This paper starts by characterising moral requirements and everyday thought. Then ways in which moral requirements shape everyday thought are identified, including the way internalised moral requirements prevent some possible actions from even being considered. The paper then explains that everyday moral thought might be structured by dispositions to which there are corresponding principles even if these principles do not usually appear in the conscious thoughts of agents while they are engaged in everyday moral (...) class='Hi'>decision-making. Nevertheless, especially when conflicts between moral considerations arise, alternative possible resolutions are typically framed in terms of principles. The paper pushes on to discuss how everyday moral thought is pushed to consider principles, engage in moral theorising, and even consider abstract moral theories. (shrink)

It is commonly thought that moral rules and principles, such as ‘Keep your promises,’ ‘Respect autonomy,’ and ‘Distribute goods according to need ,’ should play an essential role in our moral deliberation. Particularists have challenged this view by arguing that principled guidance leads us to engage in worse decision making because principled guidance is too rigid and it leads individuals to neglect or distort relevant details. However, when we examine empirical literature on the use of rules and (...) principles in other domains, we find that people can learn to use rules discriminately and that rule-based models tend to outperform even expert judgment. I argue that this evidence poses a problem for the moral particularist. If the particularist claims that we should not rely on decision-making rules when making practical decisions and it turns out that these rules help us make better decisions, then the particularists’ prescriptive account is deficient. However, if the particularist claims that we should rely on practical decision-making rules but not on moral rules, she needs to explain how practical rules are different from moral rules and why we should rely on the former but not the latter. (shrink)

Recent theories on cognitive science have stressed the significance of moral intuition as a counter to and complementary part of moral reasoning in decision making. Thus, the aim of this paper is to create an integrated framework that can account for both intuitive and reflective cognitive processes, in order to explore the antecedents of ethical decision making. To do that, we build on Scholasticism, an important medieval school of thought from which descends the main pillars of (...) the modern Catholic social doctrine. Particularly, the focus will be on the scholastic concept of synderesis, which is an innate human faculty that constantly inclines decision makers toward universal moral principles. Managerial implications are discussed, stressing how a rediscovery of decision makers’ intuitive moral judgments could be relevant in the reflective thinking practice of managers’ ethical reasoning, thus saving them from rational insensitivity to ethical dilemmas. (shrink)

Background Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. Methods A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. Results (...) Three themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. Conclusions Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question. (shrink)

This paper discusses the philosophical argument and the application of the Triple Font Theory for moral evaluation of human acts and attempts to integrate the conceptual components of major moral theories into a systematic internally consistent decision-making model that is theoretically driven. The paper incorporates concepts such as formal and material cooperation and the Principle of Double Effect into the theoretical framework. It also advances the thesis that virtue theory ought to be included in any (...) adequate justification of morality and the need to integrate or coordinate notions of virtue into various act-oriented or principles-based ethics. The TFT offers a comprehensive and practical approach to ethical decision-making and is a useful alternative embedded in traditional wisdom. This paper provides a more general framework of the TFT than traditionally presented. Practical judgment is shown to play a constitute role in providing a guide for right action and is the “glue” that integrates the various components of the TFT. (shrink)

Background In the globalizing world, nurses often meet humans from different cultures and values. This fact has led them to make ethical decisions, which do not comply with their own moral jurisdictions at care setting. Objectives The objective of the study was to investigate the relationships between moral development levels of the nurses and their scores of nursing principled thinking and practical consideration during decision making for ethical dilemmas. Methods This was a descriptive correlational study. Nursing Dilemma (...) Test, Moral Development Scale for Professionals and socio-demographic form were used. Study was conducted with 227 nurses. Ethical considerations: An institutional authorization, an ethics approval from non-interventional ethics committee of the respective university, permission from the authors of the scales used and informed consents from the nurses were obtained in order to conduct the study. Results In this study, nurses were found to be at post-conventional level according to Kohlberg’s moral development theory. Sociodemographic and working characteristics of the nurses have not affected their scores of moral development level and their scores of nursing principled thinking, practical consideration and familiarity. Nurses take attention for moral principles during decision making although not at a desirable level, and they are relatively affected by environmental factors Conclusion Although nurses are familiar with ethical problems at scenarios including ethical dilemmas, they cannot make decisions in accordance with their moral development levels during decision making for ethical dilemmas. Nurses should be instructed and supported for ethical decision making by recognizing factors that may be effective on their decision making. (shrink)

