Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty (...) physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital. (shrink)

This essay investigates, via the concepts of the philosophy of orientation, Annie Duke’s decision-making theory in "Thinking in Bets" and scrutinizes as to what extent one can universalize the 'orientation skill' of decision-making with regard to our everyday and professional life.

The prevailing case study approach to teaching biomedical ethics is compared with a new methodology using short written exercises designed to develop decision making skills. Course content of this new approach and its adaptability to computer assisted instruction with student-faculty interactive software are outlined.

Introduction Ethical climate in medical contexts is referred to the organizational environment consisting of medical staff interpersonal relationships regarding patient care. This element affects staff behavior in an organization. The investigation and comparison of the effects of the interventions promoting ethical climate are among important nursing challenges that should be considered by researchers. The present study was conducted to compare the effect of nurses’ ethical decision-making skills and interpersonal communication training on their ethical climate. Materials and methods (...) This experimental study was performed on 90 nurses working in the general teaching hospitals of Mashhad, Iran. The sampling process was conducted in two stages. Nurses were divided into three groups: intervention 1, intervention 2 and control group. The intervention was separate 12-h workshops for each of the intervention groups. The ethical climate questionnaire by Victor and Cullen was used to assess the score of ethical climate in the three groups both at the beginning and 4 weeks after the workshop. The data were analyzed in Statistical Package for Social Sciences software using descriptive statistics, analysis of variance, Kruskal–Wallis, paired sample t-test, Wilcoxon test, and post hoc Tukey’s test. Ethical considerations were as follows: The study design was approved by the Research Ethics Committee of Mashhad University of Medical Sciences. Informed consent was obtained from all subjects, and they were ensured about the confidentiality terms. Results The mean scores of the ethical climate test at the first stage were obtained as 66.0 ± 5.5, 67.8 ± 6.9, and 67.7 ± 7.2 in the ethical decision-making, interpersonal communication, and control groups, respectively. Accordingly, the three groups were not significantly different in terms of this variable. However, after the intervention, a significant difference was observed among the three groups regarding the mean scores of the ethical climate test In this regard, the calculated mean scores in the ethical decision-making, interpersonal communication, and control groups were 99.3 ± 6.3, 90.4 ± 7.7, and 67.4 ± 7.9, respectively. Conclusion Training workshops about ethical decision-making skills and interpersonal communication on the ethical professional climate of nurses was effective. Nonetheless, the effect of ethical decision-making skill training was found to be higher than interpersonal communication skill training. Therefore, it is recommended that nursing managers hold training workshops to improve the ethical climate for nurses. (shrink)

Designed specifically for the educational needs of RN to BSN students This is a unique, innovative professional nursing ethics textbook designed specifically for the educational needs of RN to BSN students. Written by experts in the field, it discusses ethical concepts geared to the licensed nurse who has spent several years in practice but is learning high-level concepts and applications. The text addresses different areas of professional practice and is rich with case studies illustrating clinical scenarios involving ethical awareness and (...) decision-making. The book fulfills the necessary criteria for the AACN Essentials for Baccalaureate Education and the QSEN and ISOM competencies. Clear and concise, the text relates content to the nurse’s current practice and professional development without extraneous information typically included in other texts. Progressing from simple to complex, chapters build on previous practice experience to focus on ethical decision-making in a variety of practice environments. The book incorporates a “four boxes” decision-making model and addresses essential communication skills, how to recognize and resolve moral distress, and the role of an ethics committee. It discusses common ethical issues likely to be encountered and ethical practice as it relates to quality and safety. Case Study Dilemmas that include evidence-based research provide the opportunity to apply ethical decision-making principles. QSEN application principles are also featured in each chapter, and interactive exercises and questions and PowerPoints provide further opportunity for critical thinking. Key Features: Addresses the specific needs of students in the RN to BSN course Fulfills AACN Essentials, IOM Competencies, and QSEN KSAs Builds upon previous practice experience of RN to BSN students Discusses ethical decision-making in a variety of practice environments Includes Case Study Dilemmas to apply ethical decision-making principles. (shrink)

