Studies of patient decision‐making use many different measures to evaluate the quality of decisions and the decision‐making process, partly to determine whether the ethical goals of informed consent, patient autonomy, and shared decision‐making have been achieved. We describe these measures, grouped under three main approaches, and review their limitations, leading to three conclusions. First, no measure or combination of measures can provide a complete assessment of decision quality. Second, the quality of a (...) class='Hi'>decision is best characterized vaguely, for instance as “good,” “satisfactory,” or “poor,” and these categorizations depend on qualitative judgments that go beyond quantitative measures. Third, bioethicists should focus on identifying and addressing poor or problematic decisions, rather than trying to incrementally increase decision quality, quantified by a measure. Decision‐quality measures can be useful in research and in advancing important goals of bioethics, as long as the challenges of defining and measuring decision quality are recognized. (shrink)

In times of person-centered care, it is all the more important to support patients in making good decisions about their care. One way to offer such support to patients is by way of Patient Decision Aids (PDAs). Ranging from patient brochures to web-based tools, PDAs explicitly state the decisions patients face, inform them about their medical options, help them to clarify and discuss their values, and ultimately make a decision. However, lingering discussions surround effectiveness research on PDAs. In (...) this article, I focus on two subjective measures of decision quality that are widely used as outcome measures in effectiveness research on PDAs (i.e., the Decisional Conflict Scale (DCS) and measures of regret). Although these measurement instruments have attracted critical attention in the scientific literature, bioethicists have hardly engaged with them. Therefore, I set myself to analyze the relationship between (the different subscales of) the DCS and measures of regret, on the one hand, and ethical principles such as beneficence and autonomy, on the other hand. In light of that analysis, I will clarify some discussions regarding the use of these measures of decision quality in effectiveness research on PDAs. This should help us to align the way we evaluate PDAs with ethical principles and avoid that our attempts to support patients in making good decisions about their care that is so central to person-centered care point in unethical directions. (shrink)

It is commonplace that care should be patient-centered. Nevertheless, no universally agreed-upon definition of patient-centered care exists. By consequence, the relation between patient-centered care as such and ethical principles cannot be investigated. However, some research has been performed on the relation between specific models of patient-centered care and ethical principles such as respect for autonomy and beneficence. In this article, I offer a detailed case study on the relationship between specific measures of patient-centered care and the ethical principle of respect (...) for autonomy. Decision Quality Instruments (DQIs) are patient-centered care measures that were developed by Karen Sepucha and colleagues. The model of patient-centered care that guided the development of these DQIs pays special attention to the ethical principle of respect for autonomy. Using Jonathan Pugh’s theory of rational autonomy, I will investigate how the DQIs relate to patient autonomy. After outlining Pugh’s theory of rational autonomy and framing the DQIs accordingly (Part I), I will investigate whether the methodological choices made while developing these DQIs align with respect for autonomy (Part II). My analysis will indicate several tensions between DQIs and patient autonomy that could result in what I call “structural paternalism.” These tensions offer us sufficient reasons, especially given the importance of the ethical principle of respect for autonomy, to initiate a more encompassing debate on the normative validity of Decision Quality Instruments. The aim of the present paper is to highlight the need for, and to offer a roadmap to, this debate. (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)

Substitute decision-makers for severely disabled neonates who can be kept alive but who will require constant medical interventions and will die at the latest in their teens are faced with a difficult decision when trying to decide whether to keep the infant alive. By and large, the primary focus of their decision-making centers on what is in the best interests of the newborn. The best-interests criterion, in turn, is importantly conditioned by quality-of-life considerations. However, the concept (...) of quality of life is logically and ethically different for patients with a developing as opposed to a developed awareness. Unfortunately, this difference is ignored by current quality-of-life considerations, there are no quality-of-life measures that take this difference into account, and decision-making proceeds entirely without acknowledging this fact. This note outlines why this is a problem and why there is a need for a new set of tools that incorporates this distinction if the substitute decision-makers are to apply the best-interest criterion in a meaningful way. (shrink)