How do business leaders make ethical decisions? Given the significant and wide-spread impact of business people’s decisions on multiple constituents, how they make decisions matters. Unethical decisions harm the decision makers themselves as well as others, whereas ethical decisions have the opposite effect. Based on data from a study on strategic decision making by 16 effective chief executive officers, I propose a model for ethical decision making in business in which reasoning and intuition interact through forming, recalling, (...) and applying moral principles necessary for long-term success in business. Following the CEOs in the study, I employ a relatively new theory, rational egoism, as the substantive content of the model and argue it to be consistent with the requirements of long-term business success. Besides explaining the processes of forming and applying principles, I briefly describe rational egoism and illustrate the model with a contemporary moral dilemma of downsizing. I conclude with implications for further research and ethical decision making in business. (shrink)

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

BackgroundDeciding whether to resuscitate extremely preterm infants (EPIs) is clinically and ethically problematic. The aim of the study was to understand neonatologists’ clinical–ethical decision-making for resuscitation of EPIs.MethodsWe conducted a qualitative study in Belgium, following a constructivist account of the Grounded Theory. We conducted 20 in-depth, face-to-face, semi-structured interviews with neonatologists. Data analysis followed the qualitative analysis guide of Leuven.ResultsThe main principles guiding participants’ decision-making were EPIs’ best interest and respect for parents’ autonomy. Participants agreed that justice (...) as resource allocation should not be considered in resuscitation decision-making. The main ethical challenge for participants was dealing with the conflict between EPIs’ best interest and respect for parents’ autonomy. This conflict was most prominent when parents and clinicians disagreed about births within the gray zone (24–25 weeks). Participants’ coping strategies included setting limits on extent of EPI care provided and rigidly following established guidelines. However, these strategies were not always feasible or successful. Although rare, these situations often led to long-lasting moral distress.ConclusionsParticipants’ clinical–ethical reasoning for resuscitation of EPIs can be mainly characterized as an attempt to balance EPIs’ best interest and respect for parents’ autonomy. This approach could explain why neonatologists considered conflicts between these principles as their main ethical challenge and why lack of resolution increases the risk of moral distress. Therefore, more research is needed to better understand moral distress in EPI resuscitation decisions.Clinical Trial Registration: The study received ethical approval from the ethics committee of UZ/ku Leuven (S62867). Confidentiality of personal information and anonymity was guaranteed in accordance with the General Data Protection Regulation of 25 May 2018. (shrink)

Acting as part of a corporation may allow an individual more easily to rationalize participating in a harmful act, but there are countervailing forces in corporate action that increase moral oversight and accountability. Making use of group agency to explain membership as a special feature of some corporate agents, I argue that when someone becomes a member of an organized group like a company, their own moral responsibility becomes entangled with the decisions of other members of the company, (...) whether or not they intend this effect. This moral entanglement in corporate decision-making explains why individuals have a moral obligation to act in their role as a corporate officer when they would not have an obligation to act in a personal capacity even if they had identical knowledge. The entanglement affects the individual’s own moral status and the moral status of the company itself. Moral entanglement of corporate decision-makers provides a principled explanation for a rule that is present in corporate criminal law that corporate officers with knowledge that another employee is about to commit a crime must actively intervene, and cannot rely on their status as bystanders. (shrink)

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

This book moves away from the frameworks that have traditionally guided ethical decision-making in the Western clinical setting, towards an inclusive, non-coercive and, reflective dialogic approach to moral decision-making. Inspired in part by Jürgen Habermas's discourse theory of morality and principles of communicative action, the book offers a proportionist approach as a way of balancing out the wisdom in traditional frameworks, set in the actual reality of the clinical situation at hand. Putting this approach into practice (...) requires having a conversation, a dialogue or a discourse, with collaboration amongst all the stakeholders. The aim of the dialogue is to reach consensus in the decision, via mutual understanding of the values held by the patient and others whom they see as significant. This book aims to underscore the moral philosophical foundations for having a meaningful conversation. Life and Death Decision in the Clinical Setting is especially relevant in our contemporary era, characterised medically by an ever-increasing armamentarium of life-sustaining technology, but also by increasing multiculturalism, a multiplicity of faiths, and increasing value pluralism. (shrink)

Automated decision making for sentencing is the use of a software algorithm to analyse a convicted offender’s case and deliver a sentence. This chapter reviews the moral arguments for and against employing automated decision making for sentencing and finds that its use is in principle morally permissible. Specifically, it argues that well-designed automated decision making for sentencing will better approximate the just sentence than human sentencers. Moreover, it dismisses common concerns about transparency, privacy and bias as (...) unpersuasive or inapplicable. The chapter also notes that moral disagreement about theories of just sentencing are plausibly resolved by applying the principle of maximising expected moral choiceworthiness, and that automated decision making is better suited to the resulting ensemble model. Finally, the chapter considers the challenge posed by penal populism. The dispiriting conclusion is that although it is in theory morally desirable to use automated decision-making for criminal sentencing, it may well be the case that we ought not to try. (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)

