Stephanie Collins’ Group Duties offers interesting new arguments and brings together numerous interconnected issues that have hitherto been treated separately. My critical commentary focuses on two particularly original and central claims of the book: (1) Only groups that are united under a group-level decision-making procedure can bear duties. (2) Attributions of duties to other groups should be understood as attributions of “coordination duties” to each member of the group, duties to take steps responsive to the others with (...) a view to the group’s φ-ing or express willingness to do so. In support of the first claim, Collins argues that only groups that can make decisions can bear duties, and that the ability to make decisions requires the relevant sort of decision-making procedure. I suggest that both parts of this argument remain in need of further support. I furthermore argue that Collins’ account of coordination duties gets certain kinds of cases wrong, and suggest that attributions of duties to groups without decision-making procedures are more plausibly understood as attributing shared duties. (shrink)

The 2005 Report on Social Responsibility and Health of the UNESCO International Bioethics Committee (Ibc) proposes a new approach to implementing the right to healthcare and suggests a number of Courses of Action to be followed in various fields. Based on the latest available data, we intend to present an overview of the current state of European health systems in two of those fields—decision-making procedures and quality assurance in health care—and to attempt a comparison of the situation with (...) the Report’s provisions, in order to pave the way for the identification of what still has to be done to bridge international recommendations and the reality of policy and practice in Europe’s health care. (shrink)

By comparing developments in two southern Italian factories, this article contrasts “aggregative” and “deliberative” procedures in trade unions. In one of the plants, the preferences of some of the workers appear to have been changed by deliberation. The process of rational persuasion seems to have required, however, more than sheer circulation of information. Based on this evidence, the article argues that when a potential conflict of interests is involved, speakers need to provide evidence that they are animated by a “communicative” (...) rather than “strategic” intent. This implies validating their implicit claim to sincerity of communication. (shrink)

In this essay I defend an institutional approach to democratic legitimacy against proceduralist approaches that are commonly endorsed by deliberative democrats. Although deliberative democrats defend a complex view of democratic legitimacy that aims to account for both the procedural and substantive dimensions of legitimacy, most accounts of the relationship between these dimensions currently on offer are too proceduralist to be plausible (I). By contrast, I argue that adopting an institutional approach helps provide a more convincing account of the interplay between (...) procedural and substantive aspects of democratic legitimacy which in turn illuminates the intricate relationship between public deliberation and decision-making procedures such as voting (II). This account also enables us to see what is wrong with interpreting the legitimacy of majoritarian and non-majoritarian institutions in terms of an alleged conflict between popular sovereignty and rights protections. In opposition to this view, I argue that the proper standard for judging the democratic legitimacy of both majoritarian and non-majoritarian institutions is whether they enable an ongoing recursive process of deliberative contestation or whether they generate antidemocratic shortcuts instead (III). (shrink)

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in a fragmented manner. This leads to partial answers on ascertaining patients’ true wishes, meaningfully engaging patients’ significant others, balancing interests among patients and significant others, and determining clinicians’ obligations to change patients’ unconventional convictions to enhance patient autonomy. A satisfactory solution based on relational autonomy must incorporate patients’ competence (apart from (...) decisional capacity), authenticity (their true desires or beliefs) and the involvement level of their significant others. To that end, we argue that John Christman’s procedural approach to relational autonomy provides critical insights, such as the diachronic or socio-historical personhood, sustained critical reflection and his recent explication of the nature of asymmetrical relationships and helpful interlocutors. This study reviews Christman’s account, proposes minor modifications and advocates for an integrated three-dimensional model for medical decision-making. Clarifying the relationship among the three elements promotes an ethical framework with a coherent understanding of relational autonomy. This model not only provides a descriptive and normative framework for end-of-life care practice but also reconsiders the nature of the clinician–patient relationship and its normative implications. We further present a case study to illustrate the merits of our proposed model. Altogether, our proposal will help navigate complex medical decision-making, foster trust and negotiate shared values between patients and their significant others, particularly in end-of-life care. (shrink)

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

A discussion of ethical decision-making literature is overdue. In this article, we summarize the current literature of ethical decision-making models used in mental health professions. Of 1,520 articles published between 2001 and 2020 that met initial search criteria, 38 articles were included. We report on the status of empirical evidence for the use of these models along with comparisons, limitations, and considerations. Ethical decision-making models were synthesized into eight core procedural components and presented based (...) on the composition of steps present in each model. This taxonomy provides practitioners, trainers, students, and supervisors relevant information regarding ethical decision-making models. (shrink)

