BackgroundDecision-making in end-stage dementia is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems.AimThis study aimed to understand the decision-making processes of clinical teams (...) and relatives in addressing life-threatening swallowing difficulties in ESD in long-term care in Malta.MethodThe study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis.ResultsFour themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient’s dignity.ConclusionDecision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life. (shrink)

Objectives—To investigate the factors considered by staff, and the practicalities involved in the decision making process regarding the withdrawal or withholding of potential life-sustaining treatment in a children's hospital. To compare our current practice with that recommended by the Royal College of Paediatrics and Child Health guidelines, published in 1997.Design—A prospective, observational study using self-reported questionnaires.Setting—Tertiary paediatric hospital.Patients and participants—Consecutive patients identified during a six-month period, about whom a formal discussion took place between medical staff, nursing staff (...) and family regarding the withholding or withdrawal of potentially life-sustaining treatments. The primary physician and primary nurse involved in the discussion were identified.Method—Two questionnaires completed independently by the primary physician and nurse.Results—Twenty-two patients were identified . In 20 cases treatment was withdrawn or withheld, in two cases treatment was continued. Nursing staff considered family wishes and family perceptions of patient suffering as significantly more important factors in decision making than medical staff, who considered prognostic factors as most important. In only two cases were the patient's expressed wishes apparently available. In most cases staff considered the patient's best interests were served and the process would not be enhanced by the involvement of an independent ethics committee. The exceptions were those cases in which treatment was continued following disagreement between parties.Conclusions—Our current practice is consistent with that recommended by the RCPCH. The contribution of the patient, provision of staff counselling and general practitioner involvement were identified as areas for improvement. (shrink)

Our comments focus on the ACMCode of Ethics and situate the Code within ageneral ethical decision-making process tospecify the five steps which logically precedehuman action in ethical matters and determinethat action, and the individual differencetraits in these five steps which bear upon theresolution of an ethical problem and lead tomorally responsible action. Our main purpose isto present a cognitive moral processing modelwhich computing professionals can use to betterunderstand their professional rights andduties. It is clear that the Code (...) providessubstantial guidance in the areas ofintellectual property rights, unauthorizedentry into computing systems, and privacy. Inother areas, such as obscenity onbulletin-board systems, the Code is silent. Aninteractive software program which allows theuser to see the ways in which the Code isintegrated and instructive in the six-stepmoral decision-making process is accessible viathe internet. Our secondary purpose is toreformulate the Code as a set of questionswhich allow the computing professional to seepractices which diminish the human person asunethical and those which enhance the humanperson as ethical. (shrink)

Though individual categorization or decision processes have been studied separately in many previous investigations, few studies have investigated how they interact by using a two-stage task of first categorizing and then deciding. To address this issue, we investigated a categorization-decision task in two experiments. In both, participants were shown six faces varying in width, first asked to categorize the faces, and then decide a course of action for each face. Each experiment was designed to include three groups, (...) and for each group, we manipulated the probabilistic contingencies between stimulus, category assignments, and decision consequences. For each group, each participant received three different sequences of category response, category feedback, decision response, and decision feedback. We found that participants were only partially responsive in the appropriate directions to the contingencies assigned to each group. Comparisons of results from different sequences provided evidence for empirical interference effects of categorization on decisions. The empirical interference effect is defined as the difference between the probability of taking a hostile action in decision-alone conditions and the total probability of taking a hostile action in categorization-decision conditions. To test competing accounts for multiple empirical results, including two-stage choice probabilities and empirical interference effects, we compared a quantum cognition model versus a two-stage exemplar categorization model at both aggregate and individual levels. Using a Bayesian information criterion, we found that the quantum model provided an overall better model fit than the exemplar model. Although both models predicted empirical interference effects, the exemplar model was able to generate probabilistic deviation by incorporating category information of the first stage into the feature representation of the subsequent decision stage, while the quantum model produced interference effect by superposition, measurement, and quantum entanglement. (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)

"Ethical Leadership" in modern multicultural corporations is first the consideration of different personal and cultural value systems in decision-making processes. Second, it is the assignment of responsibility either to individual or organisational causalities. The task of this study is to set the stage for a distinction between rational entities and the arbitrary preferences of individuals in economic decision making processes.Defining rational aspects of behaviour in economics will lead to the formal structures of organisational systems, which (...) are independent of concrete but varying values. Luhmann''s Theory of systems of communication describes the internal dynamic forces of economic communication processes in terms of formal structures. On the other hand Habermas'' Theory of discourse integrates the previous relationship between individual subjectivity and rational behaviour. Habermas gives an indication of how to separate subjective values and meaning from rational arguments in rational communication processes. The translation of these theoretical structures into practical applications for decision making processes and decision taking acts links the ethical, or value-oriented, context precisely to both individual and organisational areas of responsibility. (shrink)