The chapter juxtaposes the fairly quick and automatic thinking and decision making that constitutes everyday moral thought and action with the slower, more complicated, and more reflective thinking that steps beyond everyday moral thought. Various difficulties that can slow down everyday moral thought are catalogued in this paper. The paper explains how dealing with many of these difficulties leads to thinking about moral principles. And, even where there are not such difficulties, everyday moral thought (...) can be challenged by repeated “why?” questions. Pushed far enough, such questions have to be answered by admitting ignorance or by pointing to theses about whatever ultimately makes acts morally required, permissible, or prohibited. Such theses are moral theories. As a point about moral theories, the paper ends by pointing out a respect in which everyday moral thought is more like rule-consequentialism, contractualism, foundational pluralism, and virtue ethics than everyday moral thought is like traditional act-consequentialism. (shrink)

Background Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses’ moral reasoning, moral distress and moral sensitivity. Methods In this randomized clinical trial (...) study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. Results Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238–15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171–2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15–5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043–12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454–16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015–0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015–0.547, P = 0.009). Conclusions The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. Registration This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016. (shrink)

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

The dual-track theory of moral reasoning has received considerable attention due to the neuroimaging work of Greene et al. Greene et al. claimed that certain kinds of moral dilemmas activated brain regions specific to emotional responses, while others activated areas specific to cognition. This appears to indicate a dissociation between different types of moral reasoning. I re-evaluate these claims of specificity in light of subsequent empirical work. I argue that none of the cortical areas identified by (...) Greene et al. are functionally specific: each is active in a wide variety of both cognitive and emotional tasks. I further argue that distinct activation across conditions is not strong evidence for dissociation. This undermines support for the dual-track hypothesis. I further argue that moral decision-making appears to activate a common network that underlies self-projection: the ability to imagine oneself from a variety of viewpoints in a variety of situations. I argue that the utilization of self-projection indicates a continuity between moral decision-making and other kinds of complex social deliberation. This may have normative consequences, but teasing them out will require careful attention to both empirical and philosophical concerns. (shrink)

Normative theories can be useful in developing descriptive theories, as when normative subjective expected utility theory is used to develop descriptive rational choice theory and behavioral game theory. questions are also the essence of theories of moral reasoning, a domain of higher mental processing that could not survive without normative considerations.

Three studies test eight hypotheses about (1) how judgment differs between people who ascribe greater vs. less moral relevance to choices, (2) how moral judgment is subject to task constraints that shift evaluative focus (to moral rules vs. to consequences), and (3) how differences in the propensity to rely on intuitive reactions affect judgment. In Study 1, judgments were affected by rated agreement with moral rules proscribing harm, whether the dilemma under consideration made moral rules (...) versus consequences of choice salient, and by thinking styles (intuitive vs. deliberative). In Studies 2 and 3, participants evaluated policy decisions to knowingly do harm to a resource to mitigate greater harm or to merely allow the greater harm to happen. When evaluated in isolation, approval for decisions to harm was affected by endorsement of moral rules and by thinking style. When both choices were evaluated simultaneously, total harm -- but not the do/allow distinction -- influenced rated approval. These studies suggest that moral rules play an important, but context-sensitive role in moral cognition, and offer an account of when emotional reactions to perceived moral violations receive less weight than consideration of costs and benefits in moral judgment and decision making. (shrink)

Bernard Williams has argued that on a consequentialist moral theory, individuals cannot possess what he calls "integrity." I argue that one central strand of this criticism concerns how persons must think about life-shaping decisions. I interpret "integrity" as a pattern of continuity in an agent's moral decision-making. In order to have integrity an agent must possess a stable character which unifies one's choices. Since a sophisticated consequentialist moral structure can properly value the having of a (...) character on the basis of which agents guide their lives, it can successfully address this criticism. (shrink)

In clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation.According to Aristotle, emotions are an (...) original and integral part of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method. (shrink)

BackgroundCommentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units. Our aim was twofold: to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and determine the association between the ethical climate, moral distress, and intention to leave.MethodsWe performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and (...) physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire and the Measure of Moral Distress for Healthcare Professionals tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave.ResultsNurses perceived the ethical climate for decision-making as less favorable than physicians. They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units and also demonstrated lower moral distress scores and lower “intention to leave” scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated ; moral distress and "intention to leave" was positively correlated ; and ethical climate and “intention to leave” were negatively correlated.ConclusionsSignificant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care. (shrink)