Introduction: Responsibility and choice -- The idea of moral responsibility -- Complex choice situations -- Differing types of responsibility -- Hans Jonas' idea of "caring for beings" -- The moral experience of women -- Criticizing rational choice -- The rational choice model 5 -- Bounded rationality -- Myopic and deficient choices -- Violations of the axioms -- Rational fools -- The strategic role of emotions -- Social norms -- The communitarian challenge -- Duty, self-interest, and love -- Responsible decision (...) making -- Norms, goals, and stakeholders -- Choice as problem solving -- Ethical norms -- Who are the stakeholders? -- Co-evolving goals and alternatives -- Responsibility and the diversity of choices -- Rationality and respect -- Deontology -- Choices people can make -- The psychology of choice -- Prospect theory -- The "matching law" -- Incommensurability -- Modeling responsible decision making -- What is a responsible decision? -- Deontological payoffs -- Goal-achievement values -- Payoffs for the stakeholders -- Evaluation from multiple perspectives -- The maximin rule -- A geometric representation -- The procedural model -- Real world cases -- Donna's case -- The Ford Pinto case -- The World Bank environmental policy -- Applications in economics and public policy -- Responsibility and social justice -- The paradox of a paretian liberal -- Res ponsible agency in prisoner's dilemma situations -- Multidimensional cost-benefit analysis -- Ethical and social performance of business -- Nature, society, and future generations -- Epilogue: The responsible person. (shrink)

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

This paper examines women’s experiences with decision-making about non-invasive prenatal testing (NIPT). Such tests offer knowledge about chromosomal disorders early in pregnancy, without the risk of miscarriage associated with invasive procedures such as amniocentesis. Based on qualitative interviews with women in Germany who used, or declined, NIPT, we show how some women, who would not consider amniocentesis due to the risk of miscarriage, welcome the knowledge provided by, and the additional agency resulting from, NIPT. For others, declining the (...) offer to “know more” becomes increasingly difficult to articulate. The absence of risk strips women of a “good reason” to justify their decision not to test, thus implicitly challenging their “right not to know.” Moreover, NIPT heightens moral dilemmas within relationships with partners, existing children, and sometimes other close relatives. While clinically “non-invasive,” we argue that NIPT changes decision-making in an ethically and socially highly significant way. (shrink)

Although clinical ethics support services are becoming increasingly prevalent in Europe and North America, they remain an uncommon feature of the Irish healthcare system and Irish health professionals lack formal support when faced with ethically challenging cases. We have developed a variant on existing clinical ethics decision-making tools which is designed to build capacity and confidence amongst Irish practitioners and enable them to confront challenging situations in the absence of any dedicated support structure. The tool provided below follows (...) a transparent stepwise procedure which avoids an overcomplicated analysis while remaining sensitive to the complexity of the issues addressed. The novelty of the tool lies in the explicit association it makes between each step in the process and one or more responsibilities based on established norms of ethical decision-making in the public domain. (shrink)

Each of us makes a number of decisions, from the less important to those with far-reaching consequences. As members of different groups, we are also actors of group decision making. In order to make a rational decision, a choice-making procedure must satisfy a number of assumptions of rationality. In addition, when it comes to group decisions, those procedures should also be?fair.? However, it is not possible to define a procedure of choice-making that would (...) transform individual orders of alternatives based on preferences of perfectly rational individuals into a single social order and still meet conditions of rationality and ethics. The theory of deliberative democracy appeared in response to the impossibility of Social Choice theory. The basic assumption of deliberative democracy is that individuals adjust their preferences taking into account interests of the community. They are open for discussion with other group members and are willing to change their attitudes in order to achieve common interests. Ideally, group members come to an agreement during public discussion. Still, this concept cannot completely over?come all the difficulties posed by the theory of social choice. Specifically, there is no solution for strategic and manipulative behavior of individuals. Also, the concept of deliberative democracy faces certain problems particular to this approach, such as, to name but a few, problems with the establishment of equality of participants in the debate and their motivation, as well as problems with the organization of public hearings. (shrink)

