make sense for them spiritually. From everyday choices to landmark decisions, this book will simplify problem-solving and guide readers through all stages of life.

When making a decision, humans consider two types of information: information they have acquired through their prior experience of the world, and further information they gather to support the decision in question. Here, we present evidence that data from search engines such as Google can help us model both sources of information. We show that statistics from search engines on the frequency of content on the Internet can help us estimate the statistical structure of prior experience; and, specifically, we (...) outline how such statistics can inform psychological theories concerning the valuation of human lives, or choices involving delayed outcomes. Turning to information gathering, we show that search query data might help measure human information gathering, and it may predict subsequent decisions. Such data enable us to compare information gathered across nations, where analyses suggest, for example, a greater focus on the future in countries with a higher per capita GDP. We conclude that search engine data constitute a valuable new resource for cognitive scientists, offering a fascinating new tool for understanding the human decision-making process. (shrink)

This book, first published in 1997, is an introductory overview of decision theory. It is completely non-technical, without a single formula in the book. Written in a crisp and clear style it succinctly covers the full range of philosophical issues of rationality and decision theory, including game theory, social choice theory, prisoner's dilemma and much else. The book aims to expand the scope and enrich the foundations of decision theory. By addressing such issues as ambivalence, inner conflict, and the (...) constraints imposed upon us by our attachments to others, Frederic Schick reveals that our thinking is often more subtle than standard theories of rationality allow. Only a theory that respects that subtlety can illumine what is otherwise puzzling. The book contains many examples drawn from history and literature dealing with subjects such as love, war, friendship, and crime. (shrink)

You have a choice -- Decision-making steps -- What is a good choice? -- Identifying options -- Making predictions -- Pros and cons -- Weighing the consequences -- Values and motivations -- Thinking of others -- Choose wisely -- Glossary -- Index -- Primary source list -- Websites.

This paper applies insights from behavioral economics and nudge theory to foster sustainable and responsible investment. SRI provides an opportunity to express and promote ethical values via choice of financial instruments. While policy-makers have tried to encourage greater participation in SRI, the majority of retail investors retain a conventional approach to investment. I develop a conceptual framework to improve the effectiveness of SRI policy-making. The first part of the framework comprises a transmission mechanism which emphasizes the role of (...) SRI as a driver for sustainable development. The second part is a model of the individual decision for or against SRI. The framework suggests that low SRI demand is a case of behavioral market failure, and that nudging is a suitable tool for dismantling behavioral barriers to SRI. A specific example of smart choice architecture is used to illustrate the framework’s potential in the design of an SRI nudge. Assuming the nudge stands up to the rigors of empirical testing, it may well provide a feasible alternative for policy-makers. (shrink)

In this provocative study, Bedau demonstrates the usefulness of "casuistry," or "the method of cases" in arriving at moral decisions. He examines well-known cases, including the aftermath of the sinking of the William Brown in 1841, that compel us to consider questions about who ought to survive when not all can. By doing so, we learn something about how we actually reason concerning such life and death situations, as well as about how we ought to reason if we wish both (...) to be consistent and to properly respect human life. Bedau's elegant book will be a valuable resource for students, philosophers, and general readers. (shrink)

What is citizenship? -- What are choices? -- Choosing to think for yourself -- Choosing to say no -- Choosing to be friendly -- Choosing to be fair -- Choosing what to eat -- Choosing to spend or save money -- Choosing entertainment -- Choosing to be active -- Choosing to follow the rules -- Choosing to tell the truth -- Making choices and happiness.

