Objective Semiotica is published in six annual issues, in two languages (English and French). From time to time, Special Issues, devoted to topics of particular interest, are assembled by Guest Editors. The publishers of Semiotica offer an annual prize, the Mouton d'Or, to the author of the best article each year. The article is selected by an independent international jury. Topics We welcome papers reporting results of research in all branches of semiotic studies. Article formats Research articles, in-depth reviews, guest (...) editorials, reports Mouton D’Or Winner 2022 "Semiotricité et corps en jeu", Parlebas, Pierre, 248, 9-35. The judges commented: "The Committee members made this decision based on many appreciations. First, the article contains a concise theory on semiotics of movement, synthesizing decades of research of the author. It opens an exciting framework for the contribution of many other authors. The theoretical grounds of semiotircity are built on the most classical semiotic approaches and represent a genuine development. Second, the article refreshes semiotics methodology in very original way, by engaging the applied semiotics for furtive and instantaneous activities analysis. Third, the article is pretty clear and well structured, written in very comprehensible French. The theoretical frame it opens is thorough and far reaching. Fourth, the semiotic theory of movement comes in a very special moment when the whole world is football, but it covers also many other areas of applicability which reflect major trends such as the general gamification of life thanks to new media and digital technologies. It is crucial for semiotic theory to open its theoretic scope towards significant cultural trends and become more attractive for young researchers." Les membres du comité ont pris leur décision en fondant leur appréciation sur quatre éléments principaux. Premier élément : l'article, en peu de mots, en prenant appui sur des décennies de recherche de la part de l'auteur, déploie de manière précise les termes d'une sémiotique du mouvement. Les fondements théoriques de la sémiotricité sont construits sur des approches sémiotiques bien établies et représentent un véritable développement dans le domaine. En cela, le texte ouvre un cadre passionnant pour les contributions de nombreux autres chercheurs. Deuxièmement, l'article renouvelle la sémiotique appliquée de manière très originale, l'engageant dans une approche efficace des actions instantanées et furtives; la méthodologie sémiotique en général en tire donc aussi profit. Troisième point, en plus d'être profond, avec un cadre théorique d'ampleur et de grande portée, l'article est particulièrement bien structuré et écrit dans un français très compréhensible, ce qui est un véritable gain pour sa diffusion. Enfin, quatrièmement, s'il est indéniable que le texte pourrait bénéficier d'une visibilité complémentaire due à la ferveur liée au contexte récent de la coupe du monde de football au Qatar, il couvre surtout de nombreux autres domaines d'applicabilité qui reflètent des tendances majeures telles que la gamification générale de la vie, portée par les nouveaux médias et les technologies numériques. L'on y voit une belle opportunité pour la théorie sémiotique d'ouvrir son champ à la faveur de tendances culturelles significatives; ceci est une garantie pour continuer à attirer de nouvelles générations de chercheurs. (shrink)

Prior research has demonstrated that trust in robots and performance of robots are two important factors that influence human–autonomy teaming. However, other factors may influence users’ perceptions and use of autonomous systems, such as perceived intent of robots and decision authority of the robots. The current study experimentally examined participants’ trust in an autonomous security robot (ASR), perceived trustworthiness of the ASR, and desire to use an ASR that varied in levels of decision authority and benevolence. (...) Participants (N = 340) were recruited from Amazon Mechanical Turk. Results revealed the participants had increased trust in the ASR when the robot was described as having benevolent intent compared to self-protective intent. There were several interactions between decision authority and intent when predicting the trust process, showing that intent may matter the most when the robot has discretion on executing that intent. Participants stated a desire to use the ASR in a military context compared to a public context. Implications for this research demonstrate that as robots become more prevalent in jobs paired with humans, factors such as transparency provided for the robot's intent and its decision authority will influence users’ trust and trustworthiness. (shrink)

