In this paper I provide a critique of a set of assumptions relating to agency, choice and the legitimacy of actions impacting health that can be seen in some approaches to health promotion. After a brief discussion about the definition of health promotion, I outline two contrasting approaches to this area of health care practice. The first is focused on the provision of information and the second is concerned with seeking to change people’s preferences in a particular way. It (...) has been argued by a number of critics of health promotion that only the first approach is ethical, as it is for individuals to make their own lifestyle choices and adopt their own conception of the good life. I argue against this ‘information’ approach to health promotion on two grounds. First, I suggest that given the aims of health promotion, the provision of information is, as a matter of fact, of limited effectiveness in achieving these aims. Second, I argue that we have good reasons to question the appropriateness of respecting many of the preferences that individuals happen to have, given the origins and quality of such preferences. I then go on to argue, that by contrast we have good reasons to focus on changing at least some of the preferences that people have related to their lifestyle choices. This involves a commitment to both paternalism and a defence of a certain conception of the good life, but both can be defended. I use the example of potential responses to the growing problem of obesity to illustrate my argument, arguing that only policy that, at least sometimes, aims at preference change will be both effective and ethical. (shrink)

In 2004, prenatal risk assessment (PRA) was implemented as a routine offer in Denmark, in order to give all pregnant women an informed choice about whether to undergo prenatal testing. PRA is a non-invasive intervention performed in the first trimester of pregnancy and measures the risk of a fetus having Down's syndrome or other chromosomal disorders. The risk figure provides the basis for action, i.e. the decision about whether or not to undergo invasive fetal testing via the maternal (...) route (amniocentesis or chorionic villus sampling), which, however, involves the risk of inducing a miscarriage. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, this paper investigates how ideals such as autonomy and non-directiveness are practised in processes of decision-making. We view such ideals as forming social practice rather than neutral instruments to reach a certain goal. Focusing on one couple's trajectory through the clinical practices of PRA and the process through which a decision is reached, we call into question the assumption that more choice and more objective information is a source of empowerment and control. We make evident how decisions are made through a complicated process of meaning-making, which emerges through the relationship between professionals, the clinical setting and the social life of the couples. In the face of complex risk knowledge, PRA users are reluctant to make choices and seek to re-install authority in the health professionals. However, when assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the fetus. It is argued that PRA performs a form of government that works not through compulsion or persuasion but through choice. An ethic of a shared responsibility for PRA and its outcome between pregnant women and health professionals would be more in agreement with how decisions are actually made. (shrink)

The discourse about traceability in food chains focused on traceability as means towards the end of managing health risks. This discourse witnessed a call to broaden traceability to accommodate consumer concerns about foods that are not related to health. This call envisions the development of ethical traceability. This paper presents a justification of ethical traceability. The argument is couched in liberal distinctions, since the call for ethical traceability is based on intuitions about consumer rights to informed choice. The (...) paper suggests that two versions of ethical traceability find justification. The first version of ethical traceability entails that governments ensure that all consumers are provided with foods that respect some threshold level of, e.g., animal welfare that is supported by an overlapping consensus. The second version of ethical traceability entails that food producers provide consumers with products, and sufficient information about these products, that are relevant for reasonable, non-superficial values that are not supported by an overlapping consensus. Governments should facilitate this in the sense that consumers are not provided with misinformation about characteristics of foods that are relevant for reasonable, non-superficial values that are not supported by an overlapping consensus. (shrink)

Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal should be (...) respected. (shrink)

In 2004 prenatal risk assessment was implemented as a routine offer to all pregnant women in Denmark. It was argued that primarily the new programme would give all pregnant women an informed choice about whether to undergo prenatal testing. On the basis of ethnographic fieldwork in an ultrasound clinic in Denmark and interviews with pregnant women and their partners, we call into question the assumption underlying the new guidelines that more choice and more objective information is a (...) source of empowerment and control. We focus on one couple's experience of PRA. This case makes it evident how supposed choices in the context of PRA may not be experienced as such. Rather, they are experienced as complicated processes of meaning-making in the relational space between the clinical setting, professional authority and the social life of the couples. PRA users are reluctant to make choices and abandon health professionals as authoritative experts in the face of complex risk knowledge. When assumptions about autonomy and self-determination are inscribed into the social practice of PRA, authority is transferred to the couple undergoing PRA and a new configuration of responsibility evolves between the couple and their relationship to the foetus. It is argued that al-though the new programme of prenatal testing in Denmark presents itself in opposition to quasi-eugenic and paternalistic forms of governing couples' decisions it represents another form of government that works through the notion of choice. An ethics of a shared responsibility of PRA and its outcome would be more in agreement with how decisions are actually made. (shrink)

A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making (...) and the legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. (shrink)