The changing milieu of research—increasingly global, interdisciplinary and collaborative—prompts greater emphasis on cultural context and upon partnership with international scholars and diverse community groups. Ethics training, however, tends to ignore the cross-cultural challenges of making ethical choices. This paper confronts those challenges by presenting a new curricular model developed by an international team. It examines ethics across a very broad range of situations, using case studies and employing the perspectives of social science, humanities and the sciences. The course has (...) been developed and taught in a highly collaborative way, involving researchers and students at Zhejiang University, the Indian Institute of Technology, Bombay and Brown University. The article presents the curricular modules of the course, learning outcomes, an assessment framework developed for the project, and a discussion of evaluation findings. (shrink)

Choice feminism is a popular form of contemporary feminism, encouraging women to embrace the opportunities they have in life and to see the choices they make as justified and always politically acceptable. Though this kind of feminism appears at first glance to be tolerant and inspiring, its narratives also bring about a political stagnation as discussion, debate and critical judgement of the actions of others are discouraged in the face of being deemed unsupportive and a ‘bad’ feminist. Choice (...) feminism also encourages neoliberal values of individualism and consumerism, while downplaying the need for political and collective action against systematic inequalities. Yet in order to succeed in creating change for women, debate needs to occur, and not all decisions can be supported if they act to further inequality and a patriarchal status quo. In this article, I would like to argue for the continued need to engage politically with other feminists and with the status of the movement as a whole, by critiquing choice feminism and looking empirically at how discussion and dissent can be silenced by the choice narrative. The empirical data in this article will focus on online discussions of naming on marriage to illustrate the wider theoretical argument. (shrink)

We offer a summary of the WHO Report "Making Fair Choices on the Path to Universal Health Coverage".

Friends are fun -- Let's play -- Choose good friends -- My smart choices -- Glossary -- Index -- About the author.

This paper reports the results of an experiment designed to uncover the stochastic structure of individual preferences over lotteries. Unlike previous experiments, which have presented subjects with pair-wise choices between lotteries, our design allowed subjects to choose between two lotteries or (virtually) any convex combination of the two lotteries. We interpret the mixtures of lotteries chosen by subjects as a measure of the stochastic structure of choice. We test between two alternative interpretations of stochastic choice: the random utility (...) interpretation and the deterministic preferences interpretation. The main findings of the experiment are that the typical subject prefers mixtures of lotteries rather than the extremes of a linear lottery choice set. The distribution of choices does not change between a first and second asking of the same question. We argue that this provides support for the deterministic preferences interpretation over the random utility interpretation of stochastic choice. As a subsidiary result, we find a small proportion of subjects make choices that violate transitivity, but the level of intransitive choice falls significantly over time. (shrink)

This report by the WHO Consultative Group on Equity and Universal Health Coverage addresses how countries can make fair progress towards the goal of universal coverage. It explains the relevant tradeoffs between different desirable ends and offers guidance on how to make these tradeoffs.

An imperfect duty such as the duty to aid those in need is supposed to leave leeway for choice as to how to satisfy it, but if our reason for a certain way of satisfying it is our strongest, that leeway would seem to be eliminated. This paper defends a conception of practical reasons designed to preserve it, without slighting the binding force of moral requirements, though it allows us to discount certain moral reasons. Only reasons that offer criticism (...) of alternatives can yield requirements, but our reasons for particular ways of satisfying imperfect duties merely count in favor of the acts in question. When the state is authorized to take over charitable obligations, it should not be seen as enforcing fulfillment of our imperfect duties, but rather as forcing us to help fulfill collective duties that may be substantially modified by transfer to the state, replacing imperfect duties with perfect. Besides the cost to us in freedom of choice there is a moral cost to replacing the virtuous motives of charity with those that tend to accompany paying taxes. However, a compensating feature of state involvement is the fact that its more precise demands come with limits. (shrink)

In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, (...) different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship. (shrink)

The options in a decision problem generally have outcomes with common features. Putting aside the common features simplifies deliberations, but the simplification requires a philosophical justification that this book provides.