Prior research has demonstrated that trust in robots and performance of robots are two important factors that influence human–autonomy teaming. However, other factors may influence users’ perceptions and use of autonomous systems, such as perceived intent of robots and decision authority of the robots. The current study experimentally examined participants’ trust in an autonomous security robot (ASR), perceived trustworthiness of the ASR, and desire to use an ASR that varied in levels of decision authority and benevolence. (...) Participants (N = 340) were recruited from Amazon Mechanical Turk. Results revealed the participants had increased trust in the ASR when the robot was described as having benevolent intent compared to self-protective intent. There were several interactions between decision authority and intent when predicting the trust process, showing that intent may matter the most when the robot has discretion on executing that intent. Participants stated a desire to use the ASR in a military context compared to a public context. Implications for this research demonstrate that as robots become more prevalent in jobs paired with humans, factors such as transparency provided for the robot's intent and its decision authority will influence users’ trust and trustworthiness. (shrink)

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

In this paper, I offer a view beyond that which would narrowly reduce the role of parents in medical decision making to acting as custodians of the best interests of children and toward an account of family authority and family autonomy. As a fundamental social unit, the good of the family is usually appreciated, at least in part, in terms of its ability successfully to instantiate its core moral and cultural understandings as well as to pass on such (...) commitments to future generations. The putative rights of children to expression, information, freedom of thought, conscience, religion, and to freedom of association with others are, in this essay, assessed from the perspective of those conditions necessary for the family to function as a moral community. In so doing, I respond to the move to liberate children from parental authority and to effect the transformation of the family as implied by the United Nations’ "Convention on the Rights of the Child" and the pediatric bioethics it supports. (shrink)

Expertise is commonly viewed as a professionalized competence in a specific field. Expert professional identities are produced and reproduced through professional training and other socialization mechanisms, which work to generate for a specific group of individuals a specific set of expert skills and knowledge. In this paper, I examine participants’ orientations to their distinct expert professional identities from the perspective of deontic authority. Drawing on 15 video-recorded church workplace meetings between pastors and cantors as data, and conversation analysis as (...) a theoretical and methodological framework, I analyze situations where a non-expert participant makes a proposal that the expert participant orients to as reasonable to comply with. Specifically, I demonstrate how the expert participants respond to these proposals with displays of deontic authority, arguably in an attempt to maintain their expert identities in the face of their de facto compliance with the proposals. In these situations, the expert participants are shown to invoke a past decision of their own, a future decision of their own, or a pattern that is beyond both participants’ control. Each of these practices involves the expert participant balancing resistance and compliance by minimally acknowledging the content of the non-expert participant’s proposal, while excluding the non-expert from those who have deontic authority in the matter. In so doing, the expert speaker implies that the non-expert proposal speaker lacks procedural knowledge about the specific matters about which it is relevant to make proposals to experts and access to the distinct experiential perspective that characterizes expert perception of things. It is thus argued that, in this context, the mere claims of deontic authority, produced without any substantial displays of expert knowledge, can serve the maintenance of expert professional identities. (shrink)

IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of who might (...) be suitable as a proxy in cases where there was no clear appointment of them by a still competent individual. and is now widely seen as a useful means through which we can exercise control over decisions that affect our lives when we have lost capacity to make these decisions for ourselves.I will here limit myself to discussion of proxy consent for adults appointed prior to the loss of competence by the person they are acting as proxy for. The issue of p. (shrink)

This article examines the relation of empathy and rational judgment. When people observe a conflict most are quick to side with one of the parties. Once a side has been taken, empathy with that party further solidifies this choice. Hence, it will be suggested that empathy is not neutral to judgment and rational decision-making. This does not mean, however, that the one who empathizes will necessarily have made the best choice.

The family, like so many other modern institutions, often looks more like an arena of competing wills than an ordered life in common. If we hope, therefore, to protect the special role that parents should have in relation to their children, and that the family in general should have in relation to its members, we will need a much more developed account of the goods that are at stake and why we think they are important enough to require authority, (...) even when members of the family oppose the decisions of that authority. This essay develops an older account of authority, one rooted in the thought of Aristotle and St. Thomas Aquinas, and applies this account to our present difficulties concerning the authority of the family over its members in health care decision making. (shrink)