Robust clinical decision-making depends on valid reasoning and sound judgment and is essential for delivering quality healthcare. It is often susceptible, however, to a clinician’s biases such as towards a patient’s age, gender, race, or socioeconomic status. Gender bias in particular has a deleterious impact, which frequently results in cognitive myopia so that a clinician is unable to make an accurate diagnosis because of a patient’s gender—especially for female patients. Virtue epistemology provides a means for confronting gender bias (...) in clinical decision-making and for correcting or even preventing its impact. The medical literature on cardiovascular and coronary heart disease is used to illustrate the role intellectual virtues can play in redressing the deleterious impact of gender bias on clinical decision-making and practice. Finally, questions are considered surrounding the pedagogy of intellectual virtues for medical students and practicing clinicians in order to provide quality care for patients, regardless of gender. (shrink)

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

Background While there are many guidelines on how to make ethical decisions at the end of life, there is little evidence regarding the quality of this sort of ethical guidelines. Objectives First, this study aims to demonstrate the conceptual transferability of the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument for the quality assessment of ethical guidelines. Second, it aims to illustrate the status quo of the quality of guidelines on end-of-life decision-making by using the (...) AGREE instrument in a first practice test. Method The transferability of the AGREE instrument on the quality assessment of ethical guidelines is demonstrated by conceptual analysis. Guidelines on end-of-life decisions in medicine are identified through a systematic search in MEDLINE (from June 1999 to June 2009). The quality of all included guidelines was assessed with a slightly modified AGREE instrument. Results Of 103 guidelines identified, 34 were included as relevant. The majority of the guidelines analysed in this study were assessed as qualitatively insufficient in five out of six AGREE quality domains. A few guidelines demonstrated, however, that a high level of quality in accordance with the AGREE requirements is possible. Conclusion This review concludes that the quality of many ethical guidelines should and can be improved in all quality domains specified by the AGREE instrument. Furthermore, conceptual analysis indicates that a slightly modified AGREE instrument is transferable to the comprehensive evaluation of the quality of ethical guidelines. Nevertheless, future research is needed to improve the assessment of the presentation of the guidelines' normative basis. (shrink)

Current research suggests consumers trade off price, quality, and sustainability attributes when making choices. Prior studies have typically focused on product attribute dyads, rather than multiattribute decision-making in the sustainability context. For scholars and practitioners, understanding which attributes are more important to consumers in tradeoff contexts has been a challenge. Self-other orientation may play a significant role in predicting consumers’ sustainable choices. We use prior research on equity sensitivity to demonstrate that segmenting consumers by their disposition to self-other (...) tradeoffs helps predict price–quality–sustainability tradeoffs. We hypothesize and test how members of these equity sensitivity segments tradeoff price, quality, and sustainability attributes in consumption decisions. Through four conjoint studies featuring diverse product assortments and sustainability issues, we find that price provides high utility for Entitled consumers, while sustainability provides high utility for Benevolent consumers. When product attributes are combined, Benevolents are more likely than Entitleds to purchase sustainable products. We also demonstrate that, in the absence of product choices, Equity Sensitives are more willing to choose a sustainable option over a conventional option, even when prices are high. In light of these findings, we discuss the implications for scholars looking to broadly predict consumers’ sustainable choices and for firms looking to target consumers with consumer-centric sustainability strategy. (shrink)

The article examines the impact of environmental quality on shaping the development policy of Polish voivodeships. The main analytical tool used was the synthetic index of environmental quality, compiled by means of the Perkal method. It was constructed in order to organize Polish voivodeships in terms of environmental quality, which was determined in a comprehensive way on the basis of three thematic areas: advantages of the natural environment, the level of pollution of the environment as well as (...) active protective activities. The obtained values of synthetic measures were then compared to the level of economic growth of Polish regions. It was necessary in determining which voivodeships perceive the quality of the environment as the main factor enhancing their economic growth, and which treat it as a barrier to economic development. (shrink)