The timely feature article by van der Pijl et al 1 highlights not only the widespread frequency with which unconsented episiotomies and other procedures during labour are reported by women but also that there is hardly any discussion in the literature on the ethics of consent for procedures in labour. Those national and international bodies with responsibility for midwifery and obstetric practice need not only to recognise but also act to remedy this unacceptable situation. The studies quoted used the recollection (...) of women in reporting consent or lack of it and, although this is an entirely appropriate measure, it gives no insight into what, if any, informed decision-making the care providers carried out. Such information would be useful to determine how better practice might be achieved. A study into the practice of episiotomies by Dutch midwives and obstetricians is referred to and is not reassuring.2 They frequently expressed surprise that consent should be necessary and women were minimally involved in the decision for performing episiotomy. This and other examples quoted of lack of valid consent have a corrosive effect on the fundamental but fragile trust and necessary trustworthiness of the relationship between the person being cared for …. (shrink)

Regarding police procedures with alcohol-intoxicated witnesses, Swedish police officers have previously reported inconsistent and subjective decisions when interviewing these potentially vulnerable witnesses. Most officers have also highlighted the need for national policy guidelines aiding in conducting investigative interviews with intoxicated witnesses. The aims of the two studies presented here were to investigate whether police officers’ inconsistent interview decisions are attributable to a lack of research-based knowledge; their decision to interview, as well as their perceptions of the witnesses’ credibility could (...) be influenced by scientific research; and police officers decision-making and perceptions of witness credibility are biased by pre-existing social norms. In two separate randomized online experiments, police professionals and recruits watched a recorded fictive witness interview to which they were asked to rate the probability of interviewing the witness, the witness’ credibility, and to estimate the witness’ level of intoxication. Results showed that interview probability and perceived witness credibility were affected by witness intoxication level. While it cannot be stated definitely from the present research, these findings provided indications that police officers and recruits lacked research-based knowledge. Results also showed that interview probability, but not perceptions of credibility, was influenced by a research-based message. In line with research, interview probability for the most intoxicated witness increased after reading the message. Unexpectedly, neither interview probability nor witness credibility was affected by social norms. The current findings added to the legal psychology literature by showing that a breath alcohol concentration as low as.04% was enough for police officers and recruits to consider intoxicated witnesses less credible than sober witnesses. Findings also indicated that, despite the lower credibility assessment, police may have some understanding that these witnesses can be interviewed at low intoxication levels. However, this willingness to interview intoxicated witnesses ceased at a BrAC lower than the levels where research has found intoxicated witnesses as reliable as sober witnesses. Future directions for research and policy development as well as theoretical and practical implications of the present findings are discussed. (shrink)

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a (...) review of the context of DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations. (shrink)

The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp (...) down decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions. There are no data in this work. (shrink)

This book clarifies the meaning of the most important and pervasive concepts and tools in bioethical argumentation and assesses the methodological suitability of the main methods for clinical decision-making and argumentation. The first part of the book is devoted to the most developed or promising approaches regarding bioethical argumentation, namely those based on principles, values and human rights. The authors then continue to deal with the contributions and shortcomings of these approaches and suggest further developments by means of (...) substantive and procedural elements and concepts from practical philosophy, normative systems theory, theory of action, human rights and legal argumentation. Furthermore, new models of biomedical and health care decision-making, which overcome the aforementioned criticism and stress the relevance of the argumentative responsibility, are included. (shrink)

This chapter first outlines the general evolution of the European Union's (EU) decision‐making regime. The pattern of EU decision making has traditionally varied across policy fields to a degree that is unknown in the national constitutional law of its member states, where laws and administrative rules are usually made according to fairly standard procedures covering all policy areas. Such policy‐related variation has been a constant feature throughout the history of European integration. The chapter then examines EU (...) legislative decision making, and reviews administrative rule making by the EU institutions. The chapter then describes other relevant forms of decision making in the European Union. Finally, it shows how successive revisions of the European treaties such as Single European Act, Treaty of Maastricht, Treaty of Amsterdam, Treaty of Nice, and Treaty of Lisbon have incrementally modified the decision‐making regime of the European Union. (shrink)