This issue of the Hastings Center Report features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers’ authority when the surrogates’ judgments about a patient's treatment conflict with the physicians’. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to (...) a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient—even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma. The second article, by physician Jeffrey Berger, flips the questions. If a physician decides that a patient's intractable suffering requires palliative sedation, may the surrogate prevent it anyway? Or can the physician, pointing to a duty to alleviate the suffering, administer palliative sedation even in the face of the surrogate's objections? Such circumstances, says Berger, show the need for conceptual work delineating the limits of surrogates’ authority and practical work on mechanisms for doing so—protecting patients and giving physicians a clear route to follow. (shrink)

Environmental pragmatists are committed to analyzing questions of environmental policy. Bryan Norton's pragmatic critique of environmental decision-making shows how an implicit commitment to the fact/value distinction has hindered productive environmental action. Nonetheless, Norton, as well as the majority of environmental ethicists, have devoted more attention to theorizing value disagreements as a primary cause of controversy than to examining epistemic structures. A case study demonstrates why and how Norton's procedural account may be supplemented with sensitive attention to the construction of (...) epistemic authority in environmental disputes. I recommend supporting the development of local knowledges and just distributions of epistemic authority. (shrink)

BackgroundThere is evidence that direct journal endorsement of reporting guidelines can lead to important improvements in the quality and reliability of the published research. However, over the last 20 years, there has been a proliferation of reporting guidelines for different study designs, making it impractical for a journal to explicitly endorse them all. The objective of this study was to investigate whether a decision tree tool made available during the submission process facilitates author identification of the relevant reporting guideline.MethodsThis (...) was a prospective 14-week before–after study across four speciality medical research journals. During the submission process, authors were prompted to follow the relevant reporting guideline from the EQUATOR Network and asked to confirm that they followed the guideline (‘before’). After 7 weeks, this prompt was updated to include a direct link to the decision-tree tool and an additional prompt for those authors who stated that ‘no guidelines were applicable’ (‘after’). For each article submitted, the authors’ response, what guideline they followed (if any) and what reporting guideline they should have followed (including none relevant) were recorded.ResultsOverall, 590 manuscripts were included in this analysis—300 in the before cohort and 290 in the after. There were relevant reporting guidelines for 75% of manuscripts in each group; STROBE was the most commonly applicable reporting guideline, relevant for 35% (n = 106) and 37% (n = 106) of manuscripts, respectively. Use of the tool was associated with an 8.4% improvement in the number of authors correctly identifying the relevant reporting guideline for their study (p < 0.0001), a 14% reduction in the number of authors incorrectly stating that there were no relevant reporting guidelines (p < 0.0001), and a 1.7% reduction in authors choosing a guideline (p = 0.10). However, the ‘after’ cohort also saw a significant increase in the number of authors stating that there were relevant reporting guidelines for their study, but not specifying which (34 vs 29%; p = 0.04).ConclusionThis study suggests that use of a decision-tree tool during submission of a manuscript is associated with improved author identification of the relevant reporting guidelines for their study type; however, the majority of authors still failed to correctly identify the relevant guidelines. (shrink)

Whether adolescents should be allowed to make their own medical decisions has been a topic of discussion in bioethics for at least two decades now. Are adolescents sufficiently capacitated to make their own medical decisions? Is the mature-minor doctrine, an uncommon legal exception to the rule of parental decision-making authority, something we should expand or eliminate? Bioethicists have dealt with the curious liminality of adolescents—their being neither children nor adults—in a variety of ways. However, recently there has been (...) a trend to rely heavily, and often exclusively, on emerging neuroscientific and psychological data to answer these questions. Using data from magnetic resonance imaging and functional MRI studies on the adolescent brain, authors have argued both that the adolescent brain isn't sufficiently mature to broadly confer capacity on this population and that the adolescent brain is sufficiently mature to assume adolescent capacity. Scholars then accept these data as sufficient for concluding that adolescents should or should not have decision-making authority. Two critical mistakes are being made here. The first is the expectation that neuroscience or psychology is or will be able to answer all our questions about capacity. The second, and more concerning, mistake is the conflation of decision-making capacity with decision-making authority. (shrink)

