People experiencing similar conditions may make different decisions, and their belief systems provide insight about these differences. An example of high‐stakes decision‐making within a complex social context is the Arab Spring, in which large numbers of people decided to protest and even larger numbers decided to stay at home. This study uses qualitative analyses of interview narratives and social media addressing individual decisions to develop a computational model tracing the cognitive decision‐making process. The model builds on work (...) by Abelson and Carroll (1965), Schank and Abelson (1977), and Axelrod (1976) to systematically trace the inferences connecting beliefs to decisions. The findings show that protest decisions were often based on positive emotions such as pride, hope, courage, and solidarity, triggered by beliefs about successful protest and self‐sacrifice. By contrast, decisions to stay at home were triggered by beliefs about safety, state approval, and living conditions. As one participant said, “When I heard about the revolution in Tunisia, my heart was filled with solidarity for the people.” In the words of a non‐participant: “When people are killed, we must be careful. There are more important things than protest: safety and stability.” This study of individual explanations about events identifies the role of emotions in high‐stakes decision‐making within complex social environments. (shrink)

We challenge Johnson et al.'s assumption that people reduce unclear situations to a single narrative explanation and that such reduction would be adaptive for decision-making under radical uncertainty. Instead, we argue that people imagine and maintain multiple narrative possibilities throughout the decision-making process and that this process provides cognitive flexibility and adaptive benefits within the proposed model.

The stakes associated with an algorithmic decision are often said to play a role in determining whether the decision engenders a right to an explanation. More specifically, “high stakes” decisions are often said to engender such a right to explanation whereas “low stakes” or “non-high” stakes decisions do not. While the overall gist of these ideas is clear enough, the details are lacking. In this paper, we aim to provide these details through a detailed investigation of what we will call (...) the “Simple Stakes Thesis”. The Simple Stakes Thesis, as it will turn out, is too simple. For even if the stakes associated with a specific one-off decision are low—and hence does not engender a right to an explanation—such decisions may nevertheless form part of a high stakes pattern or aggregate of decisions. In such cases, we argue, even a low stakes decision may engender a right to explanation. Not only does this show that the right to explanation is more demanding than so far recognized. It also shows that the stakes thesis is significantly harder to apply in practice. (shrink)

In this paper, I aim to establish that, according to almost all democratic theories, instrumentalist considerations often dominate intrinsic proceduralist considerations in our decisions about whether to make extensive use of undemocratic procedures. The reason for this is that almost all democratic theorists, including philosophers commonly thought to be intrinsic proceduralists, accept ‘High Stakes Instrumentalism’. According to HSI, we ought to use undemocratic procedures in order to prevent high stakes errors - very substantively bad or unjust outcomes. However, democratically produced (...) severe substantive injustice is much more common than many proponents of HSI have realised. Proponents of HSI must accept that if undemocratic procedures are the only way to avoid these high stakes errors, then we ought to make extensive use of undemocratic procedures. Consequently, according to almost all democratic theorists, democratic theory ought, for practical purposes, to be reoriented towards difficult moral and empirical questions about the instrumental quality of procedures. Moreover, this is potentially very practically important because if there are available instrumentally superior undemocratic procedures, then wholesale institutional reform is required. This is one of the most potentially practically important findings of normative democratic theory. In spite of this, no-one has yet explicitly recognised it. (shrink)

The intention of this paper is to point to the dilemma humanity may face in light of AI advancements. The dilemma is whether to create a world with less evil or maintain the human status of moral agents. This dilemma may arise as a consequence of using automated decision-making systems for high-stakes decisions. The use of automated decision-making bears the risk of eliminating human moral agency and autonomy and reducing humans to mere moral patients. On the other hand, it also (...) has the potential to bring tremendous benefits to humanity by decreasing human-induced harm in the world. After presenting how this dilemma may arise, I explore general avenues for addressing it. I will argue that we do not have to solve this dilemma in an all-or-nothing fashion and that a more nuanced approach may be suitable. However, the main point I want to highlight is that we need to have a principled way of addressing this dilemma, which is currently missing. (shrink)