Integrative Social Contracts Theory is a popular framework to assist managers in making decisions on international moral dilemmas. Although the theory has been praised for its comprehensiveness and sophistication, commentators have raised concerns regarding the justification and identification of substantive hypernorms, fundamental moral principles valid across cultures. This paper introduces the deliberative test, a new method for testing the cross-cultural validity of ethical norms in ISCT. The test relies on the concept of Deliberative Capacity, arising from new developments in (...) system-level deliberative democracy research, which studies deliberation at the level of national societies and over time. Based on this recent stream of research, the deliberative test has the potential of providing better guidance for managers to decide which norms to follow in case of conflicting standards between home and host countries. (shrink)

Background Abortion is one of the most common gynaecological procedures. It is related to personal, social, and economic reasons under a legal term that is recognised as a common sexual and reproductive right in most of countries. However, making the decision to abort is complex, because it is politicised and is often framed in public discourse related to moral or ethical issues beyond women’s experiences. Therefore, it is subject to medical criteria, religious evaluations, and sociological analysis. Purpouse The (...) aim of this synthesis of qualitative studies was to synthesise the decision-making experiences of women who legally aborted. Research design and method The Noblit and Hare’s interpretive meta‐ethnography was conducted, and it was written in accordance with the eMERGe meta‐ethnography reporting guidance. Ten studies met the research objective and inclusion criteria, after a comprehensive systematic search strategy in five databases. Findings The metaphor “The wrestling between why and what will happen next” and three themes emerged from the data analysis: (1) Forces that incite the arm wrestling; (2) Facing social stigma; and (3) Defeated by a greater rival. The metaphor provided interpretive experiences of the moral conflict experienced by women who decided to have an abortion and emerged from the confrontation of the reasons why they decided to abort and the social repercussions that making the decision entails. The result of the struggle was loneliness and vulnerability. Conclusion The lines of action impact policy makers, the media, and health professionals. Actions should focus on the de-stigmatisation and normalisation of abortion, the use of appropriate language, and the training and sensitisation of health professionals. (shrink)

The combination of individual judgments on logically interconnected propositions into a collective decision on the same propositions is called judgment aggregation. Literature in social choice and political theory has claimed that judgment aggregation raises serious concerns. For example, consider a set of premises and a conclusion in which the latter is logically equivalent to the former. When majority voting is applied to some propositions (the premises) it may give a different outcome than majority voting applied to another set of (...) propositions (the conclusion). This problem is known as the doctrinal paradox. The doctrinal paradox is a serious problem since it is not clear whether a collective outcome exists in these cases, and if it does, what it is like. Moreover, the two suggested escape-routes from the paradox - the so-called premise-based procedure and the conclusion-based procedure - are not, as I will show, satisfactory methods for group decision-making. In this paper I introduce a new aggregation procedure inspired by an operator defined in artificial intelligence in order to merge knowledge bases. The result is that we do not need to worry about paradoxical outcomes, since these arise only when inconsistent collective judgments are not ruled out from the set of possible solutions. (shrink)

Laboratory animals, being vulnerable subjects, need the protection provided by adequate ethical review. This review falls primarily to Institutional Animal Care and Use Committees. A review committee's first duty is to identify which procedures ethically are unacceptable irrespective of any knowledge that might be derived. Examples are provided. These projects should be disapproved. Then, "on balance" judgments are assessed that weigh the animal harms against the potential benefits to humans. Several countries (but not the United States) use a classification system (...) for ranking the degree of animal pain and distress. This type of assessment is essential for careful ethical analysis. Another way to enhance ethical discussion is to strive for a more balanced perspective of different viewpoints among members of decision making committees. Inclusion of representatives of animal welfare organizations and a greater proportion on nonanimal researchers would likely achieve this objective. (shrink)

This article deals with making decisions about starting terminal care. The results are part of a larger survey on nurses’ conceptions of terminal care in community health centres in Finland. The importance, frequency and timing of decision making as well as communication and the number of investigations and procedures carried out are examined. The relationship between decision making and the size of a health centre’s catchment population is also discussed. The results make it possible to (...) compare the current situation in Finland with the national law on patients’ rights. The sample consisted of 328 nurses who worked on the wards of 32 community health centres. The data were collected by means of a structured questionnaire and processed with the Statistical Package for Social Sciences software. The nurses agreed that explicit decision making and documentation about starting terminal care were necessary, but it was highlighted that the practice had many shortcomings. Decisions were often made too late and the patients were not always aware of their situation; family members and the nursing staff were mostly better informed. It was noted that many investigations and other procedures were carried out on terminally ill patients, often at the request of family members. Decision making was found to have some relationship to the size of a health centre’s catchment area. (shrink)