In the present study business managers in Kabi Pharmacia Company were trained in the use of the autonomous method in their decision-making about solving real life business ethics problems. According to the psychological theories of Piaget, Vygotsky, and Kohlberg, it is possible to promote the acquisition of the autonomous ethical skill by instruction and training. Indeed, participation in a one-day educational programme which focused on the training of the autonomous cognitive ability and not on the transfer of moral (...) content, was sufficient to provide a shift in the mode of decision-making about business ethics problems towards the autonomous ethical function. This change was still stable one month later. A test was constructed by items representing current business ethics conflicts in order to assess ethical function. (shrink)

Decision making is a key activity, perhaps the most important activity, in the practice of healthcare. Although physicians acquire a great deal of knowledge and specialised skills during their training and through their practice, it is in the exercise of clinical judgement and its application to individual patients that the outstanding physician is distinguished. This has become even more relevant as patients become increasingly welcomed as partners in a shared decision making process. This book translates (...) the research and theory from the science of decision making into clinically useful tools and principles that can be applied by clinicians in the field. It considers issues of patient goals, uncertainty, judgement, choice, development of new information, and family and social concerns in healthcare. It helps to demystify decision theory by emphasizing concepts and clinical cases over mathematics and computation. (shrink)

The present study aims to connect more the I/O and the decision-making psychological domains, by showing how some common components across jobs interfere with decision-making and affecting performance. Two distinct constructs that can contribute to positive workplace performance have been considered: decision-making competency (DMCy) and decision environment management (DEM). Both factors are presumed to involve self-regulatory mechanisms connected to decision processes by influencing performance in relation to work environment conditions. In the framework (...) of the job demands-resources (JD-R) model, the present study tested how such components as job demands, job resources and exhaustion can moderate decision-making processes and performance, where high resources are advantageous for decision-making processes and performance at work, while the same effect happens with low job demands and/or low exhaustion. In line with the formulated hypotheses, results confirm the relations between both the decision-making skills, performance (i.e. in-role and extra-role) and moderators considered. In particular, employees with low levels of DMCy show to be more sensitive to job demands toward in-role performance, whereas high DEM levels increase the sensitivity of employees toward job resources and exhaustion in relation to extra-role performance. These findings indicate that decision-making processes, as well as work environment conditions, are jointly related to employee functioning. (shrink)

Research on the cognitive abilities involved in decision making has shown that, under objective risk conditions (i.e., when explicit information about possible outcomes and risks is available), superior decisions are especially predicted by executive functions and exact number processing skills, also referred to as objective numeracy. So far, decision-making research has mainly focused on exact number processing skills, such as performing calculations or transformations of symbolic numbers. There is evidence that such exact numeric (...) class='Hi'>skills are based on approximate number processing (ANP) skills, which enable quick and accurate processing of non-symbolic numbers (e.g. Chen and Li, 2014). Very few studies, however, have investigated ANP skills in the context of risky decision making and have analyzed direct associations among the aforementioned sub functions. Possible interactions between the closely related skills have not been considered. The current study (N = 128) examines interactions of ANP skills with executive functions and objective numeracy, in predicting risky choice behavior. ANP skills are represented by the accuracy in a dot-comparison task. Decision making is measured by two versions of the Game of Dice Task (GDT), which place different emphases on the reflection of potential risks. The results show two-way as well as three-way interactions between the measures of ANP skills, executive functions, and objective numeracy in predicting risky decisions in both GDT versions. The riskiest decisions were most frequently made in case of low scores in all of the three competencies, while good performance in any one of them resulted in significant reductions of disadvantageous decisions. The findings indicate that high ANP skills can positively affect choice behavior in individuals who have weaknesses in reflectively attributed skills, namely executive functions and objective numeracy. Potential compensatory effects and mechanisms of ANP in decision making are discussed. (shrink)