The rapidly increasing role of automation throughout the economy, culture and our personal lives has generated a large literature on the risks of algorithmic decision-making, particularly in high-stakes legal settings. Algorithmic tools are charged with bias, shrouded in secrecy, and frequently difficult to interpret. However, these criticisms have tended to focus on particular implementations, specific predictive techniques, and the idiosyncrasies of the American legal-regulatory regime. They do not address the more fundamental unease about the prospect that we might one day (...) replace judges with algorithms, no matter how fair, transparent, and intelligible they become. The aim of this paper is to propose an account of the source of that unease, and to evaluate its plausibility. I trace foundational unease with algorithmic decision-making in the law to the powerful intuition that there is a basic moral and legal difference between showing that something is true of many people just like you and showing that it is true of you. Human judgment attends to the exception; automation insists on blindly applying the rule. I show how this intuitive thought is connected to both epistemological arguments about the value of statistical evidence, as well as to court-centered conceptions of the rule of law. Unease with algorithmic decision-making in the law thus draws on an intuitive principle that underpins a disparate range of views in legal philosophy. This suggests the principle is deeply ingrained. Nonetheless, I argue that the powerful intuition is not as decisive as it may seem, and indeed runs into significant epistemological and normative challenges. At an epistemological level, I show how concerns about statistical evidence's ability to track the truth can be resolved by adopting a probabilistic, rather than modal, conception of truth-tracking. At a normative level, commitment to highly individualized decision-making co-exists with equally ingrained and competing principles, such as consistent application of law. This suggests that the “rule of law” may not identify a discrete set of institutional arrangements, as proponents of a court-centric conception would have it, but rather a more loosely defined set of values that could potentially be operationalized in multiple ways, including through some level of algorithmic adjudication. Although the prospect of replacing judges with algorithms is indeed unsettling, it does not necessarily entail unreasonable verdicts or an attack on the rule of law. (shrink)

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

The danger of human operators devolving responsibility to machines and failing to detect cases where they fail has been recognised for many years by industrial psychologists and engineers studying the human operators of complex machines. We call it “the control problem”, understood as the tendency of the human within a human–machine control loop to become complacent, over-reliant or unduly diffident when faced with the outputs of a reliable autonomous system. While the control problem has been investigated for some time, up (...) to this point its manifestation in machine learning contexts has not received serious attention. This paper aims to fill that gap. We argue that, except in certain special circumstances, algorithmic decision tools should not be used in high-stakes or safety-critical decisions unless the systems concerned are significantly “better than human” in the relevant domain or subdomain of decision-making. More concretely, we recommend three strategies to address the control problem, the most promising of which involves a complementary coupling between highly proficient algorithmic tools and human agents working alongside one another. We also identify six key principles which all such human–machine systems should reflect in their design. These can serve as a framework both for assessing the viability of any such human–machine system as well as guiding the design and implementation of such systems generally. (shrink)

This essay explores the preferences, anticipations and expectations of the elderly regarding the role of family members in making health care decisions for them should they become decisionally incapacitated. Findings are presented from a series of in-depth interviews of men and women aged 67–91 years. Following a discussion of the uncertain legal status of familial surrogate decision-making, we argue that the family unit's autonomy is sufficient to justify the elderly's preferred reliance on their own family. Further, we suggest that social (...) and legal policy changes should facilitate, rather than impede, familial decision-making. (shrink)

Because of its practical advantages, machine learning (ML) is increasingly used for decision-making in numerous sectors. This paper demonstrates that the integral characteristics of ML, such as semi-autonomy, complexity, and non-deterministic modeling have important ethical implications. In particular, these characteristics lead to a lack of insight and lack of comprehensibility, and ultimately to the loss of human control over decision-making. Errors, which are bound to occur in any decision-making process, may lead to great harm and human rights violations. It is (...) important to have a principled way of assigning responsibility for such errors. The integral characteristics of ML, however, pose serious difficulties in defining responsibility and regulating ML decision-making. First, we elaborate on these characteristics and their epistemic and ethical implications. We then analyze possible general strategies for resolving the assignment of moral responsibility and show that, due to the specific way in which ML functions, each potential solution is problematic, whether we assign responsibility to humans, machines, or using hybrid models. Then, we shift focus on an alternative approach that bypasses moral responsibility and attempts to define legal liability independently through solutions such as informed consent and the no-fault compensation system. Both of these solutions prove unsatisfactory because they leave too much room for potential abuses of ML decision-making. We conclude that both ethical and legal solutions are fraught with serious difficulties. These difficulties prompt us to re-weigh the costs and benefits of using ML for high-stake decisions. (shrink)

