How do people make difficult decisions in situations involving substantial risk and uncertainty? In this study, we presented a difficult medical decision to three expert physicians in a combined “thinking aloud” and “cross examination” experiment. Verbatim transcripts were analyzed using script analysis to observe the process of constructing and making the decision, and using referring phrase analysis to determine the representation of knowledge of likelihoods. These analyses are compared with a formal decision analysis of the same problem (...) to highlight similarities and differences. The process of making the decision resembles an incremental, sequential‐refinement planning algorithm, where a complex decision is broken into a sequence of choices to be made with a simplified description of the alternatives. This strategy results in certain kinds of relevant information being underweighted in the final decision. Knowledge of likelihood appears to be represented as symbolic descriptions capturing categorical and ordinal relations with “landrhark” likelihoods, only some of which are described numerically. Numerical probabilities, capable of being combined and compared arithmetically, were not observed. These observations suggest an explanation for the heuristics and biases in human decision making under uncertainty in terms of the processes that manipulate symbolic descriptions of likelihoods and construct plans of action for situations involving risk and uncertainty. (shrink)

This paper describes a new course in Medical Technology and Critical Decisions, part of the Technology Studies Program at Wellesley College, established with the support of the Alfred P. Sloan Foundation's New Liberal Arts Program. The course uses the dramatic new options in medicine presented by technology to individuals and society as a vehicle for promoting general technological literacy in liberal arts students. The course motivates the study of the scientific principles on which the technology rests and the mathematical (...) principles of a methodology for making rational choices. A case in point is the decision of a pregnant woman whether or not to undergo amniocentesis, a procedure used to determine the genetic make-up of a fetus from cells in the amniotic fluid. The course introduces students to the underlying notions of genetics; the physical principles behind the ultrasound imaging technique used to position the needle that draws the fluid; the probability and statistics needed to understand the risks to the woman and fetus both of having and of not having the procedure; and the methodology of decision analysis, increasingly used by genetic counselors to help prospective parents incorporate their personal values into the decision-making process. (shrink)

(2013). Review of Peter Ubel, Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. The American Journal of Bioethics: Vol. 13, No. 4, pp. 53-54. doi: 10.1080/15265161.2013.768866.

Conflict is an important consideration in the intensive care unit. In this setting, conflict most commonly occurs over the ‘best interests’ of the incapacitated adult patient; for instance, when families seek aggressive life-sustaining treatments, which are thought by the medical team to be potentially inappropriate. Indeed, indecision on futility of treatment and the initiation of end-of-life discussions are recognised to be among the greatest challenges of working in the ICU, leading to emotional and psychological ‘burnout’in ICU teams. When these disagreements (...) occur, they may be within the clinical team or among those close to the patient, or between the clinical team and those close to the patient. It is, therefore, crucial to have a theoretical understanding of decision-making itself, as unpicking misalignments in the family’s and clinical team’s decision-making processes may offer strategies to resolve conflict. Here, we relate Kahneman and Tversky’s work on cognitive biases and behavioural economics to the ICU environment, arguing that these biases could partly explain disparities in the decision-making processes for the two conflicting parties. We suggest that through the establishment of common ground, challenging of cognitive biases and formulation of mutually agreeable solutions, mediation may offer a pragmatic and cost-effective solution to conflict resolution. The litigation process is intrinsically adversarial and strains the doctor–patient–relative relationship. Thus an alternative external party should be considered, however mediation is not frequently used and more research is needed into its effectiveness in resolving conflicts in the ICU. (shrink)

This article illustrates the process of applied critical realist research using a case study of political decision-making in transport. Critical realism is often used to analyse socio-political cha...