This study explores the linear logic between consumer ethical beliefs (CEBs) and consumer unethical behavior (CUB) in a Chinese context. A relational view helps fill the belief–behavior gap by exploring the moderating role of relationship quality in reducing CUBs. Specifically, when consumers are more receptive to a set of actions that may be deemed inappropriate by moral principles, they are more likely to engage in unethical behaviors. However, when consumers perceive their misconduct as possibly damaging to the relationship developed (...) with the seller, they tend to refrain from unethical behaviors. CEBs and relationship quality also combine to affect unethical behaviors. Although consumers find the misconduct acceptable according to their ethical beliefs, they become less likely to conduct the behavior if they have a close relationship with the seller. The results contribute to a better understanding of the simplistic logic that connects CEBs and their unethical behaviors and shed light on how close relationships with consumers help contain CUBs. (shrink)

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used (...) by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups. (shrink)

How can we assess the epistemic quality of democratic decision-making? Sceptics doubt such assessments are possible, as they must rely on controversial substantive standards of truth and rightness. Challenging that scepticism, this paper suggests a procedure-independent standard for assessing the epistemic quality of democratic decision-making by evaluating whether it is adequately supported by reasons. Adequate support for conclusion is a necessary aspect of epistemic quality for any epistemic justification of democracy, though particularly relevant to theories (...) that emphasize public deliberation. Finding existing methods for measuring the quality of public discourse to fall short, we draw on an epistemological theory of argumentation to provide a more sophisticated approach to evaluating the epistemic quality of democratic decision-making, illustrate how the approach can be used, and demonstrate its relevance for the epistemic turn in democratic theory. (shrink)

The term "quality of life" has a long history in the bioethics literature. It is usually used in one of two contexts: in resource allocation discussions in the hope of arriving at an objective measure of the worth of an intervention; and in end-of-life discussions as a concept that can justify the forgoing of life-sustaining treatment. In both contexts, the term has valid uses as it is meant to measure the efficacy of a treatment. However, the term has the (...) unfortunate rhetorical problem that it often seems to be a judgment on the life of a human being. As such, it is highly inflammatory. We suggest that a return to a rhetoric that suggests a judgment on the treatment rather than the person is needed. (shrink)

Purpose: Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions.Background: The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this context may be modeled as a function of three types of need, related to age, clinical urgency, and quality of life.Methods: A web-based survey was conducted in which respondents were asked to choose between two hypothetical patients (...) who differed in clinical urgency , age, pretransplant and post-transplant quality of life, and life expectancy.Results: A pool of 1600 people were notified via email about the survey; 623 responded. Respondents preferred giving organs to younger people up to an age difference of <15.4 years and more clinically urgent people up to a difference in urgency of <2.54 months . Priority varied with the quality of life of the worst-off patient and the relative status of the patients. If both had worse than average quality of life, respondents preferred the better-off patient. When both had better than average quality of life, they preferred the worse-off patient. In analysis according to age versus clinical urgency, the older the patient, the more urgency needed to receive priority. In quality of life versus clinical urgency, the better the control’s quality of life, the more urgency the competing patient required. The worse the patient’s post-transplant outcome, the more urgency needed to receive priority.Conclusions: It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients. (shrink)

ABSTRACT School psychologists are frequently confronted with ethically challenging situations arising from the need to balance multiple parties’ competing interests and the challenge of serving as both student advocate and school employee. Use of a systematic decision-making model has been recommended as a way of improving the quality of school psychologists’ ethical decisions. In the present study, school psychology practitioners were randomly assigned to one of two conditions: a Critical Evaluative condition, requiring the use of a problem-solving approach (...) to resolve an ethical dilemma, or an Intuitive condition, which entailed generating a solution based solely on intuition and professional experience/judgment. Use of a formal decision-making model did not result in higher caliber ethical resolutions. Participants’ age and number of years in the field were significantly correlated with raters’ judgments that solutions considered the consequences of a chosen course of action. Most participants reported that they did not utilize an ethical decision-making model during the course of their practice, relying instead on consultation with peers/colleagues and their own professional experience. Implications of these findings are discussed in the context of school psychology practice. (shrink)

The 2005 Report on Social Responsibility and Health of the UNESCO International Bioethics Committee (Ibc) proposes a new approach to implementing the right to healthcare and suggests a number of Courses of Action to be followed in various fields. Based on the latest available data, we intend to present an overview of the current state of European health systems in two of those fields—decision-making procedures and quality assurance in health care—and to attempt a comparison of the situation with (...) the Report’s provisions, in order to pave the way for the identification of what still has to be done to bridge international recommendations and the reality of policy and practice in Europe’s health care. (shrink)