The ongoing explosion of interest in artificial intelligence is fueled in part by recently developed techniques in machine learning. Those techniques allow automated systems to process huge amounts of data, utilizing mathematical methods that depart from traditional statistical approaches, and resulting in impressive advancements in our ability to make predictions and uncover correlations across a host of interesting domains. But as is now widely discussed, the way that those systems arrive at their outputs is often opaque, even to the experts (...) who design and deploy them. Is it morally problematic to make use of opaque automated methods when making high-stakes decisions, like whether to issue a loan to an applicant, or whether to approve a parole request? Many scholars answer in the affirmative. However, there is no widely accepted explanation for why transparent systems are morally preferable to opaque systems. We argue that the use of automated decision-making systems sometimes violates duties of consideration that are owed by decision-makers to decision-subjects, duties that are both epistemic and practical in character. Violations of that kind generate a weighty consideration against the use of opaque decision systems. In the course of defending our approach, we show that it is able to address three major challenges sometimes leveled against attempts to defend the moral import of transparency in automated decision-making. (shrink)

‘Shared’ decision-making is heralded as the gold standard of how medical decisions should be reached, yet how does one ‘share’ a decision when any attempt to do so will undermine _autonomous_ decision-making? And what exactly is being shared? While some authors have described parallels in literature, philosophical examination of shared agency remains largely uninvestigated as an explanation in bioethics. In the following, shared decision-making will be explained as occurring when a group, generally comprised of a patient and or their family, (...) and the medical team become a genuine intentional subject which acts as a collective agent. Collective agency can better explain how some medical decisions are reached, contrary to the traditional understanding and operationalization of ‘autonomy’ in bioethics. Paradoxically, this often occurs in the setting of high-stakes moral decision-making, where conventional wisdom would suggest individuals would _most_ want to exercise autonomous action according to their personally held values and beliefs. This explication of shared decision-making suggests a social ontology ought to inform or displace significant aspects of autonomy as construed in bioethics. It will be argued that joint commitments are a fundamental part of human life, informing and explaining much human behavior, and thus suggesting that autonomy - conceived of as discrete, individuated moral reasoning of a singular moral agent - is not an unalloyed ‘good.’. (shrink)

Although treating the elderly occasion the same kinds of ethical issues as treating other patients, specific problems do arise when making decisions for persons, once competent, who no longer can express their values. I examine the problem of decisional incapacity and offer a critique of the principles, such as substituted judgment, and the instruments, such as advance directives, living wills, other instructional directives, as well as surrogate decision-makers.

This paper examines a model of decision-making within the context of current and emerging regimes of accountability being proposed and implemented for school systems in a number of jurisdictions. These approaches to accountability typically involve the use of various measurable student learning outcomes as well as other measures of performance to do with teachers and schools in general, often having high-stakes consequences. Given this context of performativity, the paper proposes a model that uses an objective knowledge growth framework, where teachers (...) can engage in their own professional learning through defined structures for solving the problems of their professional practice. The model is both empowering for teachers while being sensitive to the constraints of cultures of performativity. (shrink)

Suppose that three patients each independently confront the same high-stakes treatment decision. Perhaps it is an option to terminate a high-risk pregnancy, or to accept a blood transfusion after a catastrophic hemorrhage. Suppose further that the three patients approach their choice in radically different ways. The divergence lies not in the choice made, but in the pathway followed in arriving at it. P1 is a classic analytical reasoner. She enumerates the potential costs and benefits of each option, reviews the probabilities, (...) and makes a decision on the basis of her analysis. P2 does none of that analytical work. She has a settled and robust prior... (shrink)

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple reasonable models” (...) problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (shrink)

Mental toughness (MT) is a key psychological variable related to achievement in performance domains and perseverance in challenging circumstances. We sought to understand the lived experiences of mentally tough high-altitude mountaineers, focusing primarily upon decisions to persevere or abort summit attempts. Phenomenological interviews were conducted with 14 mountaineers including guides, expedition leaders, and doctors (Mage = 44 years). A content analysis was employed to identify key themes in the data. Participants emphasized the importance of MT in extreme environments and described (...) rational, flexible, and vigilant decision-making. Turning around without summiting was the toughest decision reported, with recognition of the thin line between persevering and overstretching. In contrast to much MT literature, mountaineers accepted limits, demonstrated restraint, and sacrificed personal goals to aid others. Costly perseverance was also reported with some mountaineers described as “too tough”: overcompetitive, goal-obsessed, and biased decision-makers. These findings revealed both benefits and dangers of MT in mountaineering. (shrink)