This article draws on analysis of a variety of problems emerging from practical applications of Group Decision Support Systems (GDSS) to propose a fundamental evolution of decision support models from the traditional single decision-spine model to the decision-hedgehog. It positions decision making through the construction of narratives making the rhizome that constitutes the body of the hedgehog with the fundamental aim of enriching understanding of the contexts of decision making. Localized processes constructing and exploring (...) prescriptions for action within a plethora of decision spines are rooted in this rhizome. It identifies a synthesis of theories that influence decision making within organizations and proposes a comprehensive system of Group Decision Authoring and Communication Support (GDACS). In doing so it proposes that the iterative development of collective narrative within an organizing system engaged with complex decision making leads to active engagement with implementation - a process we call Collaborative Authoring of Outcomes. Throughout, the article outlines the implications for the organization of GDACS and proposes a comprehensive architecture that enables this approach. (shrink)

What characteristics or attributes of a healthcare decision qualify it as acceptable to those who are empowered to judge it as adequate and hence suitable to either proceed (or not) with a recommen...

This paper draws on a social perspective of language use in the legal processes of asylum claims with particular attention to decision-writing and written texts within the context of the Greek Appeals Authority. Such a perspective aligns with an interdisciplinary call for emerging research framed in sociolinguistics and the law, that facilitates knowledge sharing in order to make visible the institutional veracity control inherent in asylum processes. To that end, applying van Leeuwen’s social actor network framework, I analyze (...) nine (9) institutional written records, issued between 2011 and 2021 by focusing on the semiotics resources at play in writing. My conclusions highlight the institutional discursive power over writing and representing the applicants and their claims. Ultimately, such institutionally controlled texts are nothing but technopolitical discourse devices through which access to or rejection of protection is granted, thereby governing asylum in fundamentally stratified ways. (shrink)

Paternal authority is recommended as a valid Christian resource for conflict resolution in biomedical (and other inner-familial) decision making. Its bases are explored in view of the two-fold creation account in Genesis, interpreted in the light of the Pauline theology. In addition, a theological account is proposed that portrays the taxis between husband and wife as a condition under which humans can seek to emulate the inner-Trinitarian love. The relationship between that love (as portrayed in St. Basil’s On (...) the Holy Spirit), the love between God and man, and the love between the sexes (as further extended to the children in a family that constitutes a “small church”), is described in terms of an interplay between the Divine offer of grace and the human response of obedience. In framing their marital love according to the model of Christ and His Church, couples can also profit from the ascetical therapy predicted for their fallen nature in the “curse” that drove our forefathers from Paradise. (shrink)

Where a person is unable to make medical decisions for themselves, law and practice allows others to make decisions on their behalf. This is common at the end of a person’s life where decision-making capacity is often lost. A further, and separate, decision that is often considered at the time of death (and often preceding death) is whether the person wanted to act as an organ or tissue donor. However, in some jurisdictions, the lawful decision-maker for the (...) donation decision (the ‘donation decision-maker’) is different from the person who was granted decision-making authority for medical decisions during the person’s life. To date, little attention has been given in the literature to the ethical concerns and practical problems that arise where this shift in legal authority occurs. Such a change in decision-making authority is particularly problematic where premortem measures are suggested to maximise the chances of a successful organ donation. This paper examines this shift in decision-making authority and discusses the legal, ethical and practical implications of such frameworks. (shrink)

Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans (...) youth capacity to consent to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified. (shrink)