Purpose: Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions.Background: The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this context may be modeled as a function of three types of need, related to age, clinical urgency, and quality of life.Methods: A web-based survey was conducted in which respondents were asked to choose between two hypothetical patients (...) who differed in clinical urgency , age, pretransplant and post-transplant quality of life, and life expectancy.Results: A pool of 1600 people were notified via email about the survey; 623 responded. Respondents preferred giving organs to younger people up to an age difference of <15.4 years and more clinically urgent people up to a difference in urgency of <2.54 months . Priority varied with the quality of life of the worst-off patient and the relative status of the patients. If both had worse than average quality of life, respondents preferred the better-off patient. When both had better than average quality of life, they preferred the worse-off patient. In analysis according to age versus clinical urgency, the older the patient, the more urgency needed to receive priority. In quality of life versus clinical urgency, the better the control’s quality of life, the more urgency the competing patient required. The worse the patient’s post-transplant outcome, the more urgency needed to receive priority.Conclusions: It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients. (shrink)

The purpose of this study is to identify the requirements of computerized Management Information Systems and their role in improving the quality of administrative decisions in the Palestinian Ministry of Education and Higher Education. The authors used the descriptive analytical method and the questionnaire method to collect the data. (247) questionnaires were distributed on the study sample and (175) questionnaires were collected back with a recovery rate of (70.8). The study showed a number of results, the most important of (...) which are: There exist a role for computerized management information system requirements in improving the quality of administrative decisions in the Ministry of Education and Higher Education. This result is due to the existence of the support and attention by the senior management in the Ministry of Education and Higher Education by 65.06%, the physical requirements available for the use of computerized Management Information Systems are available by (72.19%), and the software requirements for the use of computerized Management Information Systems are available at 67.74%. The results found that the human requirements available for the use of computerized Management Information Systems are available at (68.33%). The results showed that the organizational requirements that assist in the use of information systems are available at (64.19%). There are no statistically significant differences between respondents' responses to the role of computerized management information system requirements in improving the quality of administrative decisions in the Ministry of Education and Higher Education attributable to the variables(Gender, academic qualification, age, career level), while there are statistically significant differences in the role of computerized management information system requirements in improving the quality of administrative decisions in the Ministry of Education and Higher Education due to variable years of service. The study concluded that the Ministry of Education and Higher Education is able to cope with the external environmental changes rapidly and the limited time available for the collection and analysis of information. This means that administrative information systems should be used by increasing the approval of senior management on Management Information Systems in making their decisions, and to involve the employees in making any change and keep abreast of technical developments and try to use external bodies to advise in the field of computerized information systems, and work to increase coordination between the different departments of the ministry. (shrink)

Although the theory of moral development is widely used in business ethics research to measure the quality of an ethical decision, there have been ongoingconcerns about certain aspects of the theory. These concerns include questions about the distinctness and sequentiality of the stages, the logic for claiming that the higher levels are morally superior, and the ability of the theory to incorporate the universality of the dominant ethical theories and the particularism of the ethics of care. This paper (...) suggests that many of these concerns can be addressed through recent research, most importantly through the application of the Lectical Assessment System (LAS) (Dawson, 2002, 2003; Dawson, Xie, & Wilson, 2003). (shrink)

At the heart of entrepreneurship are imagination, creativity, novelty, and sensitivity. It takes these qualities to develop a new product or service and bring it to market, to envision the possible impacts a new product may make and come up with novel and creative solutions to problems that may arise. These qualities go to make up what could be called the spirit of entrepreneurship, a spirit that involves the ability to handle the experimental nature of entrepreunerial activity. These same qualities (...) are crucial for moral decision making, and an ethical approach which emphasizes imagination, creativity, and has an experimental thrust is much better adapted to the entrepreneurial activity and much more relevant to the unique situations that entrepreneurs face. In this sense, the process approach to ethics developed in this article is a unifying framework that brings together the activity of entrepreneurship and moral decision making. (shrink)