How can clinical ethics consultants best assist patients and their family members when patients may be dying? In this introduction, I consider this concern in light of four articles that appear in this issue of The Journal of Clinical Ethics, by Jeffrey T. Berger; Mary T. White; Linying Hu, Xiuyun Yin, Xiaolei Bao, and Jin-Bao Nie; and Thaddeus Mason Pope and Melinda Hexum.Patients and family members experience extreme stress at the end of life, a high-stakes situation in which few of (...) us have extensive experience. This stress can make us less able to process new information, cripple decision making, and even lead to long-term harm.I provide a number of practical approaches that clinical ethics consultants can use to help patients and family members in these situations, so that their decisions may reflect more what they really want and so that, after this stress has diminished, they may then do better. (shrink)

In this paper, we examine healthcare organizations’ responses to high profile cases of doctor–parent disagreement. We argue that, once a conflict crosses a certain threshold of public interest, the stakes of the disagreement change in important ways. They are no longer only the stakes of the child’s interests or who has decision‐making authority, but also the stakes of public trust in healthcare practitioners and organizations and the wide scale spread of medical misinformation. These higher stakes call for robust organization‐level (...) responses. There are responsible and thoughtful ways for healthcare organizations to directly engage with these cases. Hospitals should seek an alliance with the parents around the goal of public discussion and utilize web‐based platforms to provide the public with information about medical conditions, experimental treatments, and how clinical ethics deliberation in hospitals works. We outline five important lessons for healthcare organizations to keep in mind when responding to such cases. Approached with care, these cases could become “teachable moments” for both healthcare organizations and society. (shrink)

Algorithmic decision-making based on profiling may significantly affect people’s destinies. As a rule, however, explanations for such decisions are lacking. What are the chances for a “right to explanation” to be realized soon? After an exploration of the regulatory efforts that are currently pushing for such a right it is concluded that, at the moment, the GDPR stands out as the main force to be reckoned with. In cases of profiling, data subjects are granted the right to receive meaningful information (...) about the functionality of the system in use; for fully automated profiling decisions even an explanation has to be given. However, the trade secrets and intellectual property rights (IPRs) involved must be respected as well. These conflicting rights must be balanced against each other; what will be the outcome? Looking back to 1995, when a similar kind of balancing had been decreed in Europe concerning the right of access (DPD), Wachter et al. (2017) find that according to judicial opinion only generalities of the algorithm had to be disclosed, not specific details. This hardly augurs well for a future right of access let alone to explanation. Thereupon the landscape of IPRs for machine learning (ML) is analysed. Spurred by new USPTO guidelines that clarify when inventions are eligible to be patented, the number of patent applications in the US related to ML in general, and to “predictive analytics” in particular, has soared since 2010—and Europe has followed. I conjecture that in such a climate of intensified protection of intellectual property, companies may legitimately claim that the more their application combines several ML assets that, in addition, are useful in multiple sectors, the more value is at stake when confronted with a call for explanation by data subjects. Consequently, the right to explanation may be severely crippled. (shrink)

Providing a vibrant four-color design, market-leading BUSINESS ETHICS: ETHICAL DECISION MAKING AND CASES, Ninth Edition, thoroughly covers the complex environment in which managers confront ethical decision making. Using a proven managerial framework, this accessible, applied text addresses the overall concepts, processes, and best practices associated with successful business ethics programs--helping readers see how ethics can be integrated into key strategic business decisions. Thoroughly revised, the new ninth edition incorporates coverage of new legislation affecting business ethics, the most up-to-date examples, and (...) the best practices of high-profile organizations. It also includes 20 all-new or updated original case studies. (shrink)