During the last thirty years different methods have been proposed in order to manage and resolve ethical quandaries, specially in the clinical setting. Some of these methodologies are based on the principles of Decision-making theory. Others looked to other philosophical traditions, like Principlism, Hermeneutics, Narrativism, Casuistry, Pragmatism, etc. This paper defends the view that deliberation is the cornerstone of any adequate methodology. This is due to the fact that moral decisions must take into account not only principles and (...) ideas, but also emotions, values and beliefs. Deliberation is the process in which everyone concerned by the decision is considered a valid moral agent, obliged to give reasons for their own points of view, and to listen to the reasons of others. The goal of this process is not the reaching of a consensus but the enrichment of one's own point of view with that of the others, increasing in this way the maturity of one's own decision, in order to make it more wise or prudent. In many cases the members of a group of deliberation will differ in the final solution of the case, but the confrontation of their reasons will modify the perception of the problem of everyone. This is the profit of the process. Our moral decisions cannot be completely rational, due to the fact that they are influenced by feelings, values, beliefs, etc., but they must be reasonable, that is, wise and prudent. Deliberation is the main procedure to reach this goal. It obliges us to take others into account, respecting their different beliefs and values and prompting them to give reasons for their own points of view. This method has been traditional in Western clinical medicine all over its history, and it should be also the main procedure for clinical ethics. (shrink)

Many studies have highlighted a substantial "bureaucracy domination" in procedures relating to migrants’ access to territory. This form of domination is marked by highly discretionary and arbitrary practices, enacted by the administrative authorities of the state. Only minor attention, however, has been devoted to the arbitrariness of judicial decisions and to the judicial role in general in the numerous proceedings that increasingly affect the path of migrants. This path is the main object of this paper. The study focuses on Italian (...) case law in expulsion and detention proceedings of irregular third country national citizens and asylum seekers and presents qualitative empirical research on decisions issued by the competent national authorities. The results have been analysed using a selection of theoretical tools, all referable to the general concept of the rule of law. The judicial decisions on pre-removal detention proceedings in two case studies are examined: the jurisprudence on detention of irregular migrants, in different offices of the Justice of the Peace in Italy; and the case law on detention of asylum seekers in the Ordinary Tribunal of Rome. The assumption underlying the research is that various conceptions of the rule of law may have different explanatory power when it comes to explaining the empirical results. To verify this hypothesis, the study proposes an overview of the main rule of law doctrines in the Western tradition of political and legal thought and applies the method of historical-conceptual analysis. As a result, the explanatory power of six theoretical models of the rule of law was verified against the data with the view to highlight the virtues and vices of the respective explanatory frameworks. This article reaches a two-fold conclusion. First, as far as the explanatory frameworks are concerned: the results of the two case studies cannot be fully explained by any of the models considered in this study. This fact alone casts doubts on the explanatory power of these theories and calls for further research on judicial decision-making more generally. Secondly, a key finding of the study regarding the notions of discretion and arbitrariness is that the judicial approach which assures the highest protection of rights is also the one that is most easily influenced by arbitrariness. The author argues that this paradox can be easily dissolved by paying attention to the plural dimensions of arbitrariness. If we consider arbitrariness from a legal point of view, i.e. as an illegal decision, it is unsurprising that the authority that most uses its discretionary powers is also the one most at risk of abusing these discretionary powers and hence of exercising arbitrary power. However, if we consider arbitrariness from the point of view of philosophical-political theory, i.e. as a form of domination characterised by the absence of sufficient justification, it is unsurprising that the judicial approach which assures the highest protection of rights is also the one that takes its own role as guarantor of these rights and of the constitutional democratic legal order as such most seriously. This judicial approach thus most often risks exercising its power in criticisable ways, as compared to an authority much more in line with the requirements of law enforcement agencies. Keywords: migration, discretion, justice, arbitrariness, civil rights, Rechtsstaat, expulsion, mixed constitution. (shrink)