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used (...) by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups. (shrink)

Trapezoidal interval type-2 fuzzy sets are a special kind of type-2 fuzzy sets. TIT2FSs are useful in dealing with fuzziness inherent in decision data and the decision-making process. For multi-attribute group decision-making problems in which the attribute values and attribute weights are TIT2FSs, a new decision-making approach is proposed. On the basis of the concept of barycenters, a new approach to ranking TIT2FSs is given. Four kinds of geometric aggregation operators for TIT2FSs are developed, including the (...) TIT2FS weighted geometric average operator, TIT2FS ordered weighted geometric average operator, TIT2FS hybrid weighted geometric average operator, and extended TIT2FS hybrid weighted geometric average operator. The individual comprehensive values of alternatives are derived through the extended TIT2FS weighted geometric average operators. Using the TIT2FS hybrid weighted geometric average operator and the expert weights, the individual comprehensive values of alternatives are integrated into the collective ones, which are used to rank the alternatives. The practicability and effectiveness of the developed method are illustrated with a teaching quality assessment example. (shrink)

Essays and articles in the November‐December 2022 issue of the Hastings Center Report explore the complexities of medical decision‐making. A case‐study essay, for example, argues that the dismaying decision to perform resuscitation efforts on a patient who had obviously been dead for some time can be understood in the context of the harmful practice of defensive medicine. A narrative essay concerns whether an adolescent with locked‐in syndrome should be asked her wishes about life‐sustaining interventions, and the articles illuminate (...) the ethical value of the parental role in pediatric decision‐making, an array of ways in which patient decision‐making is interdependent, and the limitations of measures designed to evaluate the quality of a patient's decision and decision‐making process. (shrink)

Online product recommendation systems have gained prominence in the context of e-commerce over the past years. Despite the increased research on OPR use, less attention has been paid to examining how decision and affective assessment of the OPR are contingent upon the product type. This study proposes and examines a recommendation-product congruity proposition based on cognitive fit and schema congruity theories. The proposition states that when the content of the OPR [either system-generated recommendation or a consumer-generated recommendation ] matches (...) the brain-stored schema initiated by a particular product, then a consumer would use a schema-based information assessment strategy and experience favorable decision and affective assessment of the OPR. This then affects consumers’ intentions to purchase and reuse OPR. The proposition is tested via a 2 × 2 between-respondents factorial design of a cross-sectional survey with 482 Amazon customers. The results support the following two matching conditions of the proposition: SGR describing a search product and CGR explaining an experienced product, which might lead customers to perceive lower decision effort, greater decision quality, and higher enjoyment with the OPR that subsequently have a significant impact on their intentions to purchase and reuse OPR. This study expands our understanding of how recommendation-product congruence influences the consumer’s decision and affective assessment behavior and provides practical implications for the identification and presentation of the recommendation type and product type for a better customer decision. (shrink)

Modern scholarship on decision behavior dates from the late 1940s. But that scholarship has been preoccupied with two ideas that are much older. One is the notion of expected utility, first articulated in the scholarly literature by Daniel Bernoulli in 1738. In its simplest form, the expected utility concept applies to monetary gambles. Imagine you are asked to choose between two gifts, either gamble G, which you would then play and get either $9 or nothing, or else a simple, (...) direct payment of $3. As shown in the decision tree in figure 10.1, you receive gamble G's $9 payoff if the toss of a fair die yields one or two pips, but you receive nothing otherwise. (In decision trees, choice points are represented by square nodes, chance points by circular nodes.) The expected value or expectation of a gamble is the sum of its payoffs, each weighted (i.e., multiplied) by its probability. Thus, the expected value of G is EV(G) = (1/3)($9) + (2/3)($0) = $3, the same as the direct payment. So, if you generally make decisions like this one so as to maximize expected value, you would be indifferent between the present options. However, if you are like most people, you are not indifferent. Instead, you are risk‐averse, preferring the guaranteed $3. Why? (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments and (...) biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