We spend a lot of time arguing about how schools might be improved. But we rarely take a step back to ask what we as a society should be looking for from education—what exactly should those who make decisions be trying to achieve? In Educational Goods, two philosophers and two social scientists address this very question. They begin by broadening the language for talking about educational policy: “educational goods” are the knowledge, skills, and attitudes that children develop for their (...) own benefit and that of others; “childhood goods” are the valuable experiences and freedoms that make childhood a distinct phase of life. Balancing those, and understanding that not all of them can be measured through traditional methods, is a key first step. From there, they show how to think clearly about how those goods are distributed and propose a method for combining values and evidence to reach decisions. They conclude by showing the method in action, offering detailed accounts of how it might be applied in school finance, accountability, and choice. The result is a reimagining of our decision making about schools, one that will sharpen our thinking on familiar debates and push us toward better outcomes. (shrink)

Corporate social responsibility, sustainability and acting ethically are all accepted business aims, but their meaning and implementation in a global context is far less clear-cut. Global Business Ethics cuts through the confusion to provide a coherent basis for ethical decision-making within the complications of the international business landscape. Underpinned by theory and including worked-through examples of ethical dilemmas and their solutions, this textbook will guide the reader beyond theory to real-world business decisions. Practical tools such as decision (...) trees and suggested principles to apply in dilemma situations give readers the skills and confidence to tackle the ethical challenges they face. A unique working code of ethics is provided as a model with guidance to readers for adaptation and implementation. Case studies include: Walmart, Hershey's, Citibank, Ford, Nike, Johnson & Johnson, Harley- Davidson, The Body Shop and Procter and Gamble. A chapter on the legal aspects of ethics provides clear guidance on the complex relationship between law and ethics in international business. The final part takes an in-depth look at the practical application of ethics in business life. Covering all the major theories of ethics, including an examination of the role of quantification of ethics, Global Business Ethics demonstrates how their principles can be applied to inform better business decisions. (shrink)

Ethical decision-making in school administration has received considerable attention in educational leadership literature. However, most research has focused on principals working in secondary school settings while studies that explore ethical reasoning processes of academic deans have been significantly few. This qualitative study aims to describe the ethical decision-making processes employed by a select group of Filipino college deans in solving ethical dilemmas using the ethical paradigms proposed in the works of Starratt (Educ Adm Q 27:185–202, 1991) (...) and Shapiro and Stefkovich (Ethical leadership and decision-making in education: applying theoretical perspectives to complex dilemmas, 2005) as frameworks for the analysis. Data was gathered using semi-structured interviews and field text was analyzed using deductive thematic analysis. Findings of this study show that majority of the deans chose to share ethical dilemmas involving students and teachers. The findings also show the ethical frameworks of care, justice, and profession as the dominant paradigms utilized by Filipino deans and their preference for adopting multiple ethical frameworks when making their decisions. Most of the ethical dilemmas which the deans narrated relate to their tasks of academic administration such as monitoring student performance, faculty evaluation and maintaining school discipline. Interestingly, only a few dilemmas involving university administrators were expressed, and dilemmas that refer to broader societal issues usually associated with school administrators’ utilization of the ethic of critique were also significantly left out in the narratives of this study. This paper intends to contribute to current literature by expanding research to administrators working in the context of higher education in the Philippine setting. The findings of this study could serve as knowledge base in designing ethics courses to enhance educational leaders’ ethical decision-making skills. The study also provides useful insights of ethical decisions and reasoning processes employed by academic administrators in resolving real life ethical dilemmas that could be useful at the practical level for aspiring and practicing deans. (shrink)