Informed choice is increasingly recognised as important in supporting patient autonomy and ensuring that people are neither deceived nor coerced. In cancer screening the emphasis has shifted away from just promoting the benefits of screening to providing comprehensive information to enable people to make an informed choice. Cancer screening programmes in the UK now have policies in place which state that it is their responsibility to ensure that individuals are making an individual informed choice. (...) There is a need to evaluate whether such policies mean that those people invited for screening are making informed choices, and how comprehensive information affects other variables such as uptake, cost effectiveness, and satisfaction. At the present time, there is no validated measure of informed choice in cancer screening. Such a measure could be used to evaluate the effectiveness of interventions to increase informed choice and levels of informed choice in a population invited for screening. It could encourage health professionals to be accountable. Factors important when measuring informed choice in cancer screening include an individual’s understanding of the limitations of screening, the ability to make an autonomous choice, and the difference between choice and behaviour. (shrink)

Most theories in economics and finance predict what people will do, given what they know about the world around them. But what do people know about their environments? The study of information choice seeks to answer this question, explaining why economic players know what they know--and how the information they have affects collective outcomes. Instead of assuming what people do or don't know, information choice asks what people would choose to know. Then it predicts what, given that information, (...) they would choose to do. In this textbook, Laura Veldkamp introduces graduate students in economics and finance to this important new research. The book illustrates how information choice is used to answer questions in monetary economics, portfolio choice theory, business cycle theory, international finance, asset pricing, and other areas. It shows how to build and test applied theory models with information frictions. And it covers recent work on topics such as rational inattention, information markets, and strategic games with heterogeneous information.Illustrates how information choice is used to answer questions in monetary economics, portfolio choice theory, business cycle theory, international finance, asset pricing, and other areas Teaches how to build and test applied theory models with information frictions Covers recent research on topics such as rational inattention, information markets, and strategic games with heterogeneous information. (shrink)

The purpose of this paper is to show that the standard notion of informed choice is unacceptable and must be replaced. To do so, I examine Foucault's analysis of people in contemporary society, drawing attention to the ways power relations act upon us, and to the possibility of resistance. I show how feminist moral theory can be enriched by Foucault's analysis. Applying this new understanding of people and moral theory to an analysis of informed choice, I (...) claim that the standard notion of informed choice is unacceptable, in part because it relies on a false conception of people. Its “necessary” features—intention, understanding, and absence of controlling influences—are much more difficult, if not impossible, to obtain than proponents of the standard notion believe. I end by offering direction for creating a new, Foucault-inspired, feminist theory of informed choice. (shrink)

Most agree that, if all else is equal, patients should be provided with enough information about proposed medical therapies to allow them to make an informed decision about what, if anything, they wish to receive. This is the principle of informed choice; it is closely related to the notion of informed consent. Contemporary clinical trials are analysed according to classical statistics. This paper puts forward the argument that classical statistics does not provide the right sort of (...) information for informing choice. The notion of probability used by classical statistics is complex and difficult to communicate. Therapeutic decisions are best informed by statistical approaches that assign probabilities to hypotheses about the benefits and harms of therapies. Bayesian approaches to statistical inference provide such probabilities. (shrink)

The UK has a long established programme of newborn bloodspot screening. This operates under a model of informed choice. Understanding is central to the `informed’ element of an informed choice yet it is rarely assessed. To date most research within the context of newborn bloodspot screening has focussed on parental recall of information. In this paper I argue that simplistic assessments of knowledge through recall fail to reflect more complex notions of understanding. In support of (...) this contention I draw on qualitative interviews with parents of children who have undergone newborn bloodspot screening. (shrink)

Context: Despite much research on informed choice and the individuals’ autonomy in organised medical screening, little is known about the individuals’ decision-making process as expressed in their own words.Objectives: To explore the decision-making process among women invited to a mammography screening programme.Setting: Women living in the counties of Sør- and Nord-Trøndelag, Norway, invited to the first round of the Norwegian Breast Cancer Screening Program in 2003.Methods: Qualitative methods based on eight semistructured focus-group interviews with a total of 69 (...) women aged 50–69 years.Results: The decision to attend mammography screening was not based on the information in the invitation letter and leaflet provided by the NBCSP. They perceived the invitation letter with a prescheduled appointment as if a decision for mammography had already been made. This was experienced as an aid in overcoming the postponements that easily occur in daily lives. The invitation to mammography screening was embraced as an indication of a responsible welfare state, “like a mother taking care.”Conclusion: In a welfare state where governmental institutions are trusted, mass screening for disease is acknowledged by screening participants as a valued expression of paternalism. Trust, gratitude, and convenience were more important factors than information about benefits, harms, and risks when the women made their decisions to attend screening. These elements should be included in the ethical debates on informed choice in preventive medicine. (shrink)

Simulation – imagining future events – plays a role in decision-making. In Conviction Narrative Theory, people's emotional responses to their simulations inform their choices. Yet imagining one possible future also increases its plausibility and accessibility relative to other futures. We propose that the act of simulation, in addition to affective evaluation, drives people to choose in accordance with their simulations.