Focusing on millennials, individuals born between 1980 and 2000 and representing the largest generational population in our history, this research seeks to understand their ethical decision-making processes by exploring the distinctive, yet interconnected, theories of personal values and cognitive moral reasoning. Utilizing a decision-making framework introduced in the 1990s, we discover that there is a statistically supported relationship between a millennial’s personal value orientation and stage of cognitive moral reasoning. Moreover, we discover a strong relationship (...) between three of the four value orientations and a corresponding stage of cognitive moral reasoning. The theoretical and practical research implications of our discovery about millennials’ decision making are discussed. (shrink)

There are two contrasting views on the decision-making for life-sustaining treatment in advanced stages of dementia when the patient is deemed incompetent. One is to respect the patient's precedent autonomy by adhering to advance directives or using the substituted judgement standard. The other is to use the best-interests standard, particularly if the current judgement on what is best for the incapacitated patient contradicts the instructions from the patient's precedent autonomy. In this paper, I argue that the protracted clinical (...) course of dementia over many years requires the extended perspective of a progressive decision-making process—extended in both social space and time. The ongoing debate between these two competing views has missed this perspective by focussing on an exclusive disjunction between the competent former self and the incompetent current self. Drawing on theories of situated cognition in cognitive science, I will show that the cognition of a demented patient can be viewed as extended and embodied by her supportive social environment. As the disease progresses, the content of the mind of a demented person becomes partially constituted by such external resources along with her diminishing intrinsic mind. With this understanding, medical decision-making for a demented patient can be construed as a temporally and socially extended practice. A collective decision-making body consisting of the patient, her family and surrogates, and the clinician, should make progressive decisions as a whole over years of the disease course. Finally, I will provide a practical example of how this proposal can be applied in clinical practice. (shrink)

Based on our experience in teaching ethics, we have developed, tested, and presented in this article a program of instruction that rests on four pillars: popular feature films, a six-stage ethical decision-making process, the principles necessary to address ethical situations, and the classroom instructor. Taken separately, there is nothing new or unique in these pillars. Taken together, however, and to our knowledge, these four pillars, including the requirement that each student is expected to prepare a written (...) abstract of the film prior to the classroom discussion of that film in which the student is expected to demonstrate a practical application of ethical principles to actual and concrete moral situations, constitute a new, unique, and tested way to teach ethics to undergraduate students of management and economics. (shrink)

The acquisition of a new skill usually proceeds through five stages, from novice to expert, with a sixth stage of mastery available for highly motivated performers. In this chapter, we re-state the six stages of the Dreyfus Skill Model, paying new attention to the transitions and interrelations between them. While discussing the fifth stage, expertise, we unpack the claim that, “when things are proceeding normally, experts don’t solve problems and don’t make decisions; they do what normally works” (Dreyfus (...) & Dreyfus, 1988, pp. 30 – 31). This leads us to offer an account of the “perspectival deliberation” that arises for experts and masters and that is distinct from the calculative deliberation characteristic of the lower stages of skillfulness. (shrink)

Decision-making is a complex action requiring efficient information processing. Specifically, in movement in which performance efficiency depends on reaction time, e.g., open-loop controlled movements, these processes may play a crucial role. Information processing includes three distinct stages, stimulus identification, response selection, and response programming. Mainly, response selection may play a substantial contribution to the reaction time and appropriate decision making. The duration of this stage depends on the number of possible choices an individual has to (...) “screen” to make a proper decision. Given that reaction time is crucial in many sports, the possibilities of reducing it through practice are very tempting. The information processing and its relationship to the manner an individual is practicing are discussed. Especially the variability of practice issues will be explored. In variable practice conditions, an individual has to react to one or more stimuli and has to produce one of the many variations of the same movement or different movements they learned. One has to identify a stimulus appropriately and has to select a response optimally, i.e., choosing from as few choices as possible to reduce the reaction time. On the other hand, in constant practice conditions, an individual can be exposed to one or many stimuli. Still, there is only one variation of the movement that can be executed in the presence of a learned stimulus. Based on the information processing theory and the results of the research focusing on variability of practice, I discuss how the practice conditions may affect reaction time and, as a result, the decision-making process. I conceptually frame the possible implications of practice conditions on decision making related to information processing. In this review, a possible mechanism and relationship between practice conditions and decision-making are presented. Future research directions are presented. (shrink)