Despite the importance of scientific integrity to the well-being of society, recent findings suggest that training and mentoring in the responsible conduct of research are not very reliable or effective inhibitors of research misbehavior. Understanding how and why individual scientists decide to behave in ways that conform to or violate norms and standards of research is essential to the development of more effective training programs and the creation of more supportive environments. Scholars in business management, psychology, and other disciplines have (...) identified many important factors that affect ethical behavior, including individual, contextual, and organizational factors. Surprisingly little research has been conducted to examine the role of these factors in either the development of ethical decision-making skills, or their applicability to ethical issues commonly encountered in research and other scholarly and professional activities. Interdisciplinary approaches combined with research and discipline relevant paradigms should greatly enhance understanding of the individual contextual and organizational factors involved in ethical and unethical research conduct. Such studies will inform and facilitate the development of more effective ethics education programs in the sciences and engineering professions. (shrink)

Background Ethical decision-making confidence develops from clinical expertise and is a core competency for nurse leaders. No tool exists to measure confidence levels in nurse leaders based upon an ethical decision-making framework. Aims The objective of this research was to compare ethical decision-making among nurse leaders in the U.S. and three German-speaking countries in Europe by developing and testing a newly constructed Ethical Decision-Making Confidence (EDMC) scale. Methods The cross-sectional survey included 18 (...) theory-derived questions on ethical decision-making confidence which were used to develop the scale. Participants A convenience sample of nurse leaders from the U.S. and three German-speaking countries in Europe who self-identified as holding a leadership position. Ethical Considerations Ethical approval was given by the IRB Board of a U.S. university. Participation in the survey implied voluntary consent. Results The scale’s item structure dimensionality and subscale’s reliability were analyzed and compared between nurse leaders from all four countries. A principal component analysis (PCA) produced a 15-item bi-dimensional EDMC scale yielding a skill-related (9-item) and a behavior-related (6-item) confidence dimension. EDMC subscales showed good-to-excellent internal consistency. In both subscales, U.S. nurse leaders rated their mean EDMC score higher than their German-speaking counterparts in Europe. Discussion This exploratory study is the first of its kind to focus on nurse leaders’ confidence regarding ethical decision-making in an international context. An overarching factor structure was identified, which is shared by the two samples of nurse leaders and to examine (sub)scales’ psychometric properties. Conclusion This newly developed scale is an effective tool for measuring ethical decision-making confidence in nurse leaders. The promising results of this study should be replicated to ensure validity and reliability of the EDMC scale measuring skill-related and behavior-related concepts and include nurse leaders from various cultural, social, and demographic groups. (shrink)

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Adults with intellectual disabilities are characterized by the limitations in their intellectual functioning and in their adaptive behavior, which compromises three skill types, and this starts before the age of 18. Though persons with intellectual disabilities are characterized by having these limitations, they are thought to face significant decisionmaking challenges due to their disability. Moving away from this (...) generalization, Article 12 of the United Nations Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities, recognizing the right to legal capacity. (shrink)

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different (...) reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual''s prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts''the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed. (shrink)

Moral pragmatism has been largely ignored in Business Ethics, despite its natural attraction and the fact that it is prominent in philosophy and socio-economic theories. The main premise of the book is that the complexity of today's business world does not permit a grand ethical theory, notwithstanding the different attempts made by scientists. Moral pragmatism is the 'go-to' approach where the ethical decision-making of managers varies dependent on different circumstances but it always integrates moral considerations. Ethical decision- (...) class='Hi'>making is no longer based simply on known rules, but entails the constant dynamic interaction of circumstances, the development of new rules, managers' past experiences, their knowledge concerning ethics, and skills of moral reasoning. This book interweaves the postmodern approach to management studies and, based on its innovative research, reintroduces moral pragmatism in Business Ethics. The combination of decision-making theories, philosophy and postmodernism paves the way for future novel research in Business Ethics, making it an excellent resource for researchers, academics, and advanced students in the field of Business Ethics. Practitioners, on the other hand, will benefit by improving their skills in ethical decision-making and leadership. (shrink)

The consideration of deliberate versus automatic processing of numeric representations is important to math education, memory for numbers, and decision-making. In this commentary, we address the possible roles for numeric representations in such higher-level cognitive processes. Current evidence is consistent with important roles for both automatic and deliberative processing of the representations.