Taking multidimensional ethics scale approach, this article describes an empirical survey of top managers’ moral decision-making patterns and their change from 1994 to 2004 during morally problematic situations in the Finnish context. The survey questionnaire consisted of four moral dilemmas and a multidimensional scale with six ethical dimensions: justice, deontology, relativism, utilitarianism, egoism and female ethics. The managers evaluated their decision-making in the problems using the multidimensional ethics scale. Altogether 880 questionnaires were analysed statistically. It is (...) concluded that relying on the utilitarian principles is a core ethical evaluation criterion amongst top business managers in Finland. This study proves that managers’ moral decision-making patterns change over time. According to the results of this research, managers’ moral decision-making became more multidimensional during the study period. The change is explained by the inclusion of female ethics items in the scale which allows managers to show more diversity in their decision- making, the change in the Finnish economic context from depression to economic prosperity and growth during the study period, which is conducive to the spread of post materialist values, such as the importance of social relations and the increasing public discussion of the importance ethical issues in business. (shrink)

As research into Alzheimer's disease and other dementing disorders becomes more complex, risky, invasive, and commonplace, the need intensifies for discussion of the ethics of involving persons with dementia in research, specifically research of greater than minimal risk and of no expected direct benefit to the subject. Reviewing such studies pushes our traditional analysis tools to their limits. Simply balancing and prioritizing the basic ethical principles of respect for persons, beneficence, and justice that serves us well in reviewing the vast (...) majority of studies is inadequate when reviewing research of such ethical complexities as studies with marked risks and no expectation of direct benefit to subjects unable to consent or withdraw. Moving up to the level of theory, placing these principles within the commonly applied frameworks of consequentialism, deontology, or virtue ethics bring us no closer to reducing the tensions such research creates between upholding individual autonomy and advancing society's need to learn how to treat and cure these devastating diseases. What is needed is the introduction of more contemporary moral analyses. Specifically, we need to become more inclusive of the diversity of values perspectives of our general citizenry. In more theoretical terms, we ought to elevate to a more central role a communitarian perspective and a feminist ethics emphasis on relationships and context as we rush to keep in step, ethically, with this rapidly expanding area of medical inquiry. (shrink)

This article explores refusal of medical treatment by adult patients from ethical and legal perspectives. Initially, consequentialist and deontological ethical theory are outlined. The concepts of autonomy, paternalism and competence are described and an overview of Beauchamp and Childress’s principle-based approach to moral reasoning is given. Relevant common law is discussed and the provisions of the Mental Capacity Act 2005 in assessing competence is evaluated. In order to demonstrate the consideration of moral issues in clinical practice, ethical (...) theory is applied to two well-known incidents: the case of Re MB, where doubt over decision-making capacity led to a paternalistic act to override a patient’s choice; and the death of Emma Gough, a situation where respect for autonomy prevailed when healthcare staff acted lawfully in following a patient’s refusal of life-saving treatment. Finally, guidance from regulatory bodies on the roles and responsibilities of health professionals in relation to this topic are considered. (shrink)

Joshua Greene and his colleagues have proposed a dual-process theory of moral decision-making to account for the effects of emotional responses on our judgments about moral dilemmas that ask us to contemplate causing direct personal harm. Early formulations of the theory contrast emotional and cognitive decision-making, saying that each is the product of a separable neural system. Later formulations emphasize that emotions are also involved in cognitive processing. I argue that, given the acknowledgement that (...) emotions inform cognitive decision-making, a single-process theory can explain all of the data that have been cited as evidence for Greene’s theory. The emotional response to the thought of causing harm may differ in degree, but not in kind, from other emotions influencing moral decision-making. (shrink)

: How do people make decisions? Previous psychological research consistently shed light on the fact that decisions are not the result of a pure rational reasoning, and that emotions can assume a crucial role. This is particularly true in the case of moral decision-making, which requires a complex integration of affective and cognitive processes. One question that is still open to debate concern the individual factors that can affect moral decisions. Gender has been consistently identified as a (...) possible variable of interest for the adoption of different strategic behaviors, with men using more rational processes and women more deontological principles. In the present study we aimed at exploring the presence of gender differences in different decision-making scenarios. Results showed that the moral scenario led to a similar acceptance rate in both genders, while economic and shopping offers were more likely to be accepted by men. Also, women were more inclined to refuse unfair offers, which included a higher personal benefit at the expense of the opponent, even if this meant a total loss for both parties. Finally, correlational analyses revealed a different relation between risk propensity and decision-making in men and women in different scenarios. Keywords: Decision-making; Utilitarianism; Altruism; Moral Decision-making; Economic Decision-making Decisioni morali, economiche e d’acquisto a confronto. Effetti di genere e utilitarismo Riassunto: Come prendiamo le decisioni? La letteratura psicologica disponibile ha chiarito in ampia misura come le decisioni non siano il risultato di un ragionamento puramente razionale e che le emozioni possono assumere un ruolo cruciale. Questo è particolarmente vero nel caso delle decisioni morali, che richiedono una complessa integrazione tra processi affettivi e cognitivi. Una questione ancora aperta riguarda i fattori individuali che possono incidere sulle decisioni morali. Il genere è stato identificato come una possibile variabile da considerare rispetto all’adozione di comportamenti strategici differenti, in cui gli uomini sembrano più inclini a far uso di processi razionali e le donne a considerare principi deontologici. In questo lavoro abbiamo provato a esplorare la presenza di differenze di genere in diversi contesti decisionali. I risultati hanno mostrano come in ambito morale entrambi i generi siano portati ad accettare opzioni simili, mentre offerte economiche e commerciali sono accettate in misura maggiore dagli uomini. Le donne sarebbero più inclini a rifiutare offerte inique che comprendono benefici personali maggiori a discapito di una controparte, anche se questo implica una perdita totale da ambo le parti. Infine, le analisi correlazionali hanno mostrato una diversa relazione tra propensione al rischio e processi decisionali tra uomini e donne in contesti diversi. Parole chiave: Processi decisionali; Utilitarismo; Altruismo; Processi decisionali morali; Processi decisionali economici. (shrink)