BackgroundThis article is part of a study to gain insight into the decision-making process by looking at the views of the relatives of potential brain dead donors. Alongside a literature review, focus interviews were held with healthcare professionals about their role in the request and decision-making process when post-mortal donation is at stake. This article describes the perspectives of the relatives.MethodsA content-analysis of 22 semi-structured in-depth interviews with relatives involved in an organ donation decision.ResultsThree themes were identified: ‘conditions’, ‘ethical considerations’ (...) and ‘look back’. Conditions were: ‘sense of urgency’, ‘incompetence to decide’ and ‘agreement between relatives’. Ethical considerations result in a dilemma for non-donor families: aiding people or protecting the deceased’s body, especially when they do not know his/her preference. Donor families respect the deceased’s last will, generally confirmed in the National Donor Register. Looking back, the majority of non-donor families resolved their dilemma by justifying their decision with external arguments. Some non-donor families would like to be supported during decision-making.DiscussionThe discrepancy between general willingness to donate and the actual refusal of a donation request can be explained by multiple factors, with a cumulative effect. Firstly, half of the participants stated that they felt that they were not competent to decide in such a crisis and they seem to struggle with utilitarian considerations against their wish to protect the body. Secondly, non-donor families refused telling that they did not know the deceased’s wishes or contesting posthumous autonomy of the eligible. Thirdly, the findings emphasise the importance of Donor Registration, because it seems to prevent dilemmas in decision-making, at least for donor families.ConclusionDiscrepancies between willingness to consent to donate and refusal at the bedside can be attributed to an unresolved dilemma: aiding people or protect the body of the deceased. Non-donor families felt incompetent to decide. They refused consent for donation, since their deceased had not given any directive. When ethical considerations do not lead to an unambiguous answer, situational factors were pivotal. Relatives of unregistered eligible donors are more prone to unstable decisions. To overcome ambivalence, coaching during decision-making is worth investigation. (shrink)

This paper presents the results of a within-subject experiment testing whether an increase in the monetary stakes by a factor of 50 – which had never been done before – influences individual behavior in a simple ultimatum bargaining game. Contrary to current wisdom, we found that lowest acceptable offers stated by the responder are proportionally lower in the high-stake condition than in the low-stake condition. This result may be interpreted in terms of the type of utility functions which characterize the (...) subjects. However, in line with prior results, we find that an important increase of the monetary stakes in the ultimatum game has no effect on the offers made by the proposer. Yet, the present research suggests that the reasons underlying these offers are quite different when the stakes are high. (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)

This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this paper we will discuss the normative importance of vitality as a diagnostic cue and will argue that vitality, as a sign (...) perceived by doctors and nurses, has moral significance and represents a legitimate contribution to clinical decision-making in difficult cases where the child's life is at stake. We will argue that these clinical intuitions can be justified on a moral basis but only with certain qualifications that accounts for a certain objectivity and intersubjective reliability in the therapeutic judgements. (shrink)

This text provides an introduction to the topic of rational decision making as well as a brief overview of the most common biases in judgment and decision making. "Decision Making" is relatively short (300 pages) and richly illustrated with approximately 100 figures. It is suitable for both self-study and as the basis for an upper-division undergraduate course in judgment and decision making. The book is written to be accessible to anybody with minimum knowledge of mathematics (high-school level algebra and some (...) elementary notions of set theory and probability, which are reviewed in the book). At the end of each chapter there is a collection of exercises that are grouped according to that chapter’s sections. Complete and detailed answers for each exercise are given in the last section of each chapter. The book contains a total of 121 fully solved exercises. (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)

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)

It is a familiar criticism of Subject-Sensitive Invariantism that the view makes incorrect predictions about cases in which the attributor of knowledge is in a high-stakes situation and the subject of the attribution in a low-stakes situation. In a recent paper in this journal, Brian Kim has argued that the mentioned type of case should be ignored, since the relevant knowledge ascriptions are inappropriate in virtue of violating an epistemic norm of presupposing. I show, pace Kim, that the mentioned utterances (...) do not carry factivity presuppositions. To this end I discuss a phenomenon known as presupposition suspension, which is widely associated with the presuppositions of epistemic factives such as know that p or discover that p. I argue further that the problem of unknown presuppositions discussed by Kim can be circumvented by slightly amending the cases at hand. In particular, I demonstrate that factivity presuppositions are unobjectionable in problem cases in which the high-stakes ascriber knows the presuppositions at issue to be true. (shrink)

Decision making in any brain is imperfect and costly in terms of time and energy. Operating under such constraints, an organism could be in a position to improve performance if an opportunity arose to exploit informative patterns in the environment being searched. Such an improvement of performance could entail both faster and more accurate (i.e., reward-maximizing) decisions. The present study investigated the extent to which human participants could learn to take advantage of immediate patterns in the spatial arrangement of serially (...) presented foods such that a region of space would consistently be associated with greater subjective value. Eye movements leading up to choices demonstrated rapidly induced biases in the selective allocation of visual fixation and attention that were accompanied by both faster and more accurate choices of desired goods as implicit learning occurred. However, for the control condition with its spatially balanced reward environment, these subjects exhibited preexisting lateralized biases for eye and hand movements (i.e., leftward and rightward, respectively) that could act in opposition not only to each other but also to the orienting biases elicited by the experimental manipulation, producing an asymmetry between the left and right hemifields with respect to performance. Potentially owing at least in part to learned cultural conventions (e.g., reading from left to right), the findings herein particularly revealed an intrinsic leftward bias underlying initial saccades in the midst of more immediate feedback-directed processes for which spatial biases can be learned flexibly to optimize oculomotor and manual control in value-based decision making. The present study thus replicates general findings of learned attentional biases in a novel context with inherently rewarding stimuli and goes on to further elucidate the interactions between endogenous and exogenous biases. (shrink)