The purpose of this article is to share with the reader the specific findings on the role of nurse as consumer advocate from a study on ethical decision-making in an emergency department (ED). Qualitative interviews were conducted with 11 health professionals (doctors and nurses) working in the ED of a hospital. The interviews were audio-recorded, transcribed verbatim and thematically analysed.In ED, where the decision-making is described as medico-centric, advocacy ipso facto necessitates a challenge to doctor (...) class='Hi'>decision-making. The findings indicate that ED nurses experience with advocacy varied depending on the democratic qualities and communication skills of the particular doctor who had care of the consumer. It is noted that seeing the need for advocacy does not necessarily translate into effective action, as management support is essential for productive advocacy. A phenomenon of the desire not to rock the boat was reported. The findings indicate that the support of other nurses is essential for advocacy and affirm the importance of focusing on the ethical nature of the organisation as opposed to an exclusive focus on the individual. (shrink)

“4E” cognitive science has demonstrated that embodied coupling offers powerful resources for reasoning. Despite a surge of studies, little empirical attention is paid to discussing the precise scope of these resources and their possible complementariness with traditional knowledge-based inference. We use decision-making in Shiatsu practice – a bodywork method that employs hands-on interaction with a client – to showcase how the two types of cognitive resources can mesh and offer alternative paths to a task: “Local” resources such as (...) embodied presence, empathy, attunement, as well as skilled perception-action coupling are not only central for implementing a successful therapeutic intervention. The immediate coupling with a client also offers basic means of deciding about fitting and meaningful interventions. Yet, when comprehensive intervention strategies are at stake, Shiatsu decision making must be complemented through “non-local” resources, notably inferences rooted in anatomy/physiology knowledge, categories, heuristics, and mental models. To draw out implications for “4E” cognitive science, we argue that “local” embodied coupling and “non-local” conceptual inferences can functionally complement, inform, and scaffold each other in a dialectic process. (shrink)

Recent legal developments challenge how valid the concept of mental capacity is in determining whether individuals with impairments can make decisions about their care and treatment. Kong defends a concept of mental capacity but argues that such assessments must consider how relationships and dialogue can enable or disable the decision-making abilities of these individuals. This is thoroughly investigated using an interdisciplinary approach that combines philosophy and legal analysis of the law in England and Wales, the European Court of (...) Human Rights, and the United Nations Convention on the Rights of Persons with Disabilities. By exploring key concepts underlying mental capacity, the investigation concludes that both primary relationships and capacity assessments themselves must display key competencies to ensure that autonomy skills are promoted and encouraged. This ultimately provides scope for justifiable interventions into disabling relationships and articulates the dialogical practices that help better situate, interpret, and understand the choices and actions of individuals with impairments. (shrink)

Our objective is to understand how parents and children perceive their roles in decision making about research participation. Forty-five children (ages 4-15 years) with or without a chronic condition and 21 parents were the participants. A semistructured interview assessed perceptions of up to 4 hypothetical research scenarios with varying levels of risk, benefit, and complexity. Children were also administered the Peabody Picture Vocabulary Test, Third Edition, to assess verbal ability, as a proxy for the child's cognitive development. The (...) audiotaped interviews were transcribed and analyzed for themes related to parent and child decision-making roles. Both parents and children varied in their perceptions of decision-making roles. Child perceptions of parental influence on decision making as knowledge-based increased with cognitive development, whereas perceptions of parental influence as power-based decreased. Both children and parents commented that they would collaborate with each other when making decisions. Collaborative decision making appeared to increase with cognitive development. These findings suggest that approaches to child assent and parent permission should consider the parent-child relationship and how children and families typically make decisions. Future research is necessary to explain variation in the process of research decision making across children and families, explore the role of collaboration on children's decision-making skills, and understand developmental trajectories and mechanisms related to research decision making. (shrink)