SummaryA critical outline, primarily for non‐professionals, of some leading ideas and normative implications of “Bayesian Decision Theory”.Violations of the postulated transitivity of the chooser's preference relation are not necessarily symptoms of irrationality. Indeed, the overall normative constraint of “consistency” is too restrictive a guide for many real‐life choices. Rational choice might perhaps be more usefully conceived as an informal art, rather than as the pursuit, in Bayesian style, of maximal expected utility.RésuméUne description critique, destinée avant tout aux non‐professionnels, de (...) quelques idées directrices et implications normatives de la «theorie bayésienne de la décision».Le fait que la transitivité qu'on exige de la relation de préférence du décideur soit violée ne doit pas ětre nécessairement interprétée comme un signe d'irrationnalité. En effet, la contrainte normative universelle de «consistence» est un guide trop restrictif pour maint choix de la vie réelle. Le choix rationnel pourrait ětre plus utilement conçu comme un art, et non comme une recherche à la Bayes de L'utilité maximale attendue.ZusammenfassungEs wird eine kritische Darstellung einiger Hauptgedanken und normativen Implikationen der Bayesschen Entscheidungstheorie vorgelegt, die sich vor allem an Nichtprofessionelle richtet.Verletzungen der postulierten Transitivität der Relation, die das Vorziehen des Wählers ausgedrückt, sind nicht notwendigerweise Symptome für Irrationalität. Die normative Forderung der durchgängigen Konsistenz ist in der Tat als Führer in manchen aus dem Leben gegriffenen Wahlsituationen zu restriktiv. Rationale Entscheidungen sollten vielleicht in nützlicherer Weise als eine Kunst und nicht als das Verfolgen maximaler, erwarteter Nützlichkeit im Sinne Bayes' betrachtet werden. (shrink)

This introduction just aims to be a fast foreword to the special topic now turned into an e-book. The Editorial "Decision-Making Experiments under a Philosophical Analysis: Human Choice as a Challenge for Neuroscience" alongside with my opinion article "Neurophilosophical considerations on decision making: Pushing-up the frontiers without disregarding their foundations" play the real role of considering in more details the articles and the whole purpose of this e-book. What I must highlight in this foreword is that our (...) intention with such a project was to deepen into the very foundations of our current paradigms in decision neuroscience and to philosophically moot its foundations and repercussions. Normal Science (a term coined by Philosopher Thomas Kuhn) works under a research consensus among a scientific community: A shared paradigm, consolidated methods, widespread convictions. Pragmatically, winning formulas must be kept, although, not at any cost. What differentiates a gifted and revolutionary scientist from a more bureaucratic colleague is the capacity and willingness of constantly reevaluating, depurating and refining his/her own paradigm. That is best strategy to avoid that a paradigm itself would gradually come under challenge. In my view, some achievements, in this sense, were brought about in our project. The e-book will be inspiring and informative for both neuroscientists that are concerned with the very foundations of their works and for philosophers that are not blind to empirical evidence. Kant once said: “Thoughts without content are empty, intuitions without concepts are blind”. Paraphrasing Kant we could say: Philosophy without science is empty, science without philosophy is blind. (shrink)

The central theme of this book is that technological advances in medicine have created a multitude of choices for each individual -- choices that can influence how we live and die. These choices are difficult ones, and the book provides a better understanding of the issues. Thus, the implications of each choice become clearer. Such decisions remain inherently very difficult and personal. Thoughtful, compassionate societies must consider these difficult problems. Can we develop mechanisms to assist in the medical choices (...) that will inevitably take place throughout each individual's life? Jane Stein makes a stimulating effort to clarify these subjects in this book. She calls to attention problems we would prefer to avoid, touches the untouchable, and in so doing contributes to a constructive debate on the future of human life. - Preface. (shrink)

The study of decision making has multiple implications for business ethics. This paper outlines some commonly used frameworks for understanding choice in business. It characterises the dominant model for business decision making as rational choice theory (RCT) and contrasts this with a more recent, naturalistic theory of decision-making, image theory. The implications of using RCT and image theory to model decision making are discussed with reference to three ethical systems. RCT is shown to be (...) consistent with Utilitarian ethics, but not with Kantian or Virtue-based ethics. Image theory is shown to be consistent with each. The paper identifies a number of implications following from this analysis. (shrink)