Neurosurgeons have an especially high rate of exposure to serious ethical challenges in their line of work. The aim of this study was to assess the type and frequency of ethical theories used by neurosurgery residents to make extra- ethical decisions in challenging situations and their relation with the level of residency, and curricular training about medical ethics. A total of 12 neurosurgery residents in Mashhad University of Medical Sciences were interviewed; all the participants were male and aged 29–40 years (...) old. Of all, six were senior and six were junior. Using a systematic review of neurosurgery and medical ethics textbooks, five common cases were selected and a semi-structured, open-ended interview was developed. The interviews were digitally recorded and analyzed in two separate stages. Comparison of the results of the two stages led us to the final judgment about the dominant ethical theory used in each case. In all 60 cases, the decision-making process was compatible with either Deontology or Consequentialism. Only in two cases, beside Deontology, the Virtue ethics was used as an alternative in special situations. The ethical theories were not consistent for all the 12 subjects and all the five questions. No statistically significant difference was found between senior and junior residents, neither for each question nor for the aggregate. Only one of the subjects had extracurricular training in medical ethics, consequently precluding further analysis. Although not intended to be evaluated by this study, similar heterogeneity was observed in final decisions. When faced with medical ethics challenges, neurosurgery residents did not follow a consistent ethical theory for making decisions. The type and frequency of theories did not seem to be changed during the residency period. (shrink)

Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals’ ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making.Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-researched professional group.Methods: 23 purposively sampled UK community pharmacists (...) were asked, in semi-structured interviews, to describe ethical problems in their work and how they were resolved. Framework analysis of transcribed interviews utilised the four decision-making stages, together with constant comparative methods and deviant-case analysis.Results: Pharmacists were often inattentive and constructed problems in legal terms. Ethical reasoning was limited, but examples of appeals to consequences, the golden rule, religious faith and common-sense experience emerged. Ethical intention was compromised by frequent concern about legal prosecution. Ethical inaction was common, typified by pharmacists’ failure to report healthcare professionals’ bad practices, and ethical passivity emerged to describe these negative examples of the four decision-making stages. Pharmacists occasionally described more ethically active decision-making, but this often involved ethical uncertainty.Discussion: The four decision-making stages are a useful tool in considering how healthcare professionals try to resolve ethical problems in practice. They reveal processes often ignored in normative theories, and their recognition and the emergence of ethical passivity indicates the complexity of decision-making in practice. Ethical passivity may be deleterious to patients’ welfare, and concerns emerge about improving pharmacists’ ethical training and promoting ethical awareness and responsibility. (shrink)

The visual behaviour of consumers buying products in a supermarket was measured and used to analyse the stages of their decision process. Traditionally metrics used to trace decision-making processes are difficult to use in natural environments that often contain many options and unstructured information. Unlike previous attempts in this direction, our methodology reveals differences between a decision-making task and a search task. In particular the second stage of a decision task contains more (...) re-dwells than the second stage of a comparable search task. This study addresses the growing concern of taking eye movement research from the laboratory into the ‘real-world’, so findings can be better generalised to natural situations. (shrink)

The world literature shows that empirical research regarding the process of decision-making when cancer in adolescents is no longer curable has been conducted in High-income, English speaking countries. The objective of the current study was to explore in-depth and to explain the decision-making process from the perspective of Mexican oncologists, parents, and affected adolescents and to identify the ethical principles that guide such decision-making. Purposive, qualitative design based on individual, fact-to-face, semi-structured, in-depth (...) interviews. The participants were thirteen paediatric oncologists, 13 parents or primary carers, and six adolescents with incurable cancer. The participants were recruited from the paediatric oncology services of three national tertiary-care medical centres in Mexico City. The oncologists stated that they broach the subject of palliative management when they have determined that curative treatment has failed. Respect for autonomy was understood as the assent of the parent/adolescent to what the oncologist determined to be in the best interest of the adolescent. The oncologists thought that the adolescent should be involved in the decision-making. They also identified the ability to count on a palliative care clinic or service as an urgent need. For the parents, it was essential that the oncologist be truly interested in their adolescent child. The parents did not consider it necessary to inform the child about impending death. The adolescents stated that the honesty of their oncologists was important; however, several of them opted for a passive role in the decision-making process. The findings of this study evidence that to achieve good medical practice in low-middle income countries, like Mexico, it is urgent to begin effective implementation of palliative care, together with appropriate training and continuing education in the ethics of clinical practice. (shrink)

Background The world literature shows that empirical research regarding the process of decision-making when cancer in adolescents is no longer curable has been conducted in High-income, English speaking countries. The objective of the current study was to explore in-depth and to explain the decision-making process from the perspective of Mexican oncologists, parents, and affected adolescents and to identify the ethical principles that guide such decision-making. Methods Purposive, qualitative design based on individual, fact-to-face, (...) semi-structured, in-depth interviews. The participants were thirteen paediatric oncologists, 13 parents or primary carers, and six adolescents with incurable cancer. The participants were recruited from the paediatric oncology services of three national tertiary-care medical centres in Mexico City. Results The oncologists stated that they broach the subject of palliative management when they have determined that curative treatment has failed. Respect for autonomy was understood as the assent of the parent/adolescent to what the oncologist determined to be in the best interest of the adolescent. The oncologists thought that the adolescent should be involved in the decision-making. They also identified the ability to count on a palliative care clinic or service as an urgent need. For the parents, it was essential that the oncologist be truly interested in their adolescent child. The parents did not consider it necessary to inform the child about impending death. The adolescents stated that the honesty of their oncologists was important; however, several of them opted for a passive role in the decision-making process. Conclusion The findings of this study evidence that to achieve good medical practice in low-middle income countries, like Mexico, it is urgent to begin effective implementation of palliative care, together with appropriate training and continuing education in the ethics of clinical practice. (shrink)