Algorithms increasingly make managerial decisions that people used to make. Perceptions of algorithms, regardless of the algorithms' actual performance, can significantly influence their adoption, yet we do not fully understand how people perceive decisions made by algorithms as compared with decisions made by humans. To explore perceptions of algorithmic management, we conducted an online experiment using four managerial decisions that required either mechanical or human skills. We manipulated the decision-maker, and measured perceived fairness, trust, and emotional response. With the (...) mechanical tasks, algorithmic and human-made decisions were perceived as equally fair and trustworthy and evoked similar emotions; however, human managers' fairness and trustworthiness were attributed to the manager's authority, whereas algorithms' fairness and trustworthiness were attributed to their perceived efficiency and objectivity. Human decisions evoked some positive emotion due to the possibility of social recognition, whereas algorithmic decisions generated a more mixed response – algorithms were seen as helpful tools but also possible tracking mechanisms. With the human tasks, algorithmic decisions were perceived as less fair and trustworthy and evoked more negative emotion than human decisions. Algorithms' perceived lack of intuition and subjective judgment capabilities contributed to the lower fairness and trustworthiness judgments. Positive emotion from human decisions was attributed to social recognition, while negative emotion from algorithmic decisions was attributed to the dehumanizing experience of being evaluated by machines. This work reveals people's lay concepts of algorithmic versus human decisions in a management context and suggests that task characteristics matter in understanding people's experiences with algorithmic technologies. (shrink)

The authors developed this textbook in response to an increasing interest in ethics, and a growing number of courses on this topic that are now being offered in educational leadership programs. It is designed to fill a gap in instructional materials for teaching the ethics component of the knowledge base that has been established for the profession. The text has several purposes: First, it demonstrates the application of different ethical paradigms (the ethics of justice, care, critique, and the profession) through (...) discussion and analysis of real-life moral dilemmas that educational leaders face in their schools and communities. Second, it addresses some of the practical, pedagogical, and curricular issues related to the teaching of ethics for educational leaders. Third, it emphasizes the importance of ethics instruction from a variety of theoretical approaches. Finally, it provides a process that instructors might follow to develop their own ethics unit or course. * Part I provides an overview of why ethics is so important, especially for today's educational leaders, and describes a multiparadigm approach essential to practitioners as they grapple with ethical dilemmas. * Part II deals with the dilemmas themselves. Ethical dilemmas written by the authors' graduate students bring readers face-to-face with the kinds of dilemmas faced by practicing administrators in urban, suburban, and rural settings in an era full of complexities and contradictions. * Part III focuses on pedagogy and provides teaching notes for the instructor. The authors discuss the importance of self-reflection on the part of both instructors and students, and model how they thought through their own personal and professional ethical codes as well as reflected upon the critical incidents in their lives that shaped their teaching and frequently determined what they privileged in class. (shrink)

Is Bayesian decision theory a panacea for many of the problems in epistemology and the philosophy of science, or is it philosophical snake-oil? For years a debate had been waged amongst specialists regarding the import and legitimacy of this body of theory. Mark Kaplan had written the first accessible and non-technical book to address this controversy. Introducing a new variant on Bayesian decision theory the author offers a compelling case that, while no panacea, decision theory does in (...) fact have the most profound consequences for the way in which philosophers think about inquiry, criticism and rational belief. The new variant on Bayesian theory is presented in such a way that a non-specialist will be able to understand it. The book also offers new solutions to some classic paradoxes. It focuses on the intuitive motivations of the Bayesian approach to epistemology and addresses the philosophical worries to which it has given rise. (shrink)

Is Bayesian decision theory a panacea for many of the problems in epistemology and the philosophy of science, or is it philosophical snake-oil? For years a debate had been waged amongst specialists regarding the import and legitimacy of this body of theory. Mark Kaplan had written the first accessible and non-technical book to address this controversy. Introducing a new variant on Bayesian decision theory the author offers a compelling case that, while no panacea, decision theory does in (...) fact have the most profound consequences for the way in which philosophers think about inquiry, criticism and rational belief. The new variant on Bayesian theory is presented in such a way that a non-specialist will be able to understand it. The book also offers new solutions to some classic paradoxes. It focuses on the intuitive motivations of the Bayesian approach to epistemology and addresses the philosophical worries to which it has given rise. (shrink)

Newcomb's problem and similar cases show the need to incorporate causal distinctions into the theory of rational decision; the usual noncausal decision theory, though simpler, does not always give the right answers. I give my own version of causal decision theory, compare it with versions offered by several other authors, and suggest that the versions have more in common than meets the eye.