Taking multidimensional ethics scale approach, this article describes an empirical survey of top managers' moral decision-making patterns and their change from 1994 to 2004 during morally problematic situations in the Finnish context. The survey questionnaire consisted of four moral dilemmas and a multidimensional scale with six ethical dimensions: justice, deontology, relativism, utilitarianism, egoism and female ethics. The managers evaluated their decision-making in the problems using the multidimensional ethics scale. Altogether 880 questionnaires were analysed statistically. It is (...) concluded that relying on the utilitarian principles is a core ethical evaluation criterion amongst top business managers in Finland. This study proves that managers' moral decision-making patterns change over time. According to the results of this research, managers' moral decision-making became more multidimensional during the study period. The change is explained by (1) the inclusion of female ethics items in the scale which allows managers to show more diversity in their decisionmaking, (2) the change in the Finnish economic context from depression to economic prosperity and growth during the study period, which is conducive to the spread of post materialist values, such as the importance of social relations and (3) the increasing public discussion of the importance ethical issues in business. (shrink)

The post‐genomics era promises a revolution characterized by precision medicine and the integration of genomics into almost every area of biomedical research. At the same time, there are concerns that if care is not taken, the genomics revolution may widen global inequities in science and health. In Africa, these concerns are primarily linked to the underrepresentation of African populations in genomics research, limited genomics research capacity in Africa and associated macro‐level justice issues such as benefit sharing, inequitable international research collaborations, (...) and the contribution of genomics to the health and research priorities of Africa. Addressing these concerns requires an in‐depth reflection on how the ideals of global justice and equity may be advanced in genomics research. To contribute to the limited but growing scholarship on global genomics equity, especially in the African context, we performed a conceptual analysis of three accounts of justice and governance namely, Ubuntu, shared health governance and global governance of health, with the aim of identifying principles that could inform genomics governance in Africa. We used a convergence approach in the conceptual analysis, resulting in the identification of nine principles namely: solidarity, furthering the ideals of health justice, reciprocity, shared decision‐making, shared resources, shared responsibility, mutual trust, transparency, and mutual collective accountability. Examples of how the principles may be applied are provided. We recommend that these principles should form the foundation of any mechanism that seeks to systematically advance justice, fairness and equity in genomics research in Africa and more broadly, global health and science equity. (shrink)

Proponents of the dominant contemporary model of corporate governance maintain that the shareholder is the primary constituent of the firm. The responsibility for managerial decision makers in this governance system is to maximize shareholder wealth. Neoclassical economists ethically justify this objective with their interpretation of Adam Smith's notion of the Invisible Hand. Using a famous quotation from The Wealth of Nations, they interpret the Invisible Hand as Smith's (An Inquiry into the Nature and Causes of the Wealth of Nations, (...) Methuen & Co., London) assertion that market participants, in pursuing their own self-interests without regard to the interests of others, will collectively provide the optimal economic benefit to society. We argue that the traditional interpretation of Smith is too narrow and potentially harmful to society. In order to fully understand Smith's notion of the influence of the Invisible Hand on human behavior, one must also consider The Theory of Moral Sentiments. In that work, Smith (The Theory of Moral Sentiments, A. Millar, London) portrays the pursuit of self-interest as only one of several potential motivations for human action. He also acknowledged the existence of a “sympathy principle,” which refers to the ability and propensity of human beings to consider the interests of others. Heilbroner (The Essential Adam Smith, W.W. Norton, New York, p. 59) suggests that Smith's sympathy principle allows one to “determine the appropriate degree of self-interest, the proper display of benevolence, the desirable strictness of justice.” In fact, Smith indicates that (1) a society whose members pursue self-interest without a sense of justice will eventually collapse; (2) a society whose members pursue self-interest checked by their sense of justice alone will survive; (3) a society whose members pursue self-interest, justice, and the interests of others will flourish. Since a more complete reading of Smith indicates that human beings, in considering their own interests, also reflexively consider the interests of others when making decisions, then the traditional corporate governance model appears to be lacking. A broader, multiple stakeholder approach to corporate governance that considers the interests of other constituencies may be more consistent with Smith's views. In particular, Smith's sympathy principle provides a theoretical foundation for a shift away from the narrow, yet dominant, shareholder-based corporate governance model and toward multiple stakeholder models of corporate governance [e.g., Business and Society: A Strategic Approach to Corporate Citizenship, Houghton Mifflin, Boston, MA] and internal decision-making [e.g., Sloan Management Review 38, (1997) 25–37]. (shrink)