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

The paper deals with the ethical-moral dimension of Popper’s critical rationalism, which is the less analyzed aspect of his philosophy. Critical rationalism is not without assumptions. As a life attitude, it is actualized on the basis of one’s moral preferences based rather on assumptions than on critical reasonableness. Critical rationalism does not exclude logical argumentation and reasoning, but the adoption of them is predominantly the result of an individual moral decision and choice, based, paradoxically enough, (...) on an irrational belief in reason. The author considers this attitude to be productive, as it emphasizes individual moral responsibility. Nobody is able to persuade us about the relevance of what we don’t want to adopt and apply. Thus we find ourselves in the sphere of personal morality. (shrink)

Kahneman's theory of two systems assumes that human decision making in Economy is based on two cognitive systems, one that is automatic, intuitive and mostly unconscious, and one that is reflexive, rational and fully conscious. The authors consider Kahneman’s approach incomplete and limited in accounting for the creativity of embodied agents grasping the opportunities afforded by physical and social environments. This limitation leads us to argue for the existence of a third system in decision making in Economy, the (...) creative intuition based on direct perception of affordances, addressing not only the dispositions and goals of agents but also the social and environmental responsibility of corporations and governments. The authors argue that the third decision-making system the authors propose implies a concept of intuition that is different from the type of association process discussed by Morewedge and Kahneman [2] and gives an example of the third system operation, the Bolsa Família in Brazil, and finding new options for the funding of similar programs. (shrink)

"The best book available for non-mathematicians." — Contemporary Psychology. Superb nontechnical introduction to game theory and related disciplines, primarily as applied to the social sciences. Clear, comprehensive coverage of utility theory, 2-person zero-sum games, 2-person non-zero-sum games, n-person games, individual and group decision-making, much more. Appendixes. Bibliography. Graphs and figures.

The aim of this study was to investigate factors associated with seriously ill patients’ preferences for their family and physicians making resuscitation decisions on their behalf. Using SUPPORT II data, the study revealed that, among 362 seriously ill patients who were experiencing pain, 277 (77%) answered that they would want their family and physicians to make resuscitation decisions for them instead of their own wishes being followed if they were to lose decision-making capacity. Even after controlling for other variables, (...) patients who preferred the option of undergoing cardiopulmonary resuscitation (CPR) in the future were twice as likely, and those who had had ventilator treatment were four-fifths less likely, to rely on their family and physicians than those who did not want CPR (odds ratio (OR)-2.28; 95% confidence interval (CI) 1.18-4.38) or those who had not received ventilator treatment (OR-0.23; 95% CI 0.06-0.90). Psychological variables (anxiety, quality of life, and depression), symptomatic variables (severity of pain and activities of daily living) and the existence of surrogates were not significantly associated with patients’ preferences for having their family and physicians make resuscitation decisions for them. Age was not a significant factor for predicting the decision-making role after controlling for other variables. (shrink)

Based on research on the increasingly popular unconscious thought effect (UTE), it has been suggested that physicians might make better diagnostic decisions after a period of distraction than after an equivalent amount of time of conscious deliberation. However, published attempts to demonstrate the UTE in medical decision making have yielded inconsistent results. In the present study, we report the results of a meta-analysis of all the available evidence on the UTE in medical decisions made by expert and novice clinicians. (...) The meta-analysis failed to find a significant contribution of unconscious thought to the accuracy of medical decisions. This result cannot be easily attributed to any of the potential moderators of the UTE that have been discussed in the literature. Furthermore, a Bayes Factor analysis shows that most experimental conditions provide positive support for the null hypothesis, suggesting that these null results do not reflect a simple lack of statistical power. We suggest ways in which new studies could usefully provide further evidence on the UTE. Unless future research shows otherwise, the recommendation of using unconscious thought to improve medical decisions lacks empirical support. (shrink)

El presente artículo reflexiona sobre el pensamiento de Juan Donoso Cortés, a partir de una discusión con sus principales líneas interpretativas. Dichas líneas serán clasificadas de acuerdo a la respuesta que brinden a dos problemas clásicos de la historiografía donosiana: la cuestión de la conversión, que indaga sobre la relación entre los escritos del joven Donoso Cortés y del maduro y, por otro lado, la pregunta por el lugar de la tradición en su obra. Se llegará así a tres corrientes (...) básicas: la tradicionalista, la schmittiana o decisionista y la “moderatista”. Seguidamente, se procederá a ponerlas en diálogo, marcando las críticas que se hicieron entre sí. Hacia el final, el trabajo buscará ponderar los puntos fuertes y débiles de cada una de las posiciones, con el objetivo de ensayar una interpretación alternativa sobre el autor, que hemos denominado “decisionismo moral”. (shrink)

Some patients who are dependent on extracorporeal membrane oxygenation (ECMO) are alert and retain capacity to participate in decision-making, including decisions regarding whether to continue life...