Over the past decade higher education policy in England has gradually switched from a stance of 'government as purchaser' to 'government as informer'. During 2012 this policy stance has been intensified through new requirements for the advice provided by schools and the introduction of 'Key Information Sets' which are intended to 'drive up quality' through informed choice. This paper documents this policy shift and subjects it to critical scrutiny.

The concepts of choice, negation, and infinity are considered jointly. The link is the quantity of information interpreted as the quantity of choices measured in units of elementary choice: a bit is an elementary choice between two equally probable alternatives. “Negation” supposes a choice between it and confirmation. Thus quantity of information can be also interpreted as quantity of negations. The disjunctive choice between confirmation and negation as to infinity can be chosen or not in (...) turn: This corresponds to set-theory or intuitionist approach to the foundation of mathematics and to Peano or Heyting arithmetic. Quantum mechanics can be reformulated in terms of information introducing the concept and quantity of quantum information. A qubit can be equivalently interpreted as that generalization of “bit” where the choice is among an infinite set or series of alternatives. The complex Hilbert space can be represented as both series of qubits and value of quantum information. The complex Hilbert space is that generalization of Peano arithmetic where any natural number is substituted by a qubit. “Negation”, “choice”, and “infinity” can be inherently linked to each other both in the foundation of mathematics and quantum mechanics by the meditation of “information” and “quantum information”. (shrink)

Screening for unsuspected disease has both possible benefits and harms for those who participate. Historically the benefits of participation have been emphasized to maximize uptake reflecting a public health approach to policy; currently policy is moving towards an informed choice approach involving giving information about both benefits and harms of participation. However, no research has been conducted to evaluate the impact on health of an informed choice policy. Using psychological models, the first aim of this study (...) was to describe an explanatory framework for variation in screening uptake and to apply this framework to assess the impact of informed choices in screening. The second aim was to evaluate ethically that impact. Data from a general population survey of beliefs and attitudes towards participation in diabetes screening indicated that greater orientation to the present is associated with greater social deprivation and lower expectation of participation in screening. The results inform an explanatory framework of social patterning of screening in which greater orientation to the present focuses attention on the disadvantages of screening, which tend to be immediate, thereby reducing participation. This framework suggests that an informed choice policy, by increasing the salience of possible harms of screening, might reduce uptake of screening more in those who are more deprived and orientated to the present. This possibility gives rise to an apparent dilemma where an ethical decision must be made between greater choice and avoiding health inequality. Philosophical perspectives on choice and inequality are used to point to some of the complexities in assessing whether there really is such a dilemma and if so how it should be resolved. The paper concludes with a discussion of the ethics of paternalism. (shrink)

Journal of Philosophy of Education, Volume 56, Issue 3, Page 467-478, June 2022.

Journal of Philosophy of Education, Volume 56, Issue 3, Page 467-478, June 2022.

Individuals often prefer information that matches their needs. In this study, we aimed to explore the relationship between regulatory focus and information preference. Specifically, we investigated the effects of promotion-focused information and prevention-focused information on explicit and implicit information preferences and choice behavior, and examined the mediating roles of information preference. In Experiment 1, we found that prevention-focused individuals were more likely to choose functional information, whereas promotion-focused people were more likely to choose hedonic information. However, there was no (...) significant relationship between regulatory focus and explicit preference and no mediating effect of explicit information preference. In Experiment 2, we found that promotion-focused individuals had a greater implicit preference for hedonic information than did prevention-focused individuals. Implicit information preference mediated the influence of regulatory focus on information choice. The findings of this study may help us understand the psychological mechanism underlying information preference and have important implications for information dissemination. (shrink)

Due to the rise of functional foods,the distinction between foods and medicines hasbecome increasingly blurred. A new EUregulation covering health claims and otherclaims on food and drink products is on thedocks. A basic motive of legal regulation oflabeling and advertising is to inform andprotect the consumer. Promotion of informedchoice and consumer protection may, however, beconflicting objectives. A further problemsprings from the fact that choice, likeconsent, is a propositional attitude andtherefore opaque. Thus it is extremelydifficult for regulators to fasten onparticular (...) formulations of claims. Despite theprofessed respect for the autonomy of theconsumer, paternalism is never far away andeasily enters in various guises. (shrink)