This paper attempts to build on the contribution to moral imagination theory by Patricia Werhane by further integrating moral imagination with new theoretical developments that have taken place in the business ethics field. To accomplish this objective, part one will review the concept of moral imagination, from its definitional origins to its full theoretical conceptualization. Part two will provide a brief literature review of how moral imagination has been applied in empirical research. Part three will analyze and apply the construct (...) of moral imagination as it relates to the key process stages of ethical decision making including awareness, judgment, intention, and behavior. Immoral imagination is then discussed, along with other behavioral ethics concepts as they relate to moral imagination. The paper concludes with potential future research directions, as well as teaching and managerial implications for the moral imagination construct. (shrink)

Current frameworks on ethical decision-making process have some limitations. This paper argues that the consideration of moral competencies, understood as moral virtues in the workplace, can enhance our understanding of why moral character contributes to ethical decision-making. After discussing the universal nature of four moral competencies (prudence, justice, fortitude and temperance), we analyse their influence on the various stages of the ethical decision-making process. We conclude by considering the managerial implications of our (...) findings and proposing further research. (shrink)

Individuals are faced with the many opportunities to pirate. The decision to pirate or not may be related to an individual''s attitudes toward other ethical issues. A person''s ethical and moral predispositions and the judgments that they use to make decisions may be consistent across various ethical dilemmas and may indicate their likelihood to pirate software. This paper investigates the relationship between religion and a theoretical ethical decision making process that an individual uses when evaluating ethical (...) or unethical situations. An ethical decision making model was studied for general unethical scenarios and for the unethical behavior of software piracy. The research model was tested via path analysis using structural equation modeling and was found to be appropriate for the sample data. The results suggest that there is a relationship between religion and the stages of an ethical decision making process regarding general ethical situations and software piracy. (shrink)

The study reviewed 20 currently-available structured ethical decision-making models and developed an integrated model consisting of six steps with useful questions and tools that help better performance each step: (1) the identification of an ethical problem; (2) the collection of additional information to identify the problem and develop solutions; (3) the development of alternatives for analysis and comparison; (4) the selection of the best alternatives and justification; (5) the development of diverse, practical ways to implement ethical decisions and (...) actions; and (6) the evaluation of effects and development of strategies to prevent a similar occurrence. From a pilot-test of the model, nursing students reported positive experiences, including being satisfied with having access to a comprehensive review process of the ethical aspects of decision making and becoming more confident in their decisions. There is a need for the model to be further tested and refined in both the educational and practical environments. (shrink)

People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes ‘good’ proxy decision-making for research has remained unexplored. (...) Interventions are needed to improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of ‘good’ proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients’ values and preferences. (shrink)

Assessment of decision-making capacity can be difficult in acquired brain injury particularly with the syndrome of organic personality disorder. Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit and thinking about (...) psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: necessary for DMC, threatened by ABI, and assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

Artificial intelligence plays an increasingly important role in legal disputes, influencing not only the reality outside the court but also the judicial decision-making process itself. While it is clear why judges may generally benefit from technology as a tool for reducing effort costs or increasing accuracy, the presence of technology in the judicial process may also affect the public perception of the courts. In particular, if individuals are averse to adjudication that involves a high degree of (...) automation, particularly given fairness concerns, then judicial technology may yield lower benefits than expected. However, the degree of aversion may well depend on how technology is used, i.e., on the timing and strength of judicial reliance on algorithms. Using an exploratory survey, we investigate whether the stage in which judges turn to algorithms for assistance matters for individual beliefs about the fairness of case outcomes. Specifically, we elicit beliefs about the use of algorithms in four different stages of adjudication: (i) information acquisition, (ii) information analysis, (iii) decision selection, and (iv) decision implementation. Our analysis indicates that individuals generally perceive the use of algorithms as fairer in the information acquisition stage than in other stages. However, individuals with a legal profession also perceive automation in the decision implementation stage as less fair compared to other individuals. Our findings, hence, suggest that individuals do care about how and when algorithms are used in the courts. (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)