OBJECTIVES: In treating critically ill neonates, situations occasionally arise in which aggressive medical treatment prolongs the inevitable death rather than prolonging life. Decisions as to limitation of neonatal medical intervention remain controversial and the primary responsibility of the generally unprepared family. This research was designed to study response patterns of expectant mothers towards treatment of critically ill and/or malformed infants. DESIGN/SETTING: Attitudes were studied via comprehensive questionnaires divided into three sections: 1-Sociodemographic data and prior personal experience with perinatal problems; 2-Theoretical (...) philosophical principles used in making medical ethical decisions; and 3-Hypothetical case scenarios with choices of treatment options. SUBJECTS AND RESULTS: Six hundred and fifty pregnant women were studied. Maternal birthplace (p = 0.005) and level of religious observance (p = 0.02) were strongly associated with the desire for maximally aggressive medical intervention in the hypothetical case scenario. Specific personal experiences such as infertility problems, previous children with serious mental or physical problems were not correlated with the selection of different treatment choices. Of the theoretical principles studied, only the desire to preserve life at all costs was significantly associated with the choice for maximal medical treatment (p = 0.003). CONCLUSIONS: Maternal ethnocultural background and philosophical principles more profoundly influenced medical ethical decision-making than did specific personal life experiences. (shrink)

The relevance to decision research of recent advances in the philosophy of social science is considered. The critical realism of Roy Bhaskar argues for the identification of contextually contingent explanatory mechanisms at multiple levels based on concepts grounded in intersubjectively shared reality. Using examples from the author’s and other’s research on the psychology of decisions involving risk and uncertainty, this paper explores the implications of taking a critical realist approach. It is argued that critical realism has (...) the potential to advance and unify disparate experimental and naturalistic lines of research. Furthermore, a diverse range of experimental, process-tracing and observational methods can play important complementary roles in developing fruitful critical realist explanations of decisions involving risk and uncertainty. (shrink)

While this article by Waldman and Newberg is correct in its main message, it is unfortunately fraught with inaccuracies and problems. To illustrate: (1) the statement that “Inner speech is also associated with lower levels of psychological distress” is invalid as a wide array of distressing psychological disorders are associated with distorted (e.g., ruminative) inner speech activity.

To what extent do we know our own minds when making decisions? Variants of this question have preoccupied researchers in a wide range of domains, from mainstream experimental psychology to cognitive neuroscience and behavioral economics. A pervasive view places a heavy explanatory burden on an intelligent cognitive unconscious, with many theories assigning causally effective roles to unconscious influences. This article presents a novel framework for evaluating these claims and reviews evidence from three major bodies of research in which unconscious factors (...) have been studied: multiple-cue judgment, deliberation without attention, and decisions under uncertainty. Studies of priming and the role of awareness in movement and perception are also given brief consideration. The review highlights that inadequate procedures for assessing awareness, failures to consider artifactual explanations of “landmark” results, and a tendency to uncritically accept conclusions that fit with our intuitions have all contributed to unconscious influences being ascribed inflated and erroneous explanatory power in theories of decision making. The review concludes by recommending that future research should focus on tasks in which participants' attention is diverted away from the experimenter's hypothesis, rather than the highly reflective tasks that are currently often employed. (shrink)

How ought we to understand the sources and limits of the authority of family members to make health care decisions for their decisionally incapacitated relatives? This question is becoming increasingly crucial as the population ages and the power of medical technology waxes. It is also becoming increasingly contested, as faith in advance directives shows signs of waning, and the moral complexities of intimate relationship become more theoretically patent.This last point—the newly visible moral richness of intimate relationship—provides this paper with its (...) field. I am interested in probing the images of the relationship between self and other, particularly self and intimate other, that seem presupposed by some leading attempts to determine the basis for proxy decision-making authority, and what constraints it must observe. In the light of both recent work in the philosophy of mind and considerations closer to common experience, the reigning images seem too slight to support the weight of current practices and beliefs about proxy authority; supplanting them with images more faithful to our experience will have implications for our practice with proxies. (shrink)