We describe an evaluation undertaken on contract for the New Zealand State Services Commission of a major project (the Administrative Decision-Making Skills Project) designed to produce a model of administrative decision making and an associated teaching/learning packagefor use by government officers. It describes the evaluation of a philosophical model of decision making and the associated teaching/learning package in the setting of the New Zealand Public Service, where a deliberate attempt has been initiated to (...) improve the quality of decision making, especially in relation to moral factors. (shrink)

How can we help people develop judgement and decision skills? One approach is to teach formal methods such as decision analyses, but these are difficult to apply in ill-structured settings, and the methods are unworkable when one is under time pressure and uncertain conditions. If we regard these skills as types of expertise that can be developed, then in a given domain we may attempt to define the cues, patterns, and strategies used by experts, and develop (...) a programme to teach people how to think like experts. However, in many settings this can be impractical. A different approach to decision skills training is to teach people how to learn like experts. By identifying a set of strategies used by experts to develop their proficiency at decision making, we can develop a programme aimed at helping people become reflective practitioners. This article describes such a training programme. (shrink)

One of the most influential studies in all expertise research is de Groot’s (1946) study of chess players, which suggested that pattern recognition, rather than search, was the key determinant of expertise. Many changes have occurred in the chess world since de Groot’s study, leading some authors to argue that the cognitive mechanisms underlying expertise have also changed. We decided to replicate de Groot’s study to empirically test these claims and to examine whether the trends in the data have changed (...) over time. Six Grandmasters, five International Masters, six Experts, and five Class A players completed the think-aloud procedure for two chess positions. Findings indicate that Grandmasters and International Masters search more quickly than Experts and Class A players, and that both groups today search substantially faster than players in previous studies. The findings, however, support de Groot’s overall conclusions and are consistent with predictions made by pattern recognition models. (shrink)

Decision making is the physician's major activity. Every day, in doctors' offices throughout the world, patients describe their symptoms and com plaints while doctors perform examinations, order tests, and, on the basis of these data, decide what is wrong and what should be done. Although the process may appear routine-even to the physicians in volved-each step in the sequence requires skilled clinical judgment. Physicians must decide: which symptoms are important, whether any laboratory tests should be done, how the (...) various items of clinical data should be combined, and, finally, which of several treatments (including doing nothing) is indicated. Although much of the information used in clinical decision making is objective, the physician's values (a belief that pain relief is more important than potential addiction to pain-killing drugs, for example) and subjectivity are as much a part of the clinical process as the objective findings of laboratory tests. In recent years, both physicians and psychologists have come to realize that patient management decisions are not only subjective but also prob abilistic (although this is not always acknowledged overtly). When doc tors argue that an operation is fairly safe because it has a mortality rate of only 1 %, they are at least implicitly admitting that the outcome of their decision is based on probability. (shrink)

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

BackgroundContemporary medical practice is complicated by many dilemmas requiring ethical sensitivity and moral reasoning.ObjectiveTo investigate physicians’ experience in ethical decision-making and their attitude towards ethics consultation.MethodsIn a cross-sectional survey 126 physicians representing the main clinics of Pleven University hospital were investigated by a self-administered questionnaire. The following variables were measured: occurrence, nature and ways of resolving ethical problems; physicians’ attitudes towards ethics consultation; physicians’ opinions on qualities and skills of an ethics consultant, and socio-demographic characteristics. Data analysis (...) included descriptive statistics, χ2 and t-test.ResultsResponse rate was 88.9% (n = 112). Men and women were equally represented (48.2%–51.8%). The sample consisted of experienced physicians: 42.9% had 11–20 years experience, and 33% had 21–30 years. According to 84.8% of respondents, ethical problems have been discussed in their specialty. Predominant dilemmas included relationships with patients and relatives (76.8%) and team work (67.6%). Over ¾ of physicians needed an advice in solving ethical problems. Ninety six percent responded positively to ethics consultation. They would mainly request it for resolving conflicts (72.5%), and in case of concern for the rightness of their decisions (52.7%). The image of an ethics consultant was built of clinical competence (70.9%), ability to deal with conflicts (59.1%), communication skills (58.2%), tolerance for different views (55.4%), and a special qualification in ethics (52.7%).ConclusionsThe study underlined that Pleven University hospital physicians face similar ethical dilemmas as their colleagues in other countries do. The expressed positive attitudes to ethics consultation should serve as a basis for further research and development of ethics consultation services. (shrink)