How can free and equal people cooperate to solve conflicts and common problems in a rational and legitimate way? In this article I deduce principles for doing so from the requirements of rational communication set out in the discourse theory of Jürgen Habermas. I apply them in defining a process of efficient decision making. What I call ‘communicative design’ denotes the design of a reason giving process in which the practice of proposing and assessing claims with regard to (...) rulemaking and problem solving is undertaken on an equal and autonomous basis. Two sets of prescriptions are given: organisational principles for the composition of groups and argumentative principles for deliberation. However, any procedure aimed at achieving a rational consensus in decision making in organisations has to deal in practice with limitations of time, participation and the information available. Communicative design may not guarantee strictly rational decisions, then, but the procedure it constructs does promise relatively ‘more valid’ decisions than might be expected if another procedure had been adopted. (shrink)

Despite significant ethical advances in recent years, including professional developments in ethical review and codification, research deception continues to be a pervasive practice and contentious focus of debate in the behavioral sciences. Given the disciplines' generally stated ethical standards regarding the use of deceptive procedures, researchers have little practical guidance as to their ethical acceptability in specific research contexts. We use social contract theory to identify the conditions under which deception may or may not be morally permissible and formulate practical (...) recommendations to guide researchers on the ethical employment of deception in behavioral science research. (shrink)

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

It has been argued that environmental decision-making can be improved be introducing citizen panels. The authors argue that citizen panels and other models of citizen participation should only be used as a consulting forum in exceptional cases at the local level, not as a real decision-making procedure. But many problems in the field of environmental policy need nonlocal, at least regional or national, regulation due to the fact that they are of national impor-tance. The authors (...) argue that there are good reasons not to institutionalise national citizen panels. They advocate the view that more reasonable and more competent solutions can be found by introducing forms of direct democracy. (shrink)

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)

In order to strengthen RI in the private sector, it is imperative to understand how companies organise this process, where it takes place, and what considerations and motivations are central in the innovation process. In this chapter, the questions of whether and where normative considerations play a role in the innovation process, and whether dimensions of RI are present in the innovation process, are addressed. In order answer these research questions, a theoretical framework is developed based on Jones’s theory of (...) ethical decision making and Cooper’s stagegate model of innovation management. In order to answer the research questions, a specific case of innovations that contribute to public health is explored, namely, that of food companies that participate in a Front-of-Pack logo for healthier food. As the use of healthy food logos does not necessarily have a positive impact on sales and profits, it is expected that in the decision-making process, as part of their innovation process, companies make several trade-offs between economic, technical and moral factors. As the social-ethical values at stake in corporate innovation processes have remained to a large extent unexplored in research on innovation management, the aim of this chapter is to identify the motivations and barriers for companies embracing and continuing a FoP logo for healthier food, and to assess whether ethical considerations play a role in this innovation process. From the findings in this research, it will become clear that although the studied companies participated in a programme for healthy food and thus are responsive to the needs of society, and although the companies feel responsible for public health, ethical considerations do not play a central role in the operational innovation process. Instead, technical and economic considerations seem to prevail in the operational innovation process. Furthermore, none of the procedural dimensions of RI seems to be present at this level in the innovation trajectory. It is argued that this may be an indication that the ethical decision-making process for RI is not located at the level of the operational innovation process itself, but is something that might be located on a higher strategic level in the company. It is at this level that the moral decision is taken to adopt the FoP logo and to engage in the RI process. The findings cast a new light on the discourse on RI in general, and in the private sector in particular. (shrink)

Rapid advances in neuroscience may enable us to identify the neural correlates of ordinary decision making. Such knowledge opens up the possibility of acquiring highly accurate information about people’s competence to consent to medical procedures and to participate in medical research. Currently we are unable to determine competence to consent with accuracy and we make a number of unrealistic practical assumptions to deal with our ignorance. Here I argue that if we are able to detect competence to consent (...) and if we are able to develop a reliable neural test of competence to consent, then these assumptions will have to be rejected. I also consider and reject three lines of argument that might be developed by a defender of the status quo in order to protect our current practices regarding judgments of competence in the face of the availability of information about the neural correlates of ordinary human decision making. (shrink)