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

This paper attempts to explain the significance of the ideologies — or middle-level normative discourse — described by Kenneth Goodpaster in his paper Business Ethics, Ideology, and the Naturalistic Fallacy. It is argued that the propositions constitutive of this discourse are not invokable moral principles (i.e. principles which generate solutions to actual moral problems). Rather, they are characterizations of the normative contexts in which moral decisions are made. As such, they place limits on the ways in which (...) the abstract moral principles of traditional moral theory may be applied or interpreted in making real-life moral decisions. (shrink)

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using (...) hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities. (shrink)

This paper applies Wempe’s (2005, Business Ethics Quarterly 15(1), 113–135) boundary conditions that define the external and internal logics for contractarian business ethics theory, as a system of argumentation for evaluating current or prospective institutional arrangements for arriving at the “good life,” based on the principles and practices of social justice. It does so by showing that a more dynamic, process-oriented, and pluralist ‘dialogic twist’ to Donaldson and Dunfee’s (2003, ‘Social Contracts: sic et non’, in P. Heugens, H. van (...) Oosterhout and J. Vromen (eds.), The Social Institutions of Capitalism: Evolution and Design of Social Contracts (Cheltenham, UK, Edward Elgar Publishing, Ltd.) pp. 109–126; 1999, Ties that Bind: A Social Contracts Approach to Business Ethics (Boston, MA, Harvard Business School Press); 1995, Economics and Philosophy 11(1), 85–112; 1994, Academy of Management Review 19(2), 252–284.) integrated social contracting theory (ISCT) of economic ethics will further develop this promising and influential approach to moral reasoning, ethical decision-making, and stakeholder governance. This evolutionary, interactive learning-based model of ethical norm generation via dialogic stakeholder engagement is particularly appropriate within economic communities that are experiencing value conflict and pressures for institutional change. (shrink)

The business ethics education literature provides many in-depth explorations looking at the impact of ethics education and occasionally the influence of gender. Yet, research exploring decision making is primarily focused at the individual level, often omitting important influences that might occur when decision making occurs within a group setting. This paper utilizes a classroom simulation, the Corporate Policy Simulation, in a Business, Government and Society course to assess student group decision-making. We rely on theoretical principles found in (...) Social Role Theory and two philosophical ethics of moral reasoning to assess the impact of gender within a group decision-making environment. Specifically, we assess if males in our study are better able to process financial decisions more effectively than females in our study, and if females in our study tend to process socially responsible or ethical decisions more effectively than males in our study. Our results support the expectations that all-female groups generally are able to make better socially responsible or ethical decisions, whereas there is no significant gender difference among any of the groups when focusing on financially orientated decisions. Possible explanations and the implications of this research on workplace practice and business ethics education are discussed. (shrink)

This article conceptualises theories of ethics relevant to the recognised problem of decision variability in child protection. Within this field, social workers are faced with multiple ethical imperatives when making decisions about children’s care. They must respond to justice principles concerned with duties and consequences, as well as ethical obligations created by the relational and contextual elements of each case. Recent scholarship on decision variability highlights the justice issues that arise when decisions in response to apparently similar cases (...) differ. An ethical imperative is that similar cases should be treated ‘like for like’ so that children’s and family’s rights are upheld consistently. This article contends that ethical concepts relating to both universalist duties such as respect for persons, extended by the concept of interactive universalism, and contextual responses based on an ethic of care, help theorise the complexities of ethical decisions in child protection. These concepts develop a nuanced understanding of the ways social workers resist risk discourses, may make decisions reflecting the participation of service users, and contextual evaluations of risk based on understanding service user’s life histories. Understanding this combination helps explain the reasons behind variability, and evaluate the moral acceptability or otherwise of apparently variable decisions. (shrink)