Assessing the quality of translation is never straightforward and rarely objective. Context, audience, text type, function and lexis are only some of the criteria that need to be taken into account. In the case of constrained intersemiotic translation, subtitling being a prime example thereof, determining universal criteria for assessment is particularly testing. Often referred to as “necessary evil”, audiovisual translation needs to avoid distracting the audience, while aiding their comprehension of the audiovisual message. This is particularly the case for (...) additive AVT, for instance subtitling, where the translation does not replace the original, but coexists with it. Relevance Theory, a controversial but flexible approach to communication, may provide a viable framework for gauging subtitling quality. The interplay between relevance, communicative intention and processing effort can help explain the rationale behind the process of decision-making in the practice of AVT. This paper provides a theoretical foundation for the application of Sperber and Wilson’s Relevance Theory to interlingual subtitling, followed by an analysis of selected examples from a large corpus of mostly English-language movies, series and documentaries streamed on Netflix with Polish subtitles. Though the corpus is Polish-centred, the research conclusions are intended to be universal enough to apply regardless of the language pair. (shrink)

Building on a functionalist framework for decision-making in legal translation, a holistic approach to quality is presented in order to respond to the specificities of this field and overcome the shortcomings of general models of translation quality evaluation. The proposed approach connects legal, contextual, macrotextual and microtextual variables for the definition of the translation adequacy strategy, which guides problem-solving and the rest of the translation process. The same parameters remain traceable between the translation brief and the translation (...) product both in pre-delivery revision and in post-delivery assessment. They are the yardstick for identifying predictable evaluative criteria and competence requirements for translators and quality controllers. The implications of the approach on quality assessment and quality management practices are also discussed. Overall, the model illustrates the potential benefits of enhancing predictability and reducing subjectivity on the basis of specific legal translation methodologies. It supports the need for legal translation expertise in quality evaluation and the relevance of Legal Translation Studies to raising standards in professional practice. (shrink)

Nature quality in relation to farming is a complex field. It involves different traditions and interests, different views of what nature is, and different ways of valuing nature. Furthermore there is a general lack of empirical data on many aspects of nature quality in the farmed landscape. In this paper we discuss nature quality from the perspective of organic farming, which has its own values and goals in relation to nature – the Ecologist View of Nature. This (...) is in contrast to the Culturist View characteristic of much conventional agriculture and the Naturalist View characteristic of the traditional biological approach to nature quality. This threefold distinction forms a framework for exploration of nature quality criteria in the farmed landscape. The traditional work on nature quality has mainly focused on biological interests based on a Naturalist View of Nature. In this paper we will explore how criteria for nature quality based on the Ecologist View can be developed and thereby feed into the ongoing discussion of the development of the organic farming practices. We suggest additional criteria for nature quality based on an Ecologist View of Nature: biodiversity, habitat diversity, extent and structure, functional integrity of habitats and agro-ecosystems, landscape integrity, accessibility, and experientiality. The larger set of Naturalist and Ecologist criteria can provide a wider and more balanced basis for developing nature quality indicators that are relevant in the farmed landscapes. This broader approach to nature quality is also expected to benefit the general societal discussions and decisions on farming and nature. (shrink)

Patients rely on, benefit from, and are strongly influenced by physicians’ recommendations. In spite of the centrality and importance of physicians’ recommendations to clinical care, there is only a scant literature describing the conceptual process of forming a clinical recommendation, and no discrete professional standards for making individual clinical recommendations. Evidence-based medicine and shared decision making together are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from either (...) of those processes or how patients’ preferences ought to be considered and how much weight they should hold. Moreover, physicians’ bias has been reported to strongly influence how a recommendation is derived, thereby undermining the quality of healthcare decisions and patients’ trust. To demonstrate a potential for improving the quality of decisions, this article proposes a conceptual framework for how physicians should reach a clinical recommendation and apply the process in practice. For preference-sensitive clinical decisions—that is, clinical decisions when patients’ values and preferences are relevant—the process for reaching a recommendation should be transparent to patients and should be based solely on the medical evidence and patients’ values and preferences. When patients’ preferences for care do not prioritize health, physicians decide whether their recommendation will prioritize a welfare-enhancing versus an autonomy-enhancing approach. When there are gaps in understanding how physicians derive their clinical recommendations and how to further improve the quality of the decisions, the author calls for further empiric research. (shrink)