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts (...) about who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

This paper discusses the use of deep brain stimulation for the treatment of neurological and psychiatric disorders in children. At present, deep brain stimulation is used to treat movement disorders in children and a few cases of deep brain stimulation for psychiatric disorders in adolescents have been reported. Ethical guidelines on the use of deep brain stimulation in children are therefore urgently needed. This paper focuses on the decision-making process, and provides an ethical framework for (future) treatment decisions in (...) pediatric deep brain stimulation. I defend a shared decision-making model in case of deep brain stimulation for neurological and psychiatric disorders in children. To protect the vulnerable child patient, a dual consent process is needed where parents or parental guardians give their consent, and the child gives his/her assent. (shrink)

Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow (...) physicians and internal medicine attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (shrink)

The processing of sensitive information in the health field is subject to rigorous standards that guarantee the protection of information confidentiality. Recently, the Italian Data Protection Authority (Garante per la Protezione dei Dati Personali) stated their formal opinion on a standard procedure in dental offices involving the submission of a questionnaire that includes the patient's health status. HIV infection status is included on the form. The Authority has stated that all health data collection must be in accordance with (...) the current Italian normative framework for personal data protection and respect the patient's freedom. This freedom allows the patient to decide, in a conscious and responsible way, whether to share health information with health personnel without experiencing any prejudice in the provision of healthcare requested. Moreover, data collection must be relevant and cannot exceed the principles of treatment goals with reference to the specific care of the concerned person. However, the need for recording information regarding HIV infection at the first appointment, regardless of the clinical intervention or therapeutic plan that needs to be conducted, should not alter the standard protection measures of the healthcare staff. In fact, these measures are adopted for every patient. (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)

The classic formulation of causal decision theory (CDT) appeals to counterfactuals. It says that you should aim to choose an option that would have a good outcome, were you to choose it. However, this version of CDT faces trouble if the laws of nature are deterministic. After all, the standard theory of counterfactuals says that, if the laws are deterministic, then if anything—including the choice you make—were different in the present, either the laws would be violated or the distant (...) past would be changed. And as several authors have shown, it's easy to transform this upshot of the standard theory of counterfactuals into full-blown counterexamples to CDT. In response to these counterexamples, I argue here that the problem lies, not so much with CDT's guiding idea—that it's the expected causal consequences of your actions that matter for rational decision-making—but with the fact that the classic formulation of CDT doesn't pay sufficient attention to the context-sensitivity of counterfactuals. I develop a contextualist version of CDT which better accounts for this context-sensitivity. And I show that my theory avoids the problems faced by the classic formulation of CDT in determinstic worlds. (shrink)

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by (...) trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted. (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)

Several authors have recently advocated a so-called new case for paternalism, according to which empirical findings from distinct decision sciences provide compelling reasons in favour of paternalistic interference. In their view, the available behavioural and neuro-psychological findings enable paternalists to address traditional anti-paternalistic objections and reliably enhance the well-being of their target agents. In this paper, I combine insights from decision-making research, moral philosophy and evidence-based policy evaluation to assess the merits of this case. In particular, I articulate (...) and defend three complementary arguments that, I claim, challenge even the best available calls for such case. In doing so, I identify the main justificatory challenges faced by the new paternalists and explicate the implications of these challenges for the ongoing philosophical debate about the justifiability of paternalistic interference. (shrink)

Jim Joyce has argued that David Lewis’s formulation of causal decision theory is inadequate because it fails to apply to the “small world” decisions that people face in real life. Meanwhile, several authors have argued that causal decision theory should be developed such that it integrates the interventionist approach to causal modeling because of the expressive power afforded by the language of causal models, but, as of now, there has been little work towards this end. In this paper, (...) I propose a variant of Lewis’s causal decision theory that is intended to meet both of these demands. Specifically, I argue that Lewis’s causal decision theory can be rendered applicable to small world decisions if one analyzes his dependency hypotheses as causal hypotheses that depend on the interventionist causal modeling framework for their semantics. I then argue that this interventionist variant of Lewis’s causal decision theory is preferable to interventionist causal decision theories that purportedly generalize Lewis’s through the use of conditional probabilities. This is because Lewisian interventionist decision theory captures the causal decision theorist’s conviction that any correlation between what the agent does and cannot cause should be irrelevant to the agent’s choice, while purported generalizations do not. (shrink)