Objective: This study examined the process through which elderly patients with new-onset acute leukemia make treatment decisions from the time of diagnosis, in order to identify factors influencing this decision-making process in Japan. Methods: Semi-structured interviews were conducted with twenty-two elderly patients with leukemia. The data were analyzed using the modified grounded theory approach. Results: The process of decision-making in elderly patients with leukemia includes three stages: Initial reactions at diagnosis, change in attitudes, (...) and entrusting the physician with the treatment plan. Initial reactions at diagnosis were affected by interactions with others that brought peace of mind to the patients. Change in attitudes was affected by encouragement from others to undergo treatment and their own motivation to face treatment. Patients came to entrust their treatment plan completely to their physician, because they wanted to feel relief and did not want to have to grapple with difficult medical information that was relevant to decision-making about their disease and treatment options. Conclusions: The process of decision-making in elderly patients with leukemia is affected by several factors and included three stages. Our present study findings can provide suggestions on how medical professionals might better support the process of decision-making in elderly patients with leukemia. (shrink)

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

Background and Purpose The decision to perform decompressive craniectomy for patients with malignant MCA syndrome can be ethically complex. We investigated factors that clinicians consider in this decision-making process. Methods A survey including clinical vignettes and attitudes questions surrounding the use of hemicraniectomy in malignant MCA syndrome was distributed to 203 neurosurgeons, neurologists, staff and residents, and nurses and allied health members specializing in the care of neurological patients. These were practicing health care providers situated in (...) an urban setting in Canada where access to health care is covered by national policy and is a human right. Results Eighty-eight participants responded to survey. All participants unanimously supported the procedure for young and healthy patients. Advanced age, the presence of aphasia, comorbid medical conditions, and poor baseline functional status were dominant factors associated with increasing reluctance to offer surgical decompression. Patients’ previously expressed wishes were also an important consideration. Eighty-six percent of respondents agreed that withholding surgery is ethically justified if the outcome is perceived as futile. Conclusions Health care providers use similar factors to determine if aggressive management is justified given anticipated burden on patient quality of life and extended impact on society. This convergence can be harnessed beneficially for the transparent communication of medical options in the ethically complex setting of decompressive hemicraniectomy post-stroke. (shrink)

This article focuses on both daily forms of weakness of will as discussed in the philosophical debate and psychopathological phenomena as impairments of decision making. We argue that both descriptions of dysfunctional decision making can be organized within a common theoretical framework that divides the decision making process in three different stages: option generation, option selection, and action initiation. We first discuss our theoretical framework, focusing on option generation as an aspect that has (...) been neglected by previous models. In the main body of this article, we review how both philosophy and neuropsychiatry have provided accounts of dysfunction in each decision-making stage, as well as where these accounts can be integrated. Also, the neural underpinnings of dysfunction in the three different stages are discussed. We conclude by discussing advantages and limitations of our integrative approach. (shrink)

Artificial intelligence tools used in employment decision-making cut across the multiple stages of job advertisements, shortlisting, interviews and hiring, and actual and potential bias can arise in each of these stages. One major challenge is to mitigate AI bias and promote fairness in opaque AI systems. This paper argues that the equal opportunity merit principle is an ethical approach for fair AI employment decision-making. Further, explainable AI can mitigate the opacity problem by placing greater emphasis on (...) enhancing the understanding of reasonable users and affected persons as to the AI output. Both the equal opportunity merit principle and explainable AI should be integrated in the design and implementation of AI employment decision-making systems so as to ensure, as far as possible, that the AI output is arrived at through a fair process. (shrink)

Objectives: To elicit the perceptions and preferences of patients with rheumatoid arthritis regarding information and participation in treatment decision-making. To analyse the patients’ narratives on the background of the ethical discourse on various approaches to treatment decision-making. Design: In-depth interviews with themes identified using principles of grounded theory. Participants: 22 patients with long-standing rheumatoid arthritis. Main outcome measures: Qualitative data on patients’ perceptions and preferences regarding information and participation in decision-making about treatment. Results: (...) class='Hi'>Decision-making about treatment has been described by the patients as a process consisting of different stages with shifting loci of control and responsibility. Patients initially received one treatment recommendation and were not aware of alternative treatment options. Those participants in this study who wanted information about negative effects of a treatment cited “interest in one’s own health” and the potential “use of information” as reasons for their preference. The physicians’ expert knowledge and clinical experience regarding the effects of medication were cited as arguments by patients for a treatment recommendation. Conclusions: The patients’ accounts of decision-making about treatment differ from models of physician–patient relationship that have been put forward in ethical discourse. These differences may be relevant with respect to the starting point of an ethical analysis of treatment decision-making. Patients’ accounts with respect to a lack of information on treatment alternatives point to ethically relevant challenges regarding treatment decision-making in clinical practice. (shrink)