The problem of algorithmic fairness is typically framed as the problem of finding a unique formal criterion that guarantees that a given algorithmic decision-making procedure is morally permissible. In this paper, I argue that this is conceptually misguided and that we should replace the problem with two sub-problems. If we examine how most state-of-the-art machine learning systems work, we notice that there are two distinct stages in the decision-making process. First, a prediction of a relevant property is made. (...) Secondly, a decision is taken based (at least partly) on this prediction. These two stages have different aims: the prediction is aimed at accuracy, while the decision is aimed at allocating a given good in a way that maximizes some context-relative utility measure. Correspondingly, two different fairness issues can arise. First, predictions could be biased in discriminatory ways. This means that the predictions contain systematic errors for a specific group of individuals. Secondly, the system’s decisions could result in an allocation of goods that is in tension with the principles of distributive justice. These two fairness issues are distinct problems that require different types of solutions. I here provide a formal framework to address both issues and argue that this way of conceptualizing them resolves some of the paradoxes present in the discussion of algorithmic fairness. (shrink)

This paper argues that the function of moral education in the biomedical context should be exactly the same as in a general, philosophical framework: it should not provide ready-to-use kits of moral principles; rather, it must show the history, epistemology and conceptual structure of moral theories that would enable those who have to make decisions to be as informed and as responsible as possible. If this complexity cannot be attained, an incomplete product—i.e. bioethics or bioethical principles—should not (...) be seen as a viable substitute. This theoretical position is subsequently illustrated by a case study involving research ethics committees. It is argued that within these committees, that are carefully formed multidisciplinary bodies, what makes competent decision-making possible is not a bioethical theory, nor even a sound philosophical ethics, but the dynamics of the discussion of a number of experts coming from different disciplines. This multidisciplinary expertise is necessary and sufficient to undertake the challenges of complex decisions in the biomedical context. (shrink)

Normative ethical theories and religious traditions offer general moral principles for people to follow. These moral principles are typically meant to be fixed and rigid, offering reliable guides for moral judgment and decision-making. In two preregistered studies, we found consistent evidence that agreement with general moral principles shifted depending upon events recently accessed in memory. After recalling their own personal violations of moral principles, participants agreed less strongly with those very principles—relative to participants who (...) recalled events in which other people violated the principles. This shift in agreement was explained, in part, by people’s willingness to excuse their own moral transgressions, but not the transgressions of others. These results have important implications for understanding the roles memory and personal identity in moral judgment. People’s commitment to moral principles may be maintained when they recall others’ past violations, but their commitment may wane when they recall their own violations. (shrink)

The judiciary is a key policy actor that is involved in deciding health rights and policy by intervening in the policy process through a variety of judicial mechanisms, yet the appropriate extent of its involvement remains contentious. Taking the competence objection seriously requires understanding it as an epistemic problem about how courts assess empirical and scientific evidence in order to competently adjudicate controversial health claims. This paper examines recent advances in social epistemology to develop insights for the epistemic competence of (...) the judiciary from a system‐oriented approach. I outline three epistemic features that set the judiciary and the judicial decision‐making process apart from other types of decision‐makers in health policy: the distribution of epistemic power, the epistemic authority of a justified believer, and the principle of disinterestedness. Finally, I relate these insights back to the judicial decision‐making process with a specific focus on recent court decisions in health rights and health policy in Chile. (shrink)

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues (...) for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

The history of medical and professional ethics has largely been a history of attempts to identify, articulate, and defend principles that explain when and why certain actions, institutions, health care professionals, and particular decisions count as right or wrong, just or unjust, virtuous or vicious. Medical ethics has been dominated by principlism. However, so-called moral particularists have forcefully attacked the dominance of principle-based normative theories. The particularist critique of traditional moral theory derives from the rejection of the (...) claim that the normative content of ethics and medical... (shrink)

Los cuidados paliativos deben manejar los diferentes problemas que los pacientes y las familias pueden tener al final de la vida. La sedación es una maniobra terapéutica utilizada con cierta frecuencia en cuidados paliativos y constituye una buena práctica médica cuando está bien indicada; sin embargo, presenta el riesgo de conculcar algunos principios éticos. Los principios de beneficencia y autonomía son posiblemente los principios éticos mayormente afectados cuando se considera la sedación. Se deben cumplir los siguientes requisitos: síntoma refractario, enfermedad (...) terminal y consentimiento, y en lo posible estar avalada por una segunda opinión médica. La sedación paliativa no es eutanasia y las diferencias están en el objetivo, el proceso y el resultado. En el presente trabajo se discuten algunos de los aspectos para prevenir la conculcación de los principios éticos, asimismo se proporcionan algunas sugerencias para ayudar en la toma de decisiones. Palliative care to the different problems encountered by patients and their families at the end of life. Sedation is a therapeutic manoeuvre frequently used in palliative medicine, that could eventually infringe some ethical principles. From our standpoint, beneficence and autonomy are probably the most affected principles when sedation is considered. The following conditions are required in order for it to be applied: refractory symptom, terminal illness and consent, and as long as possible, the decision must be supported by a second medical opinion Palliative sedation is different from euthanasia, and the differences lie in the objective, the pro- cess and the result. Some measures to prevent such violations to occur are discussed, and suggestions intended to guide in decision making are proposed. (shrink)