The best interests principle is commonly utilized in acute care settings to assist with decision making about life-saving and life-sustaining treatment. This ethical principle demands that the decision maker refers to some conception of quality of life that is relevant to the individual patient. The aim of this article is to describe the factors that are required to be incorporated into an account of quality of life that will provide a morally justifiable basis for making a (...) judgement about the future quality of life, and therefore the best interests, of critically ill patients who are mentally incompetent. This account consists of three major components - pain and suffering, body functioning, and autonomy - and is applicable in situations where very limited information is available to guide decision making. This framework helps to make decisions about the provision of life-saving treatment that are as consistent as possible in all patient situations. (shrink)

A number of factors must be considered in facility location decisions. Recent research on job design suggests that the effects jobs may have on quality of work life and quality of life in general should be considered in facility location decisions in addition to other normal factors. The present study was designed to examine quality of work life and quality of life factors of residents in a low income and low education area. The intent was to (...) determine what types of jobs might have the most positive effect on people in this type of region. Data were collected from 409 households in a low income/education region. The results showed that people from this region were as satisfied with their quality of work life and quality of life as people in other regions with better jobs, higher incomes, and better general life situations. Results are discussed in light of facility location decisions and types of jobs having the most positive impact. (shrink)

Neither in theory nor in practice does there exist a single model of decision making. It is very difficult to identify a model, or models, which would be most useful during and after a disaster. Within the disaster timeframe (a difficult and complex situation), specific moral dilemmas arise. All the decision making theories tend to be associated with different assumptions about human nature, the quality of the decisions made and the manner in which they are made. Different (...) assumptions may result in different tools being used and subsequently different consequences. The paper will provide a general introduction to the ethical decision making model, and will suggest two ways in which decisions in ethics might be made. The paper will try to deepen the discussion, and suggest answers to questions such as which type of ethical decision making is better in a specific situation such as a disaster? Is there any need to use a different decision making model (from an ethical point of view) in a disaster than in another event? Nonetheless, the article does not provide explicit solutions to these questions, since providing them would require further investigation than is the aim of this paper. (shrink)

The guidelines on Decisions Relating to Cardiopulmonary Resuscitation begin with a reassuringly objective view of medicine: its “primary goal” is to benefit patients by “restoring or maintaining their health as far as possible, thereby maximising benefit and minimising harm”. Some might want to add that medicine has several goals, not all of which relate to promoting health; however, those who see the aim of the profession as more than consumer satisfaction will welcome the suggestion here that not just any choice (...) counts as medicine. In the same way, the statement which heads the next paragraph would be rejected by very few readers if “quality of life” were suitably defined. If all we mean by “quality of life” is the patient's level of wellbeing, with no suggestion that the value of his or her “being” can fall to zero or below, it is uncontroversial that “it is not an appropriate goal of medicine to prolong life at all costs with no regard to its quality or the burdens of treatment on the patient”. This is, however, an overly benign interpretation of “quality of life” observations as they appear in the guidelines. (shrink)

The aim of this study was to investigate factors associated with seriously ill patients’ preferences for their family and physicians making resuscitation decisions on their behalf. Using SUPPORT II data, the study revealed that, among 362 seriously ill patients who were experiencing pain, 277 (77%) answered that they would want their family and physicians to make resuscitation decisions for them instead of their own wishes being followed if they were to lose decision-making capacity. Even after controlling for other variables, (...) patients who preferred the option of undergoing cardiopulmonary resuscitation (CPR) in the future were twice as likely, and those who had had ventilator treatment were four-fifths less likely, to rely on their family and physicians than those who did not want CPR (odds ratio (OR)-2.28; 95% confidence interval (CI) 1.18-4.38) or those who had not received ventilator treatment (OR-0.23; 95% CI 0.06-0.90). Psychological variables (anxiety, quality of life, and depression), symptomatic variables (severity of pain and activities of daily living) and the existence of surrogates were not significantly associated with patients’ preferences for having their family and physicians make resuscitation decisions for them. Age was not a significant factor for predicting the decision-making role after controlling for other variables. (shrink)