How ought we to understand the sources and limits of the authority of family members to make health care decisions for their decisionally incapacitated relatives? This question is becoming increasingly crucial as the population ages and the power of medical technology waxes. It is also becoming increasingly contested, as faith in advance directives shows signs of waning, and the moral complexities of intimate relationship become more theoretically patent.This last point—the newly visible moral richness of intimate relationship—provides this paper with its (...) field. I am interested in probing the images of the relationship between self and other, particularly self and intimate other, that seem presupposed by some leading attempts to determine the basis for proxy decision-making authority, and what constraints it must observe. In the light of both recent work in the philosophy of mind and considerations closer to common experience, the reigning images seem too slight to support the weight of current practices and beliefs about proxy authority; supplanting them with images more faithful to our experience will have implications for our practice with proxies. (shrink)

Discussions of whistleblowing whether in academic literature or in more popular media have tended to very one-sided assessments of the moral worth of the act. Indeed, much of the current literature concentrates on psychological or managerial aspects of whistleblowing while taking for granted this or that moral position or eschewing any normative commitment on the question. The purpose of this article is firstly to reemphasise the importance and complexity of the normative foundations of whistleblowing acts; and secondly, through a moral (...) philosophical analysis of the component decisions that make up any act of whistleblowing, to contribute to a more balanced and less polarised treatment of the topic. It is argued that the polarisation of views on the topic is in part due to a failure to decompose the act of whistleblowing into a number of inevitable component moral decisions leading up to the act. It is furthermore argued on the basis of the analysis that it is impossible to state a priori as a matter of general principle that whistleblowing is always morally right or morally wrong . The article will close with a reflection on the degree to which the weighing up of good and bad in the act of whistleblowing differs sharply among cultures; and with a conjecture as to a possible relation to a people's history which may serve as a pointer to interesting future empirical research on the topic. (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)

This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French; applicable to specific and identifiable jurisdictions; and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was (...) extracted from each guideline on: 1) the development process; 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources; and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within individual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, divergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources. (shrink)

CRISPR is currently viewed as the central tool for future gene therapy. Yet, many prominent scientists and bioethicists have expressed ethical concerns around CRISPR gene therapy. This paper provides a critical review of concerns about CRISPR gene therapy as expressed in the mainstream academic literature, paired with replies also generally found in that literature. The expressed concerns can be categorised into three types depending on whether they stress risk/benefit ratio, autonomy and informed consent, or concerns related to various aspects (...) of justice. In the reviewed literature, we found no intrinsic objections to CRISPR gene therapy, even though many such objections were present in discussions of gene editing in the 1990s. The paper then proposes a brief outline for a practically applicable moral framework for public decision-making about CRISPR gene therapy and suggests how such a framework might be supported. We also suggest that this framework should govern public engagement about CRISPR gene therapy in order to reduce the risk that we make decisions about CRISPR gene therapy based on misperceptions, inflated views of risk, or unreasonable moral or religious views. (shrink)

Teaching the nuances of ethical decision making is particularly challenging in fully online, asynchronous courses where real-time discussion is not an option. Digital simulations, in the context of an integrative online ethics course, can offer applied learning and assessment experiences. However, scholarship on the impact of digital simulations for teaching ethical decision making is limited. The purpose of this study is to explore whether digital simulation used as an assessment for ethical reasoning and complex decision making is (...) effective in helping business students heighten their awareness of values in tension and discern ethical paths to resolution. We conduct an exploratory analysis of two ethics simulations used in teaching nine graduate business ethics classes offered in an asynchronous, online format. We discuss the results in terms of the Markkula Center for Applied Ethics’ five-step ethical decision making framework and outline implications for teaching and future research on business ethics simulations. (shrink)

Egg or sperm? The mechanism of sexual fate decision in germ cells has been a long‐standing issue in biology. A recent analysis identified foxl3 as a gene that determines the sexual fate decision of germ cells in the teleost fish, medaka. foxl3/Foxl3 acts in female germline stem cells to repress commitment into male fate (spermatogenesis), indicating that the presence of mitotic germ cells in the female is critical for continuous sexual fate decision of germ cells in (...) medaka gonads. Interestingly, foxl3 is found in most vertebrate genomes except for mammals. This provides the interesting possibility that the sexual fate of germ cells in mammals is determined in a different way compared to foxl3‐possessing vertebrates. Considering the fact that germline stem cells are the cells where foxl3 begins to express and sexual fate decision initiates and mammalian ovary does not have typical germline stem cells, the mechanism in mammals may have been co‐evolved with germline stem cell loss in mammalian ovary. (shrink)