A framework is presented to better characterize the role of individual differences in information processing style and their interplay with contextual factors in determining decision making quality. In Experiment 1, we show that individual differences in information processing style are flexible and can be modified by situational factors. Specifically, a situational manipulation that induced an analytical mode of thought improved decision quality. In Experiment 2, we show that this improvement in decision quality is highly contingent on the compatibility between the (...) dominant thinking mode and the nature of the task. That is, encouraging an intuitive mode of thought led to better performance on an intuitive task but hampered performance on an analytical task. The reverse pattern was obtained when an analytical mode of thought was encouraged. We discuss the implications of these results for the assessment of decision making competence, and suggest practical directions to help individuals better adjust their information processing style to the situation at hand and make optimal decisions. (shrink)

Individuals are downloading copyrighted materials at escalating rates (Hill 2007; Siwek 2007). Since most materials shared within these networks are copyrighted works, providing, exchanging, or downloading files is considered to be piracy and a violation of intellectual property rights (Shang et al. 2008). Previous research indicates that personal moral philosophies rooted in moral absolutism together with social context may impact decision making in ethical dilemmas; however, it is yet unclear which motivations and norms contextually impact moral awareness in a peer-to-peer (...) (P2P) file sharing context (Shang et al. 2008). In sum, factors affecting the decision to share copyrighted material require further clarification and investigation (Shang et al. 2008). The purpose of this study was to use a consumer-based scenario and multiple ethics measures to explore how idealism, formalism, and perceived social consensus impact users’ propensity to recognize that the sharing of copyrighted media through P2P networks was an ethical issue and their subsequent ethical intentions. Results showed that high levels of idealism and formalism were associated with an increased recognition that file sharing was an ethical issue, but neither construct had a direct effect on ethical intention. Strong social consensus among respondents that other people consider file sharing to be unethical was also positively related to the recognition that file sharing was an ethical issue, and ethical recognition was a moderate predictor of intention not to engage in file sharing. Finally, a post hoc mediation analysis indicated that idealism, formalism, and social consensus operated through recognition of an ethical issue to impact ethical intention (indirect-only mediation). (shrink)

Higher courts sometimes assess the constitutionality of law by working through a concrete case, other times by reasoning about the underlying question in a more abstract way. Prior research has found that the degree of concreteness or abstraction with which an issue is formulated can influence people's prescriptive views: For instance, people often endorse punishment for concrete misdeeds that they would oppose if the circumstances were described abstractly. We sought to understand whether the so-called ‘abstract/concrete paradox’ also jeopardizes the consistency (...) of judicial reasoning. In a series of experiments, both lay and professional judges sometimes reached opposite conclusions when reasoning about concrete cases versus the underlying issues formulated in abstract terms. This effect emerged whether participants reasoned with broad principles, such as human dignity, or narrow rules, and was largest among individuals high in trait empathy. Finally, to understand whether people reflectively endorse the discrepancy between abstract and concrete resolutions, we examined their reactions when evaluating both, either simultaneously or sequentially. These approaches revealed no single pattern across lay and expert populations, or exploratory and confirmatory studies. Taken together, our studies suggest that empathic concern plays a greater role in guiding the judicial resolution of concrete cases than in illuminating judges' professed standards—which may result in concrete decisions in violation of their own abstract principles. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (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)