Background Developing confident capacity for ethical decision-making is vital in nursing education. However, no tool examines nursing students’ competence in ethical decision-making. Aim This study aimed to develop an Ethical Decision-Making Competence Scale (EDM-CS) to assess ethical care decision-making competencies in nursing students. Participants and research context Original items were obtained by employing a focus group and the Delphi method. A cross-sectional design was used to confirm the items remained on the scale. (...) Additionally, the scale’s reliability and validity were assessed. The EDM-CS was completed by 498 nursing students. An exploratory factor analysis (EFA) was used to examine the factor structure based on data from group 1 ( n = 250). A second-order confirmatory factor analysis (CFA) was used to examine the model’s fitness based on data from group 2 ( n = 248). This study was conducted between August 2022 and July 2023. Ethical considerations The Institutional Review Board of OO Medical University Hospital approved this study’s design and procedure. Results From the original 34 items, nine were deleted in the EFA. Thus, the EDM-CS had 25 items and a four-factor structure (ethical judgement, ethical sensitivity, ethical motivation, and ethical action), which explained 60.97% of the total variance. A second-order CFA identified a second-order factor termed ‘ethical decision-making competence’ with 18 items (root mean square residual = 0.052). The EDM-CS scores correlated significantly and positively with the scores on the Scale of Protective Factor-24 (r = 0.47, p <.001), which indicated good convergent validity. Cronbach’s alpha coefficient of the final EDM-CS was 0.90 and ranged from 0.73 to 0.80 for the four subscales. Discussion and conclusion The EDM-CS was validated to fit the data adequately. It can be used to evaluate clinical nursing students’ ethical decision-making abilities and to develop education strategies to improve their ethical care competence. (shrink)

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, (...) calculations, and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient. (shrink)

Clinical evidence suggests that many patients undergo surgery that they would decline if fully informed. Failure to communicate the relevant risks, benefits, and alternatives of a procedure violates medical ethics and wastes medical resources. Integrating shared decision-making, a method of communication between provider and patient, into medical decisions can satisfy physicians' ethical obligations and reduce unwanted procedures. This article proposes a three-step process for implementing a nationwide practice of shared decision-making: create model integration programs; provide (...) legal incentives to ease the transition; and incorporate shared decision-making into medical necessity determinations. (shrink)

Adaptive decision making and veridical decision making are based on different mechanisms. Veridical decision making is based on the identification of the correct response, which is intrinsic to the external situation and is actor-independent. Adaptive decision making is actor-centered and is guided by the actor's priorities. The prefrontal cortex is particularly critical for adaptive decision making and less so for veridical decision making. However, most experimental procedures used in (...) cognitive psychology and neuropsychology focus on veridical decision making and ignore adaptive decision making. Innovative experimental procedures are required to characterize the contribution of the prefrontal cortex to adaptive decision making. We have designed a prototype for such procedures, the Cognitive Bias Task, and present the novel findings generated by this task. (shrink)

Background:The decision-making process should be done according to a set of rules and principles so as to be fairly understood.Objectives:The aim of this study was to identify the basic principles and rules used by nurses to understand justice in nurse managers’ decision-making processes based on a procedural justice model.Research design and participants:This research was a qualitative study based on directed content analysis, which was performed on a group of 15 nurses working in different hospitals in Tehran, (...) Iran. An in-depth semi-structured interview was used as the method of data collection for this study.Ethical consideration:This research has been approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. The respondents were informed about the aim of the study, about voluntary participation, anonymity and confidentiality.Findings:The results of this study showed that in order to understand procedural justice, nurses use several rules, including: duties organization, managerial support, consistency, bias-suppression, accuracy, correctability, representativeness, and ethicality.Conclusion:Nursing leaders must consider the importance of justice rules as one of many strategies to ensure the nurses’ perception of fairness in decision-making processes. (shrink)

Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at (...) the time of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)

Background Ensuring individual free and informed decision‐making for research participation is challenging. It is thought that preliminarily informing communities through ‘community sensitization’ procedures may improve individual decision‐making. This study set out to assess the relevance of community sensitization for individual decision‐making in research participation in rural Gambia. Methods This anthropological mixed‐methods study triangulated qualitative methods and quantitative survey methods in the context of an observational study and a clinical trial on malaria carried out by (...) the Medical Research Council Unit Gambia. Results/discussion Although 38.7% of the respondents were present during sensitization sessions, 91.1% of the respondents were inclined to participate in the trial when surveyed after the sensitization and prior to the informed consent process. This difference can be explained by the informal transmission of information within the community after the community sensitization, expectations such as the benefits of participation based on previous research experiences, and the positive reputation of the research institute. Commonly mentioned barriers to participation were blood sampling and the potential disapproval of the household head. Conclusion Community sensitization is effective in providing first‐hand, reliable information to communities as the information is cascaded to those who could not attend the sessions. However, further research is needed to assess how the informal spread of information further shapes people's expectations, how the process engages with existing social relations and hierarchies (e.g. local political power structures; permissions of heads of households) and how this influences or changes individual consent. (shrink)