Adolescents present a puzzle. There are foundational unclarities about how they should be regarded as decision-makers. Although superficially adolescents may appear to have mature decisional capacity, their decision-making is in many ways unlike that of adults. Despite this seemingly obvious fact, a concern for the claims of autonomy has led to the development of the legal doctrine of the mature minor. This legal construct considers adolescents, as far as possible, as equivalent to adults for the purpose of medical (...) decision-making. The movement to support independent decision-making by adolescents through providing information to them and securing their consent apart from their parents is encouraged by those legal understandings that hold that unemancipated minors should generally be considered as possessing effective decisional capacity. Such legal structures, however, do not adequately take account of the wide variations in adolescent capacities, the immaturity of most adolescent decision-makers, or the important contributions made by parents to the development of their adolescents through parental partnering in the adolescent’s decision-making. The data available indicate that in general adolescents should be regarded as apprentice decision-makers who should make decisions in collaboration with their parents until at least the age of 18. Steps should not be taken pre-emptively to isolate adolescents from the guidance of their parents. As a general rule, what Piker has referred to as “collaborative paternalism” appears most likely both to protect adolescents from their own untoward choices, while also very importantly helping them with parental guidance to develop into mature decision-makers with the capacity to make medical choices on their own. (shrink)

HARWOOD L and CLARK AM. Nursing Inquiry 2012; 19: 29–38Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney diseaseThis paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self-management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home-dialysis has clear health, societal and economic benefits yet service (...) usage is low despite efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home-dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re-conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. (shrink)

The Rule of Double Effect (RDE) holds that it may be permissible to harm an individual while acting for the sake of a proportionate good, given that the harm is not an intended means to the good but merely a foreseen side-effect. Although frequently used in medical ethical reasoning, the rule has been repeatedly questioned in the past few decades. However, Daniel Sulmasy, a proponent who has done a lot of work lately defending the RDE, has recently presented a reformulated (...) and more detailed version of the rule. Thanks to its greater precision, this reinvented RDE avoids several problems thought to plague the traditional RDE. Although an improvement compared with the traditional version, we argue that Sulmasy's reinvented RDE will not stand closer scrutiny. Not only has the range of proper applicability narrowed significantly, but, more importantly, Sulmasy fails to establish that there is a morally relevant distinction between intended and foreseen effects. In particular, he fails to establish that there is any distinction that can account for the alleged moral difference between sedation therapy and euthanasia. (shrink)

Decision support systems, which incorporate artificial intelligence and big data, are receiving significant attention in the public sector. Decision support systems are sociocultural artefacts that are subject to a mix of technical and political choices, and critical investigation of these choices and the rationales they reflect are paramount since they are inscribed into and may cause harm, violate fundamental rights and reproduce negative social patterns. Applying and merging the concepts of sense-making and translation, this article investigates the (...) rationales, translations and critical reflections that shape the development of a decision support system to support social workers assessing referrals concerning child neglect. It presents findings from a qualitative case study conducted in 2019–2020 at the Citizen Centre Children and Young People, Copenhagen Municipality, Denmark. The analysis shows how key actors through processes of translation construct, negotiate and readjust problem definitions, roles, interests, responsibilities and ideas of ambiguity and accountability. Although technological solutionism is present in these processes, it is not the only rationale invested. Rather, technological and data-driven rationales are adjusted to and merged with rationales of efficiency, return on investment and child welfare. Through continuous renegotiation of roles, responsibilities and problems according to these rationales, the key actors attempt to orchestrate ways of managing the complexity facing child welfare services by projecting images of future potentials of the decision support system that are yet to be realised. (shrink)