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

Ethical decision making in medicine has recently seen calls to move towards less prescriptive- based approaches that consider the particularities of each case. The main alternative call from the literature is for better understanding of phronesis concepts applied to decision making. A well-cited phronesis-based approach is Kaldjian’s five-stage theoretical framework: goals, concrete circumstances, virtues, deliberation and motivation to act. We build on Kaldjian’s theory after using his framework to analyse data collected from a three-year empirical (...) study of phronesis and the medical community. The data are a set of narratives collected in response to asking a medical community what making ethically wise decisions means to them. We found that Kaldjian’s five concepts are present in the accounts to some extent but that one of the elements, motivation, is constructed as playing a different, though still crucial role. Rather than being an end-stage of the process as Kaldjian’s framework suggests, motivation was constructed as initiating the process and maintaining the momentum of taking a phronesis-based approach. The implications for medical ethics decision-making education are significant as motivation itself is a highly complex concept. We therefore theorise that motivation is required for leading in, continuing and completing the actions of the ethical decision taken. Appreciating the central importance of motivation through the whole of Kaldjian’s framework has implications for cultivating the virtues of phronesis and courage to take the right course of action. (shrink)

Piéron's Law describes the relationship between stimulus intensity and reaction time. Previously (Stafford & Gurney, 2004), we have shown that Piéron's Law is a necessary consequence of rise-to-threshold decision making and thus will arise from optimal simple decision-making algorithms (e.g., Bogacz, Brown, Moehlis, Holmes, & Cohen, 2006). Here, we manipulate the color saturation of a Stroop stimulus. Our results show that Piéron's Law holds for color intensity and color-naming reaction time, extending the domain of this law, (...) in line with our suggestion of the generality of the processes that can give rise to Piéron's Law. In addition, we find that Stroop condition does not interact with the effect of color saturation; Stroop interference and facilitation remain constant at all levels of color saturation. An analysis demonstrates that this result cannot be accounted for by single-stage decision-making algorithms which combine all the evidence pertaining to a decision into a common metric. This shows that human decision making is not information-optimal and suggests that the generalization of current models of simple perceptual decision making to more complex decisions is not straightforward. (shrink)

Variation in decision-making about end-of-life care among ethnic groups creates clinical conflicts. In order to understand changes in preferences for end-of-life care among Japanese who immigrate to the United States, we conducted 18 focus groups with 122 participants: 65 English-speaking Japanese Americans, 29 Japanese-speaking Japanese Americans and 28 Japanese living in Japan.Negative feelings toward living in adverse health states and receiving life-sustaining treatment in such states permeated all three groups. Fear of being meiwaku, a physical, psychological or financial (...) caregiving burden on loved ones, was a prominent concern. They preferred to die pokkuri (popping off) before they become end stage or physically frail. All groups preferred group-oriented decision-making with family. Although advance directives were generally accepted, Japanese participants saw written directives as intrusive whereas Japanese Americans viewed them mainly as tools to reduce conflict created by dying person's wishes and a family's kazoku no jo– responsibility to sustain the dying patient. These findings suggest that in the United States Japanese cultural values concerning end-of-life care and decision-making process are largely preserved. (shrink)

The goal is to present how shared decision-making in paediatric oncology occurs from the viewpoints of parents and physicians. Eight Swiss Pediatric Oncology Group centres participated in this prospective study. The sample comprised a parent and physician of the minor patient. Surveys were statistically analysed by comparing physicians’ and parents’ perspectives and by evaluating factors associated with children’s actual involvement. Perspectives of ninety-one parents and twenty physicians were obtained for 151 children. Results indicate that for six aspects of (...) information provision examined, parents’ and physicians’ perceptions differed. Moreover, parents felt that the children were more competent to understand diagnosis and prognosis, assessed the disease of the children as worse, and reported higher satisfaction with decision-making on the part of the children. A patient’s age and gender predicted involvement. Older children and girls were more likely to be involved. In the decision-making process, parents held a less active role than they actually wanted. Physicians should take measures to ensure that provided information is understood correctly. Furthermore, they should work towards creating awareness for systematic differences between parents and physicians with respect to the perception of the child, the disease, and shared decision-making. (shrink)

Although the role of imagination in moral reasoning is often neglected, recent literature, mostly of pragmatist signature, points to imagination as one of its central elements. In this article we develop some of their arguments by looking at the moral role of imagination in practice, in particular the practice of neonatal intensive care. Drawing on empirical research, we analyze a decision-making process in various stages: delivery, staff meeting, and reflection afterwards. We show how imagination aids medical practitioners (...) demarcating moral categories, tuning their actions, and exploring long-range consequences of decisions. We argue that imagination helps to bring about at least four kinds of integration in the moral decision-making process: personal integration by creating a moral self-image in moments of reflection; social integration by aiding the conciliation of the diverging perspectives of the people involved; temporal integration by facilitating the parties to transcend the present moment and connect past, present, and future; and epistemological integration by helping to combine the various forms of knowledge and experience needed to make moral decisions. Furthermore, we argue that the role of imagination in these moral decision-processes is limited in several significant ways. Rather than being a solution itself, it is merely an aid and cannot replace the decision itself. Finally, there are also limits to the practical relevance of this theoretical reflection. In the end, it is up to care professionals as reflective practitioners to re-imagine the practice of intensive care and make the right decisions with hope and imagination. (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)