Background Ethical decision-making education in nursing can be taught effectively by combining different teaching models that support the visualisation of taught concepts and integrating theory into practice. Objectives The study aims to examine the effect of flipped and jigsaw learning models on ethical decision-making and ethical sensitivity in nursing. Research design We used a nested mixed design. A pretest-posttest single-group quasi-experimental design was used in the quantitative part, and a case study method was used in the qualitative (...) part. Participants and research context This study was conducted in fall semester with second-year nursing students who studied an ethics course for the first time, using two different collaborative learning models. In the quantitative part, ethical dilemma and ethical sensitivity scales were made as pre-test with 117 and post-test with 128 students. In the qualitative part, a semi-structured three focus group interviews was conducted with 16 students. Ethical considerations After obtaining the approval of the University’s ethics committee, the study was carried out after obtaining participants’ informed written and verbal consent. Findings Students’ perspectives changed positively after training. This was related to six cases in section A of the Ethical Dilemma Scale. In part B, Practical Consideration (PC) and Principled Thinking (PT) mean scores were similar, showing no significant difference. For Familiarity in section C, it was determined that 68.4% of students in the pre-test and 77.3% in the post-test were familiar with similar dilemmas. The ethical sensitivity scale’s total scores were in a similar range. In the qualitative stage, ethical decision-making, ethical sensitivity, ethical dilemma and the improvement process were obtained as a theme. Conclusions There was an increase in the level of ethical sensitivity and familiarity with ethical dilemmas of nursing students after education. Flipped and jigsaw learning models can be used for nursing ethics courses. (shrink)

In recent articles, Daniel Gannon argues that, according to Catholic morality, morally good decision making about life-sustaining treatment is intrinsically based on in-the-moment circumstances. Measured against this moral criterion, Gannon finds physician orders for life-sustaining treatment to be morally unacceptable and proposes his own medical order form. The authors argue here that Catholic moral teaching and tradition do not reduce the role of circumstances to those in the present moment and that such a reductive criterion undermines many (...) of the sources of morality, including conscience, prudence, and moral principles such as the principle of ethically proportionate and disproportionate means. The authors also show that Gannon’s criterion and form generate conceptual and practical contradictions, that POLST is not intrinsically evil, and that when properly implemented, POLST can be morally acceptable. National Catholic Bioethics Quarterly 15.1 : 53–61. (shrink)

This article examines the relation between policies concerning Corporate Social Responsibility (CSR) and philosophical moral theories. The objective is to determine which moral theories form the basis for CSR policies. Are they based on ethical egoism, libertarianism, utilitarianism or some kind of common-sense morality? In order to address this issue, I conducted an empirical investigation examining the relation between moral theories and CSR policies, in companies engaged in CSR. Based on the empirical data I collected, I start (...) by suggesting some normative arguments used by the respondents. Secondly, I suggest that these moral arguments implicitly rely on some specific moral principles, which I characterise. Thirdly, on the basis of these moral principles, I suggest the moral theories upon which the CSR policies are built. Previous empirical studies examining the relation between philosophical moral theories and the ethical content of business activities have mainly concentrated on the ethical decision-making of managers. Some of the most prominent investigations in that regard propose that managers mainly act in accordance with utilitarian moral theory (Fritzsche, D. J. and H. Becker: 1984 , Academy of Management Journal 27 (1), 166–175; Premeaux, S. and W. Mony: 1993 , Journal of Business Ethics 12 , 349–357; Premeaux, S.: 2004 , Journal of Business Ethics 52 , 269–278). I conclude that CSR policies are not based on utilitarian thinking, but instead, on some kind of common-sense morality. The ethical foundation of companies engaged in CSR, thus, does not mirror the ethical foundation of managers. (shrink)

Recent research in empirical moral psychology attempts to understand (rather than place judgment on) the salient normative differences that laypeople have when making moral decisions by using survey methodology that is based on the operationalized principles from moral theories. The PPIMT is the first measure designed to assess respondents’ preference for the precepts implied in the three dominant moral theories: virtue ethics, deontology, and consequentialism. The current study used a latent modeling approach to determine the most (...) theoretically and psychometrically-sound model for the PPIMT using a combined sample of college students from a southeastern university in U.S. and MTurk respondents. The PPIMT model fit was acceptable (χ2 = 84.125, df = 40, p = 0.001; RMSEA = 0.052, 90%CI = 0.037 to 0.068; CFI = 0.980; SRMR = 0.035) with four items for Virtue, four items for Deontology, and three items for Consequentialism. (shrink)