The teaching of ethics in science within the disciplines provides an avenue to deepen students’ scientific understanding and to develop their critical thinking skills. This study showcases a module which connects ethics to science within a large introductory geoscience course. The module components, a tutorial plus homework assignment and an exam question, require students to decide on ethical issues using a 5-step approach that mirrors the scientific decision-making process. The assignment is graded using a developed rubric. An (...) analysis of exam question responses reveals that students correctly identify stakeholders and mention contributions by geoscientists, but have difficulties recognizing their own assumptions. Furthermore, many acknowledge the complexity of the ethical issue at hand. The module provides an example of how disciplinary instructors can include ethics in their teaching and assess students’ ethical decision-making process. (shrink)

Operational psychology is an emerging subdiscipline that has enhanced the U.S. military's combat capabilities during the Global War on Terrorism. What makes this subdiscipline unique is its use of psychological principles and skills to improve a commander's decision making as it pertains to conducting combat (or related operations). Due to psychology's expanding role in combat support, psychologists are being confronted with challenges that require the application of their professional ethics in areas in which little if any guidance (...) has been provided. Operational psychologists are at the forefront of this expansion. Accordingly, they need a decision model to assist them in this complex dynamic environment. To this end, this article reviews various decision models and ethical frameworks, selects the most appropriate, and then applies it to the challenges faced by operational psychologists. A naturalistic decision model that integrates rational and intuitive elements is recommended. (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)

Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision - Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients._ The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient,_the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical trials and (...) meta-analyses. It is the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient._ For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added._ This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice. (shrink)

BackgroundIt has been well investigated that nature exposure intervention can restore directed attention and improve subsequent cognitive performance. The impairment of decision-making skills in mentally fatigued soccer players was attributed to the inability of attention allocation. However, nature exposure as the potential intervention to counter mental fatigue and improve the subsequent decision-making skill in soccer players has never been investigated.ObjectsThis study aimed to evaluate the effects of nature exposure intervention on decision-making skills (...) among mentally fatigued university soccer players. Moreover, different durations of nature exposure were also evaluated.MethodsA random control between-subject design was adopted. Players were randomly assigned into six groups with three different durations of the experimental group compared with the corresponding control group. All players were first mentally fatigued by performing a 45-min Stroop task; then, they viewed virtual photos of natural or urban scenes; and finally, they performed a soccer decision-making task.ResultsThe subjective ratings of mental fatigue were significantly higher following the Stroop task. Only Exp 3 significantly improved decision-making reaction time compared with Con 3. Moreover, the accuracy slightly increased in Exp 3 after the intervention.ConclusionIn line with attention restoration theory, nature exposure significantly improved decision-making skills in mentally fatigue university players. However, the duration must be 12.50 min for each stimulus to stay longer to attract involuntary attention. (shrink)