It is often argued that future-directed decisions are effective at shaping our future conduct because they give rise, at the time of action, to a decisive reason to act as originally decided. In this paper, I argue that standard accounts of decision-based reasons are unsatisfactory. For they focus either on tie-breaking scenarios or cases of self-directed distal manipulation. I argue that future-directed decisions are better understood as tools for the non-manipulative, intrapersonal division of deliberative labor over time. A future-directed (...) decision to ϕ gives rise to a defeasible exclusionary reason to ϕ. This reason is grounded on the default authority that is normally granted to one’s prior self as an “expert” deliberator. I argue that this kind of exclusionary reason is the only one that can account for the effectiveness of future-directed decisions at shaping our diachronic agency without violating our autonomy over time. (shrink)

The paper re-expresses arguments against the normative validity of expected utility theory in Robin Pope (1983, 1991a, 1991b, 1985, 1995, 2000, 2001, 2005, 2006, 2007). These concern the neglect of the evolving stages of knowledge ahead (stages of what the future will bring). Such evolution is fundamental to an experience of risk, yet not consistently incorporated even in axiomatised temporal versions of expected utility. Its neglect entails a disregard of emotional and financial effects on well-being before a particular risk is (...) resolved. These arguments are complemented with an analysis of the essential uniqueness property in the context of temporal and atemporal expected utility theory and a proof of the absence of a limit property natural in an axiomatised approach to temporal expected utility theory. Problems of the time structure of risk are investigated in a simple temporal framework restricted to a subclass of temporal lotteries in the sense of David Kreps and Evan Porteus (1978). This subclass is narrow but wide enough to discuss basic issues. It will be shown that there are serious objections against the modification of expected utility theory axiomatised by Kreps and Porteus (1978, 1979). By contrast the umbrella theory proffered by Pope that she has now termed SKAT, the Stages of Knowledge Ahead Theory, offers an epistemically consistent framework within which to construct particular models to deal with particular decision situations. A model by Caplin and Leahy (2001) will also be discussed and contrasted with the modelling within SKAT (Pope, Leopold and Leitner 2007). (shrink)

In a two-tiered, or Dual Oughts, moral theory, the objective account of right and wrong is supplemented by decision guides designed to enable an agent, uncertain about the circumstances or consequences of her possible actions, to indirectly apply the objective theory by using an appropriate decision guide. But are the decision guides counsels of morality or counsels of rationality? Peter Graham argues they are counsels of pragmatic rationality. This paper shows Graham’s view is unsuccessful, and argues, based (...) on the approach recently developed in [Author] that decision guides must be seen as moral principles. An explanation is provided for why we may be tempted to interpret decision guides as principles of rationality. (shrink)

Future mobility planning to cope with ongoing environmental challenges such as air pollution has to be anchored in the work of every public authority worldwide. One recent trend that could support public authorities to meet the European Union’s sustainability targets is the creation and sharing of transport and mobility “big” data between public authorities via tools such as crowdsourcing. While the benefits of the use of big data to increase public authorities’ efficiency and effectivity and their citizens’ lives is (...) well understood, examples from the public sector that highlight public authorities’ engagement in such sharing activities is still missing. To date relevant literature has highlighted issues around the capacity of public authorities that hinder shared activities. In this paper we want to raise distrust as a key reason for lack of engagement. Based on comprehensive data collected over the period of 4 years via several workshops and semi-structured interviews with seven public authorities in Europe, we are able to demonstrate that a major obstacle for not providing and sharing data via crowdsourcing for mutual benefit lies primarily in the hands of the public authority’s servants of the middle and high-level management. Our results show firstly, that distrust may emerge toward different referents such as the community, particular individuals, or the technology itself and thus, managerial implications have to be very specific to overcome distrust. Secondly, we show how distrust may spread from one referent to another through negative reciprocity and which, if unchecked may lead to an all-encompassing state that affects the whole sharing economy framework and inhibits potential benefits. (shrink)