A significant body of research concludes that stable beliefs of perceived consumer effectiveness lead to sustainable consumption choices. Consumers who believe that their decisions can significantly affect environmental and social issues are more likely to behave sustainably. Little is known, however, about how perceived consumer effectiveness can be increased. We find that feelings of guilt and pride, activated by a single consumption episode, can regulate sustainable consumption by affecting consumers’ general perception of effectiveness. This paper demonstrates the impact that guilt (...) and pride have on perceived consumer effectiveness and shows how this effect rests on the ability of these emotions to influence perceptions of agency. After experiencing guilt or pride, consumers see themselves as the cause of relevant sustainability outcomes. The process of causal attribution associated with these emotions influences consumers’ use of neutralization techniques. Through the reduction in consumers’ ability to neutralize their sense of personal responsibility, guilt and pride positively influence perceived consumer effectiveness. The inability to rationalize-away their personal responsibility, persuades consumers that they affect sustainability outcomes through their decisions. The research advances our understanding of sustainable consumption and identifies a new avenue for the regulation of individual consumer behavior that has significant implications for the development of sustainable marketing initiatives. (shrink)

The principle of beneficence directs healthcare practitioners to promote patients’ well-being, ensuring that the patients’ best interests guide treatment decisions. Because there are a number of distinct theories of well-being that could lead to different conclusions about the patient’s good, a careful consideration of which account is best suited for use in the medical context is needed. While there has been some discussion of the differences between subjective and objective theories of well-being within the bioethics literature, less attention has been (...) given to the questions of what work a theory of well-being needs to do in bioethics and which standards of success ought to be used in selecting a theory of well-being for use in medicine. In this article, I argue that traditional theories of well-being developed in philosophy are not well suited to meet the needs of the medical context. For the principle of beneficence to be most useful, the underlying account of well-being should satisfy two conditions: first, it needs to lead to a concrete, action-guiding determination of the patient’s good; and, second, any recommendations it offers need to be justifiable to patients. Standard accounts of well-being have difficulty satisfying both conditions. Exploring the limitations of these theories when applied to treatment dilemmas helps point the way toward the development of an account of well-being better suited to healthcare. (shrink)

In his paper, ‘Patients, doctors and risk attitudes’, Makins argues that doctors, when choosing a treatment for their patient, need to follow their risk profile.1 He presents a pair of fictitious diseases facing a patient who either has ‘exemplitis’, which requires no treatment or ‘caseopathy’, which is severe and disabling and for which there is a treatment with unpleasant side effects. The doctor needs to decide whether the patient should pursue the unpleasant treatment, just in case he has caseopathy. Makins (...) believes that rational-choice theory is a productive way to approach this problem. This theory frames all decisions as gambles. Each possible gamble (eg, not to pursue treatment) leads, probabilistically, to a set of outcomes (life with no disease and no side effects, but also, possibly, life with a disabling disease, since no treatment is taken). Utilities of these outcomes and probabilities that they will happen are combined to yield a number—expected utility. One is supposed to gamble—to make a choice—in a way that maximises this expected utility. Makins takes this framework for granted and is focused on an additional complication, the patient’s risk preference. He believes that, in his hypothetical example, even if expected utility were exactly the same, withholding treatment …. (shrink)

Although autonomy is clearly still the paradigm in bioethics, there is increasing concern over its value and feasibility. In agreeing with those concerns, I argue that autonomy is not just a status, but a skill, one that must be developed and maintained. I also argue that nearly all healthcare interactions do anything but promote such decisional skills, since they rely upon assent, rather than upon genuinely autonomous consent. Thus, throughout most of their medical lives, patients are socialised to be heteronomous, (...) rather than autonomous. Yet, at the worst possible time – critical care decision-making – when life and death consequences are attached to the choices, the paradigm shifts and real consent is sought, even demanded, thereby making an often traumatic situation even harder.I go on, though, to also reject paternalistic models of beneficence as an alternative. Rather, I conclude that the problem is so fundamental in healthcare that a genuine solution would require a radical restructuring. I recommend steps that can be taken in the interim to improve the situation and to move toward such a restructuring. (shrink)