There are marked differences between countries with regard to reimbursement decision-making, yet few studies have tried to understand this process and its consequences by a detailed analysis of the local context and decision-making structure. This article describes reimbursement decision-making and subsequent prescribing patterns of new pharmaceuticals by means of a case study on glitazones in treatment of type 2 diabetes mellitus patients in Denmark. The study shows that institutional arrangements, providing the context in which evidence is used, are highly important (...) for understanding the reimbursement decision-making process. In particular the Danish Medicines Agency (DMA) has shaped the decision to reimburse glitazones on the basis of physician-mediated requests of individual patients. Relatively few patients have been prescribed glitazones since their introduction in 2000, suggesting that individual reimbursement may be an effective instrument in controlling overall expenditure of selected pharmaceuticals, although in the case of glitazones this has likely been achieved at the expense of equality in access to the products. The discussion focuses on the generalizability of the findings to both other pharmaceuticals in the individual reimbursement scheme in Denmark, and to other countries that are trying to balance the need to control overall pharmaceutical care expenditure with the need to secure equality in access to new drugs with therapeutic added value. (shrink)

In marketing, the use of visual-art-based designs on products or packaging crucially impacts consumers’ decision-making when purchasing. While visual art in product packaging should be designed to induce consumer’s favorable evaluations, it should not evoke excessive affective arousal, because this may lead to the depletion of consumer’s cognitive resources. Thus, consumers may use heuristic decision-making and commit an inadvertent mistake while purchasing. Most existing studies on visual arts in marketing have focused on preference using subjective evaluations. To address this, we (...) applied a neuroscientific measure, electroencephalogram to increase experimental validity. Two successive tasks were designed to examine the effects of affective arousal and affective valence, evoked by visual artwork, on the consecutive cognitive decision-making. In task 1, to evaluate the effect of visual art, EEG of two independent groups of people was measured when they viewed abstract artwork. The abstract art of neoplasticism group was showing Mondrian’s artwork, while the abstract art of expressionism group viewed Kandinsky’s artwork. The neoplasticism movement strove to eliminate emotion in art and expressionism to express the feelings of the artist. Building on Gallese’s embodied simulation theory, AbNP and AbEX artworks were expected to induce lower and higher affect, respectively. In task 2, we investigated how the induced affect differentially influenced a succeeding cognitive Stroop task. We anticipated that the AbEX group would deplete more cognitive resources than AbNP group, based on capacity limitation theory. Significantly stronger affect was induced in the AbEX group in task 1 than in the AbNP group, especially in affective arousal. In task 2, the AbEX group showed a faster reaction time and higher error rate in the Stroop task. According to our hypotheses, the higher affective arousal state of the AbEX group might deplete more cognitive resources during task 1 and result in poorer performance in task 2 because affect impacted their cognitive resources. This is the first study using neuroscientific measures to prove that high affective arousal induced by visual arts on packaging may induce heuristic decision-making in consumers, thereby advancing our understanding of neuromarketing. (shrink)

Information is a force multiplier. Knowledge of the enemy's capability and intentions may be of far more value to a military force than additional troops or firepower. Situation assessment is the ongoing process of inferring relevant information about the forces of concern in a military situation. Relevant information can include force types, firepower, location, and past, present and future course of action. Situation assessment involves the incorporation of uncertain evidence from diverse sources. These include photographs, radar scans, and other forms (...) of image intelligence, or IMINT; electronics intelligence, or ELINT, derived from characteristics (e.g., wavelength) of emissions generated by enemy equipment; communications intelligence, or COMINT, derived from the characteristics of messages sent by the enemy; and reports from human informants (HUMINT). These sources must be combined to form a model of the situation. The sheer volume of data, the ubiquity of uncertainty, the number and complexity of hypotheses to consider, the high-stakes environment, the compressed time frame, and deception and damage from hostile forces, combine to present a staggeringly complex problem. Even if one could formulate a decision problem in reasonable time, explicit determination of an optimal decision policy exceeds any reasonable computational resources. While it is tempting to drop any attempt at rational analysis and rely purely on simple heuristics, we argue that this can lead to catastrophic outcomes. We present an architecture for a ``complex decision machine'' that performs rational deliberation to make decisions in real time. We argue that resource limits require such an architecture to be grounded in simple heuristic reactive processes. We thus argue that both simple heuristics and complex decision machines are required for effective decision making in real time for complex problems. We describe an implementation of our architecture applied to the problem of military situation assessment. (shrink)

Decision making comes under pressure when the stakes are high and the information is imperfect. That is risk. Most of the risks can be most easily presented in terms of tensions between the recommendations of a simple theory and the complex reactions. The theory is the standard philosophers' and economists' account of rationality in the face of risk, in terms of expected utility, and the cases derive mostly from the intuitive sense many people have had that there is something wrong (...) with the theory. This chapter aims to give a diagnosis of what underlies these intuitions. It also presents an extreme example bringing out one aspect of risk‐aversion. It further considers a family of related examples which bring out both the force of the EU rule and some of the problems with it. An appeal of EU lies in its connections with the intuitive 'grammar' of risk taking. (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)