The ethics of decision making for the critically ill elderly is an area of concern for all those involved in the decision-making process. The number of participants involved in decision making around end-of-life issues may be many: treatment and care decisions often bring together not only the patient and the physician, but the family, an extended medical care team, and impartial members of a hospital or institutional ethics committee. In addition, treatment and care decisions made at the (...) end of life occur in a variety of settings, not just the acute care hospital. Elderly patients who are critically ill, or in the final days or weeks of life, are found in intensive care or medical units of hospitals, in hospital and nursing home based hospice programs, in long-term care settings such as skilled nursing facilities, or at home, where they are tended by family caregivers. Differences in patterns of decision making regarding the care and treatment of critically ill older adults can be found across these settings, and decisions often vary according to the roles of the participants. (shrink)

An evolutionary model of human behavior should privilege emotions: essential, phylogenetically ancient behaviors that learning and decision making only subserve. Infants and non-mammals lack advanced cognitive powers but still survive. Decision making is only a means to emotional ends, which organize and prioritize behavior. The emotion of pride/shame, or dominance striving, bridges the social and biological sciences via internalization of cultural norms. (Published Online April 27 2007).

Fairness-related decision making is an important issue in the field of decision making. Traditional theories emphasize the roles of inequity aversion and reciprocity, whereas recent research increasingly shows that emotion plays a critical role in this type of decision making. In this review, we summarize the influences of three types of emotions (i.e., the integral emotion experienced at the time of decision making, the incidental emotion aroused by a task-unrelated dispositional or situational source, and the (...) interaction of emotion and cognition) on fairness-related decision making. Specifically, we first introduce three dominant theories that describe how emotion may influence fairness-related decision making (i.e., the wounded pride/spite model, affect infusion model, and dual-process model). Next, we collect behavioral and neural evidence for and against these theories. Finally, we propose that future research on fairness-related decision making should focus on inducing incidental social emotion, avoiding irrelevant emotion when regulating, exploring the individual differences in emotional dispositions, and strengthening the ecological validity of the paradigm. (shrink)

Objective Explore parents’ point of view about forgoing life sustaining treatment in terminal critically ill children and factors affecting their decisions. Method This was a qualitative study using in-depth interviews with parents whose child died between 6–12 months old in pediatric intensive care unit of a university-affiliated teaching hospital. Interviews were audiotaped and transcribed. Data were analyzed using interpretive description method. Result A total of 7 parents of 5 children decided to withhold or withdraw LST. Five parents from 4 children (...) decided to sign the do not attempt resuscitation, and none choose to withdrew the LST, including mechanical support. Factors influenced their decision were communication, value of children, child best interest, intuition, religious belief, and emotions. Economic factors did not influence the decision-making. Conclusion Most parents decided to sign the DNAR, none choose to withdrew mechanical support. Communication was the most important factor that influenced parents to make a forgoing LST decision. (shrink)

While agreeing with the main conclusion of Dominic Wilkinson and colleagues (Wilkinson, Butcherine, and Savulescu 2019), namely, that there is no moral difference between treatment withholding and withdrawal as such, we wish to criticize their approach on the basis that it treats the widespread acceptance of withdrawal aversion (WA) as a cognitive bias. Wilkinson and colleagues understand WA as “a nonrational preference for withholding (WH) treatment over withdrawal (WD) of treatment” (22). They treat WA as a manifestation of loss aversion (...) and refer to Kahneman and colleagues (1991), which defined this effect as follows: “the disutility of giving up an object is greater that the utility associated with acquiring it” (194). In a previous work, Wilkinson and Savulescu understood nonequivalence between treatment withholding and withdrawal as a reflection of slightly different, although related, phenomena: status quo bias or omission bias (Wilkinson and Savulescu 2012, 130–131). In neither of these two papers do they describe precisely the relation between these well-known psychological effects and WA, nor do they explain why they treat these effects as examples of nonrational preferences, despite the fact that these issues have been the subject of wide-ranging discussions on the intersection of psychology, economy, and philosophy. (shrink)

Death and grief in the ancient world -- Predictions and disability in Rome.

Bayesianism is the predominant philosophy of science in North-America, the most important school of statistics world-wide, and the general version of the rational-choice approach in the social sciences. Although often rejected as a theory of actual behavior, it is still the benchmark case of perfect rationality. The paper reviews the development of Bayesianism in philosophy, statistics and decision making and questions its status as an account of perfect rationality. Bayesians, who otherwise are squarely in the empiricist camp, invoke a (...) priori reasoning when they recommend Bayesian methods - a recommendation that is not justified by their own standards. (shrink)