Departing from a contemporary novel about a boy who is going to die from leukaemia, this article shows how the dimension of time can be seen as a morally relevant category that bridges both ‘dramatic’ issues, which constitute the dominant focus of bioethical decision making, and ‘undramatic’ issues, which characterize the lived experience of patients, relatives and health care workers. The moral task of comparing the various time dimensions of a given situation is explained as an act of (...) ‘synchronizing’ the clocks. Ethical sensitivity and competence are presented as core skills that allow a continuity of care in situations where dramatic issues seem to be resolved, but undramatic ones are still not addressed. A nine-step model of shared decision making is proposed as an approach to identifying critical junctures within an illness trajectory and synchronizing the clocks of the involved actors. (shrink)

The case method approach to introducing ethical issues is a traditional tool for applying critical thinking skills to a specific dilemma (Beauchamp & Childress, 2001). It allows for personal reflection and clarification of an individual's conceptual framework for deciding what is and is not ethical behavior. However, it also affords the student distance from the story line and may, through providing a retrospective critique, prevent sufficient challenge to the student to articulate and defend personal value assessments in addressing the (...) ethical dynamics reflected in the case. Providing teaching exercises that encourage the creation of language to form that conceptual framework and a comfort in using that language allows the student to not only identify ethical issues but also recognize and more effectively communicate the struggles with molding a personal values portrait to apply to such cases. (shrink)

Committee decision making is examined in this study focusing on the role assigned to the committee members. In particular, we are concerned about the comparison between committee performance under specialization and non-specialization of the decision makers. Specialization (in the context of project or public policy selection) means that the decision of each committee member is based on a narrow area, which typically results in the acquirement and use of relatively high expertise in that area. When the (...) committee members’ expertise is already determined, specialization only means that the decision of each committee member is based solely on his/her relatively high expertise area. This form of specialization is potentially inferior relative to non-specialization under which the decision of each committee member is based on different areas, not just his/her relatively high expertise area. Given that the expertise of the committee members is already determined but unknown, our analysis focuses on non-specializing individuals whose decision is based on a decision rule that does not require information on the decision-making skills. Under these realistic assumptions, non-specialization is shown to be preferable over specialization, depending on the aggregation rule applied by the committee. The significance of our approach is not limited to the specific results that we obtain. Rather, it should be viewed as a first step toward a deeper examination of the role of individual decision makers in enhancing the performance of collective decision making. (shrink)

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with (...) suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)

Background Ethics positions, consisting of the two fundamental dimensions of idealism and relativism, influence individuals’ decision-making significantly. Particularly in an applied field such as nursing, the ethics positions of nurses can play a significant role in clinical decisions. Therefore, it is important to know the factors affecting the ethics positions of nurses in clinical decision-making. Aim The aim of the study is to examine the factors affecting the ethics positions of nursing students in clinical decision- (...) class='Hi'>making. Research design This is a two-phase sequential explanatory mixed methods study designed in accordance with the COREQ criteria. A participant Information Form and the Ethics Position Questionnaire were used to collect quantitative data. Qualitative data were obtained through focus group interviews. Ethical considerations This study was conducted after receiving written permission from X University Ethics Board. Additionally, permission was obtained from the participating nursing faculty. Participants Among the fourth-year nursing students, 180 students participated in the quantitative phase and 30 students in the qualitative phase of the study. Results The quantitative data analysis showed that the idealism sub-dimension mean scores of the participants were higher than the relativism sub-dimension mean scores. The analysis of the qualitative data resulted in four main themes that influence participants’ ethics positions in clinical decision-making: (1) attitudes of role models in clinical practice (staff nurses/mentors/lecturers), (2) resources related to clinical practice (labs, hospitals/classrooms), (3) health system (hospital policies/school policies), and (4) personal differences (act with emotion/act with logic). Conclusion The results showed that the health system, role models in the clinic, personal differences, and skill-related resources affect the ethics positions of nursing students in clinical decision-making. In this regard, awareness can be raised by providing training to nursing students by academic instructors on ethics positions and the factors that are determined to affect ethics positions in clinical decision-making. (shrink)

An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease, involving dialysis or conservative care. Shared decision-making is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs (...) further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD. (shrink)