The goal of this essay is to explore "the highly contested nature of [decision-making through adopting] a historically comparative and interdisciplinary approach." Internalist history of game theory treats decision theory as a science of making choices to maximize expected gain. Game theory is applied to nuclear deterrence and military strategy, building markets and designing institutions, analyzing collective action, developing jurisprudence, and addressing crime and punishment. This essay draws on recent historiography of Cold War decision-making to draw into focus the constructive (...) aspects of decision theory to argue that the perceived need to avoid worst-case scenarios has instead contributed to a world in which the worst outcome is probabilistically assured to occur over the long duree timeframe. (shrink)

Patients can be harmed by a religiously motivated surrogate decision maker whose decisions are contrary to the standard of care; therefore, surrogate decision making should be held to a high standard. Stewart Eskew and Christopher Meyers proposed a two-part rule for deciding which religiously based decisions to honor: (1) a secular reason condition and (2) a rationality condition. The second condition is based on a coherence theory of rationality, which they claim is accessible, generous, and culturally sensitive. In this article, (...) I will propose strengthening the rationality condition by grounding it in a theory of intellectual virtue, which is both rigorous and culturally sensitive. (shrink)

New and experienced psychotherapists alike can find themselves overwhelmed by an ethical quandary where there doesn't seem to be an easy solution. This book presents positive ethics as a means to overcome such ethical challenges. The positive approach focuses on not just avoiding negative consequences, but reaching the best possible outcomes for both the psychotherapist and the client. The authors outline a clear decision-making process that is based on three practical strategies: the ethics acculturation model to help therapists incorporate personal (...) ethics into their professional roles, the quality enhancement model for dealing with high-risk patients who are potentially harmful, and ethical choice-making strategies to make the most ethical decision in a situation where two ethical principles conflict. Throughout the decision-making process, psychotherapists are encouraged to follow four basic guidelines: Focus on overarching ethical principles Consider intuitive, emotional, and other nonrational factors Accept that some problems have elusive solutions Solicit input from colleagues and consultation groups Numerous vignettes illustrate how to apply positive ethics to many different ethical challenges that psychotherapists will likely encounter in practice. (shrink)

Decisions about continuing or terminating a pregnancy touch on profound, individualized questions about bodily integrity, reproductive autonomy, deeply held values regarding one's capacity for parenthood, and, in the case of a high-risk pregnancy, the risks one is willing to take to have a baby. So far as possible, reproductive decisions are made between a patient, in some cases her partner, and her medical provider. However, this standard framework cannot be applied if the patient lacks decision-making capacity. In this essay, we (...) discuss one such case that came before our clinical ethics team. We describe the challenges of respecting a patient's reproductive preferences when the patient cannot share what those preferences are, and we argue that decisions regarding reproductive health care should not be treated with exceptionalism. Rather, they should proceed under the normal processes of surrogate decision-making, including the application of substituted judgment. This approach enables us to take the patient's values into account when considering the questions implicated in reproductive health care, just as we do for other kinds of health care decisions in which a patient's deeply held values are salient. (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-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)

Men often make riskier decisions than women across a wide range of real-life behaviors. Whether this sex difference is accentuated, diminished, or stable under stressful conditions is, however, contested in the scientific literature. A critical blind spot lies amid this contestation: Most studies use standardized, laboratory-based, cognitive measures of decision making rather than complex real-life social simulation tasks to assess risk-related behavior. To address this blind spot, we investigated the effects of acute psychosocial stress on risk decision making in men (...) and women using a standardized cognitive measure and a novel task that simulated a real-life social situation. Participants were exposed to either an acute psychosocial stressor or an equivalent control condition. Stressor-exposed participants were further characterized as high- or low-cortisol responders. Results confirmed that the experimental manipulation was effective. On the IGT, participants characterized as low-cortisol responders made significantly riskier decisions than those characterized as high-cortisol responders. Similarly, in the online chatroom, participants characterized as low-cortisol responders were, relative to those in the Non-Stress group, significantly more likely to make risky decisions. Together, these results suggest that at lower levels of cortisol both men and women tend to make riskier decisions in both economic and social spheres. (shrink)