Surrogate (proxy) decision makers must make research decisions for people with dementia who lack decision-making capacity. Proxies’ decision-making processes are minimally understood. We randomly assigned 82 proxies of AD patients to informed consent for one of three hypothetical protocols with differing levels of risk and benefit. Proxies answered questions about potential benefits of the described research to the patient and society, as well as about whether they would enroll their relative and why or why not. (...) Proxies interested in enrolling their relative cited the potential for direct benefit to their relative, altruism, and trust in researchers. Those declining cited risks, inconvenience, and stage of illness. Proxies weighed numerous factors, incorporating both substituted judgment and best interests standards in their decision-making processes. Although further empirical work is needed to understand the influences on and adequacy of proxies’ decision making regarding research, these findings can help inform policy regarding surrogate consent. (shrink)

We have it on the authority of Aristotle that “reason (nous) is the best thing in us” (EN X.7, 1177a20). This idealization of reason permeates his account of eudaimonia, a term commonly translated as ‘happiness’, which Aristotle identifies with living and doing well (EN I.4, 1095a18-20). In harmony with a certain intellectualism peculiar to the mainstream of ancient philosophical accounts of eudaimonia, Aristotle holds that living well requires the unique practical application of rationality of which only humans are capable (EN (...) I.7, 1098a13-15/EE I.7, 1217a25-27). This dissertation investigates Aristotle’s substantive view on the practical application of reason by examining how, according to him, human agents use reason to decide what to do, what kind of person to be, and indeed how to live well. A distinctively human way of making decisions is deliberation (bouleusis), an exercise of practical reason par excellence. The first chapter reconstructs Aristotle’s account of deliberation from a wide range of texts in the corpus. It argues that deliberation is a complex decision-making process that, for the most part, unfolds into four stages: (1) positing a provisional goal; (2) constructing a set of alternatives; (3) identifying the best alternative; (4) forming an intention to do the most proximate action as identified in the penultimate stage. This reading offers a comprehensive representation of Aristotle’s theory while rendering his theory more sophisticated—and indeed more modern—than the alternatives in recent years. Deciding what to do often requires that we confront the question, “Which is preferable (hairetōteron) or better (beltion) between two or more options?” In Topics III, a text widely acknowledged as the inaugural treatment of the logic of preference, Aristotle articulates a set of principles to guide our preference-ranking. While scholars pay historical homage to Aristotle, there is little engagement with his treatment of preference logic. The second chapter addresses the need for a current study and reassessment of Aristotle’s preference-ranking principles. It argues that, despite differences in scope and methodology between the Aristotelian and modern systems, the description inaugural treatment of preference logic comfortably, and accurately, applies to Topics III. When one looks at the role that Aristotle allows reason to play in the production and motivation of action, it is tempting to conclude that Aristotle endorses the Humean division of labor. For Aristotle claims that deliberation is about “the things towards the goal” (EN III.3, 1112b11-16) and that virtue (aretē) makes our goals right (EN VI.12, 1144a7-9). Chapter three seeks to show, against a recent influential quasi-Humean interpretation, that the primary function of practical reason is mapping the landscape of value corresponding to the agent’s reasoned conception of what eudaimonia consists in, as a rational being that she is. Aristotle notoriously defends the political subordination of individuals he believes to have a defective deliberative capacity. In Politics I.13, he claims that the deliberative faculty is undeveloped in children and “ineffectual” (akuron) in women (1260a12). The concluding chapter considers a puzzle about the development of the female’s deliberative faculty: How do women become ineffective in their deliberation, but freemen do not, given that all children have deliberative faculties that are unperfected? Drawing from the theories defended in previous chapters, I argue that the female’s deliberative defect is primarily due to her lack of moral education rather than inalterable sexual, biological differences—a thesis widely endorsed by scholars lately. (shrink)

In response to the lack of empirical studies examining the internal disclosure behavior in the Chinese context, this study tested a whistleblowing -decision-making process among employees in the Chinese banking industry. For would-be whistleblowers, positive affect and organizational ethical culture were hypothesized to enhance the expected efficacy of their whistleblowing intention, by providing collective norms concerning legitimate, management-sanctioned behavior. Questionnaire surveys were collected from 364 employees in 10 banks in the Hangzhou City, China. By and large, the (...) findings supported the hypotheses. Issues of whistleblowing in the Chinese context and implications were discussed. (shrink)

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

Many decisions involve multiple stages of choices and events, and these decisions can be represented graphically as decision trees. Optimal decision strategies for decision trees are commonly determined by a backward induction analysis that demands adherence to three fundamental consistency principles: dynamic, consequential, and strategic. Previous research found that decision-makers tend to exhibit violations of dynamic and strategic consistency at rates significantly higher than choice inconsistency across various levels of potential reward. The current research extends these (...) findings under new conditions; specifically, it explores the extent to which these principles are violated as a function of the planning horizon length of the decision tree. Results from two experiments suggest that dynamic inconsistency increases as tree length increases; these results are explained within a dynamic approach–avoidance framework. (shrink)