Democracy is not naturally plausible. Why turn such important matters over to masses of people who have no expertise? Many theories of democracy answer by appealing to the intrinsic value of democratic procedure, leaving aside whether it makes good decisions. In Democratic Authority, David Estlund offers a groundbreaking alternative based on the idea that democratic authority and legitimacy must depend partly on democracy's tendency to make good decisions.Just as with verdicts in jury trials, Estlund argues, the authority (...) and legitimacy of a political decision does not depend on the particular decision being good or correct. But the "epistemic value" of the procedure--the degree to which it can generally be accepted as tending toward a good decision--is nevertheless crucial. Yet if good decisions were all that mattered, one might wonder why those who know best shouldn't simply rule.Estlund's theory--which he calls "epistemic proceduralism"--avoids epistocracy, or the rule of those who know. He argues that while some few people probably do know best, this can be used in political justification only if their expertise is acceptable from all reasonable points of view. If we seek the best epistemic arrangement in this respect, it will be recognizably democratic--with laws and policies actually authorized by the people subject to them. (shrink)

Davis Lewis describes that decision theory is no more than a systematic account of an ordinary, common sense philosophy of mind. It is a tool applied to the task of coming to know ourselves and others as persons. The aim is to extend the value function from individual words to propositions so that it gives a measure of degrees of desire. Decision theorists agree that desirability is to be explicated as expected value. They agree that insofar as (...) class='Hi'>decision theory is a normative enterprise, it prescribes that one choose so as to maximize expected value. They agree that the notion of expected value involves the notion of revision of degrees of belief. Desire‐as‐belief implies near‐opinionation or indifference. The author thinks that there is no small irony in the fact that the greatest contemporary defender of Humeanism is also one of the co‐founders of the only version of decision theory. (shrink)

Memory evolved to supply useful, timely information to the organism’s decision-making systems. Therefore, decision rules, multiple memory systems, and the search engines that link them should have coevolved to mesh in a coadapted, functionally interlocking way. This adaptationist perspective suggested the scope hypothesis: When a generalization is retrieved from semantic memory, episodic memories that are inconsistent with it should be retrieved in tandem to place boundary conditions on the scope of the generalization. Using a priming paradigm and a (...) decision task involving person memory, the authors tested and confirmed this hypothesis. The results support the view that priming is an evolved adaptation. They further show that dissociations between memory systems are not—and should not be—absolute: Independence exists for some tasks but not others. (shrink)

The authors review the empirical literature in order to assess which variables are postulated as influencing ethical beliefs and decision making. The variables are divided into those unique to the individual decision maker and those considered situational in nature. Variables related to an individual decision maker examined in this review are nationality, religion, sex, age, education, employment, and personality. Situation specific variables examined in this review are referent groups, rewards and sanctions, codes of conduct, type of ethical (...) conflict, organization effects, industry, and business competitiveness. The review identifies the variables that have been empirically tested in an effort to uncover what is known and what we need to know about the variables that are hypothesized as determinants of ethical decision behavior. (shrink)

In recent years, a plethora of high-profile scientific publications has been reporting about machine learning algorithms outperforming clinicians in medical diagnosis or treatment recommendations. This has spiked interest in deploying relevant algorithms with the aim of enhancing decision-making in healthcare. In this paper, we argue that instead of straightforwardly enhancing the decision-making capabilities of clinicians and healthcare institutions, deploying machines learning algorithms entails trade-offs at the epistemic and the normative level. Whereas involving machine learning might improve the accuracy (...) of medical diagnosis, it comes at the expense of opacity when trying to assess the reliability of given diagnosis. Drawing on literature in social epistemology and moral responsibility, we argue that the uncertainty in question potentially undermines the epistemic authority of clinicians. Furthermore, we elucidate potential pitfalls of involving machine learning in healthcare with respect to paternalism, moral responsibility and fairness. At last, we discuss how the deployment of machine learning algorithms might shift the evidentiary norms of medical diagnosis. In this regard, we hope to lay the grounds for further ethical reflection of the opportunities and pitfalls of machine learning for enhancing decision-making in healthcare. (shrink)