A central tenet of cognitive linguistics is that adults’ knowledge of language consists of a structured inventory of constructions, including various two-argument constructions such as the active, the passive and “fronting” constructions. But how do speakers choose which construction to use for a particular utterance, given constraints such as discourse/information structure and the semantic fit between verb and construction? The goal of the present study was to build a computational model of this phenomenon for two-argument constructions in Mandarin. First, we (...) conducted a grammaticality judgment study with 60 native speakers which demonstrated that, across 57 verbs, semantic affectedness – as determined by further 16 native speakers – predicted each verb’s relative acceptability in the bei-passive and ba-active constructions, but not the Notional Passive and SVO Active constructions. Second, in order to simulate acquisition of these competing constraints, we built a computational model that learns to map from corpus-derived input to an output representation corresponding to these four constructions. The model was able to predict judgments of the relative acceptability of the test verbs in the ba-active and bei-passive constructions obtained in Study 1, with model-human correlations in the region of r = 0.5 and r = 0.3, respectively. Surprisingly, these correlations increased when lexical verb identity was removed; perhaps because this information leads to over-fitting of the training set. These findings suggest the intriguing possibility that acquiring constructions involves forgetting as a mechanism for abstracting across certain fine-grained lexical details and idiosyncrasies. (shrink)

Multiple-choice questions have an undeserved reputation for only being able to test student recall of basic facts. In fact, well-crafted mechanically gradable questions can measure very sophisticated cognitive skills, including those engaged at the highest level of Benjamin Bloom’s taxonomy of outcomes. In this article, I argue that multiple-choice questions should be a part of the diversified assessment portfolio for most philosophy courses. I present three arguments broadly related to fairness. First, multiple-choice questions allow one to consolidate (...) subjective decision making in a way that makes it easier to manage. Second, multiple-choice questions contribute to the diversity of an evaluation portfolio by balancing out problems with writing-based assessments. Third, by increasing the diversity of evaluations, multiple-choice questions increase the inclusiveness of the course. In the course of this argument I provide examples of multiple-choice questions that measure sophisticated learning and advice for how to write good multiple-choice questions. (shrink)

A causal approach to biological information is outlined. There are two aspects to this approach: information as determining a choice between alternative objects and information as determining the construction of a single object. The first aspect has been developed in earlier work to yield a quantitative measure of biological information that can be used to analyze biological networks. This article explores the prospects for a measure based on the second aspect and suggests some applications for such a measure. These (...) two aspects are not suggested to exhaust all the facets of biological information. (shrink)

In this paper we discuss a particular example of the passage from the informal, but rigorous description of a concept to the axiomatic formulation of principles holding for the concept; in particular, we look at the principles of continuity and lawlike choice in the theory of lawless sequences. Our discussion also leads to a better understanding of the rôle of the so-called density axiom for lawless sequences.

Does addiction to heroin undermine the voluntariness of heroin addicts' consent to take part in research which involves giving them free and legal heroin? This question has been raised in connection with research into the effectiveness of heroin prescription as a way of treating dependent heroin users. Participants in such research are required to give their informed consent to take part. Louis C. Charland has argued that we should not presume that heroin addicts are competent to do this since (...) heroin addiction by nature involves a loss of ability to resist the desire for heroin. In this article, I argue that Charland is right that we should not presume that heroin addicts are competent to consent, but not for the reason he thinks. In fact, as Charland's critics correctly point out, there is plenty of evidence showing that heroin addicts can resist their desire for heroin. These critics are wrong, however, to conclude from this that we should presume that heroin addicts are competent to give their voluntary consent. There are, I shall argue, other conditions associated with heroin addiction that might constrain heroin addicts' choice in ways likely to undermine the voluntariness of their consent. In order to see this, we need to move beyond the focus on the addicts' desires for heroin and instead consider the wider social and psychological circumstances of heroin addiction, as well as the effects these circumstances may have on the addicts' beliefs about the nature of their options. (shrink)

This article provides an experimental analysis of attitude toward imprecise and variable information. Imprecise information is provided in the form of a set of possible probability values, such that it is virtually impossible for the subjects to guess or estimate, which one in the set is true or more likely to be true. We investigate how geometric features of such information pieces affect choices. We find that the subjects care about more features than the pairs of best-case and worst-case, which (...) is a counter-evidence to the well-known models, maximin and α-maximin. We find that presence of nonextreme points in the set affects choice, which suggests that attitude toward imprecision is ‘nonlinear.’ We also obtain an observation, though not significant, that information pieces have a complementarity that may not be explained by the Bayesian view. (shrink)

The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole‐genome sequencing and micro‐array based analysis enable genome‐wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre‐test information and achieving autonomous decision‐making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized (...) by the International Association of Bioethics, these challenges were presented for three different areas in which these so‐called ‘new genetics’ technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set‐up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set‐up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct‐to‐consumer applications of the new genetics. (shrink)