German legislation demands that decisions about the treatment of mentally incompetent patients require an ‘informed consent’. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person (...) under his/her care. This includes ‘end-of-life decisions’. Deviations from this procedure are only allowed in acute emergencies or cases of ‘medical futility’. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical ‘end of life-decisions’ and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like• the assessment of mental competence• the options for exercising patient self-determination via advance directives and durable powers of attorney• the improvement of palliative care facilities,• the clarification of formal procedures for surrogate decision-making in health care and towards the end of life• and the possibilities and their limitations of controlling these decision-making processes ‘externally’ (e.g., by Guardianship Courts or committees).The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction and the European traditions of philosophy of health care and bioethics. (shrink)

First responders to chemical, biological, radiological, or nuclear (CBRN) events face decisions having significant human consequences. Some operational decisions are supported by standard operating procedures, yet these may not suffice for ethical decisions. Responders will be forced to weigh their options, factoring-in contextual peculiarities; they will require guidance on how they can approach novel (indeed unique) ethical problems: they need strategies for “on the spot” ethical decision making. The primary aim of this paper is to examine how first (...) responders should approach on the spot ethical decision-making amid the stress and uncertainty of a CBRN event. Drawing on the long-term professional CBRN experience of one of the authors, this paper sets out a series of practical ethical dilemmas potentially arising in the context of a large-scale chemical incident. We propose a broadly consequentialist approach to on the spot ethical decision-making, but one which incorporates ethical values and rights as “side-constraints”. (shrink)

Objective—To determine the objectivity, consistency and professional unanimity in the initiation, continuation and withdrawal of life-prolonging procedures in intensive care–to determine methods, time-scale for withdrawal and communication with both staff and relatives–to explore any professional unease about legality, morality or professional defensibility.Design—A structured questionnaire directed at clinical nurse managers for intensive care.Setting—All intensive care units in the Yorkshire region.Results—The survey reported a lack of consistency and objectivity in decision making in this area, with accompanying unease amongst staff.Conclusions—There is (...) a need to work towards more consistent care, both before and during admission, for the protection of the individual patient and to allow rational assessment of intensive care need. Comprehensive audit should lead to objective defensible decisions and facilitate informed choice. More open debate and better communication should minimise this issue as a source of stress amongst staff in intensive care. (shrink)

The management literature is not short of tools for helping people to make wiser decisions. This paper outlines another tool so it must be asked how can it justify itself given the substantial work that is already done. We suggest that many tools either fail to properly integrate, or simply lack an analysis of (i) showing how emotions help or hinder solving the problem, (ii) the role of creative and critical thinking and (iii), working out what values are at issue (...) in the problem. These three categories can be integrated into a decision-making procedure through an analysis of the stages of decision making. While the emphasis that is laid on these stages will differ depending upon the problem, we suggest that wise decision making requires (i) gaining an adequate understanding of the situation, (ii) working out what matters, (iii) generating options, (iv) selecting an option on the basis of what matters and (v) carrying out the option. As practical philosophers we must ask how each of these stages can be adequately carried out, and here we seek to show how philosophy, and other disciplines, can help for the three areas we identify above as lacunae. In looking at the role of emotions we base our analysis on the Aristotelian and Stoic notion that the core of emotions is that they are judgements. This analysis allows us to make sense of both the rationalist view that emotions are a hindrance, and the romantic notion that emotions are a help. Wise decision making involves unpacking emotions to see what they can reliably tell us about the situation, our values, potential options and how they can motivate us. We suggest ways this task can be achieved. Critical thinking needs to be employed throughout the decision-making procedure so that we fairly and adequately understand the situation and assess potential values and options. We outline some key skills and interventions that can be employed. Critical thinking needs material to work on so we suggest how creative thinking can be used to reframe the situation, and generate potential values and options. The driving force of making a decision is, or at least should be, the values we wish to realise with our decision; what we think matters. Some decisions are purely prudential and here we draw upon ideas of Nozick, Griffin, Aristotle and Epicurus to suggest ways the decision maker can evaluate their prudential values. For ethical decisions ideas from Mill, Kant and others can help us think through what we wish to achieve. We end with a case study to illustrate how the procedure works in practice. (shrink)