Abstract:This paper develops a framework for examining decision making about ethical issues and tests the applicability of a social contract perspective. Using two separate samples of students and salespeople, we determine that community members (salespeople) tend to judge a potentially unethical act to constitute a violation of an implicit social contract and non-community members (students) do not. Also, consistent with the emphasis on context specificity of integrative social contracts theory, situational variables influence perceptions of ethicality for the community (...) members, but do not affect the perceptions of individuals outside the community. The study finds considerable support for the use of a social contractarian perspective in the study of decision-making processes about ethical issues. (shrink)

Background Nurses have an essential role in caring for end-of-life patients. Nevertheless, the nurse’s involvement in the passive euthanasia decision-making process is insufficient and lower than expected. Objectives To explore factors associated with nurses’ intention to be involved in non-treatment decisions (NTD) regarding passive euthanasia decision-making versus their involvement in the palliative care of patients requesting euthanasia, using the Theory of Planned Behavior (TPB) framework. Design A cross-sectional study utilizing a random sample. Participants and research (...) context The study was conducted in one of the largest hospitals in Israel among 125 nurses employed in internal and surgical care wards. Data was collected through face-to-face interviews between March and April 2019. Method A closed structured questionnaire was developed according to TPB instructions. A paired sample t test and two multiple hierarchical regressions were conducted. Variance explained (R2) and the significance of F change were calculated for each regression. The study used the STROBE statement guideline. Ethical considerations The study was approved by the hospital’s Helsinki Committee (#20.11.2017). Findings A paired sample t test revealed that nurses’ involvement in the palliative care of patients requesting passive euthanasia was significantly higher than in NTD regarding euthanasia. Regression analyses revealed that nurses’ position and attitudes explain their intention to be involved in decision-making; attitudes and perceived behavioral control explain nurses’ intention to be involved in the care of patients requesting euthanasia. Conclusions According to the TPB, nurses’ attitudes explained their intention to participate in decision-making regarding passive euthanasia. It is recommended to enhance open discussion of this complex issue to encourage nurses’ willingness to participate in NTD decision-making regarding euthanasia. (shrink)

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

In experiments of games, players frequently make choices which are regarded as irrational in game theory. In papers of Khrennikov (Information Dynamics in Cognitive, Psychological and Anomalous Phenomena. Fundamental Theories of Physics, Kluwer Academic, Norwell, 2004; Fuzzy Sets Syst. 155:4–17, 2005; Biosystems 84:225–241, 2006; Found. Phys. 35(10):1655–1693, 2005; in QP-PQ Quantum Probability and White Noise Analysis, vol. XXIV, pp. 105–117, 2009), it was pointed out that statistics collected in such the experiments have “quantum-like” properties, which can not be explained in (...) classical probability theory. In this paper, we design a simple quantum-like model describing a decision-making process in a two-players game and try to explain a mechanism of the irrational behavior of players. Finally we discuss a mathematical frame of non-Kolmogorovian system in terms of liftings (Accardi and Ohya, in Appl. Math. Optim. 39:33–59, 1999). (shrink)

We propose in this paper DIAL, a framework for inter-agents dialogue, which formalize a collective decision-making process to compose divergent interests and perspectives. This framework bounds a dialectics system in which argumentative agents play and arbitrate to reach an agreement. For this purpose, we propose an argumentation-based reasoning to manage the conflicts between arguments having different strengths for different agents. Moreover, we propose a model of argumentative agents which justify the hypothesis to which they commit and take (...) into account the commitments of their interlocutors according to their reputations. In the scope of our dialectics system, a third agent is responsible of the final decision outcome which is taken by resolving the conflict between two players according to their competences and the advanced arguments. (shrink)

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

In this comparative survey of 191 Egyptian and 92 U.S. executives, we explore the relationship between national culture and ethical decision-making within the context of business. Using Reidenbach and Robin’s (1988) multi-criteria ethics instrument, we examine how differences on two of Hofstede’s national culture dimensions, individualism/collectivism, and power distance, are related to the manner in which business practitioners make ethical decisions. Egypt and the U.S. provide an interesting comparison because of the extreme differences in their economies and related (...) business development. Our results indicate that respondents from the U.S, individualistic and low in power distance, were likely to view the decision making outcome in ethics scenarios as more unethical than the more collectivistic and high power distance Egyptians, when applying ethical criteria based on justice, utilitarianism, relativism, and (contrary to our predictions) egoism. However, we also found that both Egyptians and Americans rely on justice, utilitarianism, and relativism in predicting their intentions to behave ethically, and that Americans substitute egoism for justice, when the behavioral intentions of peers are examined. (shrink)