One field in ethics that has been developed during recent decades is virtue ethics, represented most importantly by Alasdair MacIntyre's work After Virtue. Virtue ethics is not opposed to principle-based ethics, but rather complements its task and develops it more fully. In the field of US bioethics, this option has proved to be even more fruitful, especially in the work of Edmund Pellegrino and David Thomasma. Virtue ethics is also being reappraised in relation to the ethics of organisations and business. (...) It is considered that the best way of running a company does not depend solely on a group of ethical principles or agreed criteria, but on the effective exercise of certain qualities of character. Indeed, minimal ethics do not guarantee the excellence of organisations, or even their correct development. They guarantee certain standards of coexistence, but this is not sufficient to carry forward a collective enterprise in a creative way. It is impossible to achieve the aims of an organisation without ambition, magnanimity, humility, prudence, responsibility and courage. This group of intangible elements are virtues. This article explores the process of decision-making in the light of Aristotelian ethics, in particular his work _Nicomachean Ethics_. Making decisions is a common task on the managerial agenda. The decisions of a manager affect individuals, the future of the organisation and, of course, they have consequences for the organisation and its surroundings. Aristotle dedicates Book III of the work in question to studying the art of deliberation and examining which virtues must be taken into account when reaching the best decision. Aristotle tells us that we deliberate about things that are within our power and can be done. There can be no deliberation upon exact and sufficient knowledge; however, we deliberate upon the things that are brought about by our own efforts, although not always in the same way. Leading an organisation is not a mechanical matter, but rather a process that requires creativity and responsibility. There are many different ways of doing it. Following the Aristotelian doctrine, this article aims to examine the elements that must be taken into consideration for correct decisions to be made. The following virtues play a fundamental role in this process: prudence, fortitude, justice and temperance, referred to below as called cardinal virtues. (shrink)

Political equality is in tension with political quality, and quality has recently been neglected. My thesis is that proper attention to the quality of democratic procedures and their outcomes requires that we accept substantive inequalities of political input in the interest of increasing input overall. Mainly, I hope to refute political egalitarianism, the view that justice or legitimacy requires substantive political equality, specifically equal availability of power or influence over collective choices that have legal force. I hope (...) to show that political egalitarianism exaggerates individual rights in the conduct of political procedures, and neglects the substantive justice of the decisions made through those procedures. Some unequal distributions of influence may better promote just decisions, and without reliance on any invidious comparisons such as the relative wisdom of the wealthy or the educated. (shrink)

The use of quality of life (QOL) outcomes in clinical trials is increasing as a number of practical, ethical, methodological, and regulatory reasons for their use have become apparent. It is important, then, that QOL measurements and differences between QOL scores be readily interpretable. We study interpretation in two contexts: when determining QOL and when basing decisions on QOL differences. We consider both clinical situations involving individual patients and research contexts, e.g., randomized clinical trials, involving groups of patients. We (...) note the ethical importance of such understanding: proper interpretation and communication facilitate health care decision making. Communication that facilitates interpretation is of moral significance since better communication can attenuate ethical problems and inform choices. Much of what is communication worthy about QOL assessments is determined by the particular QOL instrument used in the assessment and how it is administered. In practice, these choices will be driven by the purpose of the assessment, but, it is argued, to maximize understanding, we should combine the information garnered from traditional standardized QOL instruments, from individualized QOL assessments, and from a recently proposed dialogic paradigm, where QOL is determined by shared conversation regarding the interpretation of texts. And, while some studies can surely succeed using abbreviated methods of administration (e.g., postal surveys may suffice for certain purposes), we will focus on methods of administration involving interviewer–respondent interaction. We suggest that during the QOL elicitation process, interviewer and respondent should engage in a two-way conversation in order to achieve a shared understanding of the “answers” to QOL “questions” and, finally, to reach a shared interpretation of the individual’s QOL. (shrink)

Medical decision making relies heavily on the notion of the quality of a person's life in providing a reason to utilize one therapy over another or to withhold certain therapies altogether. The concept of quality of life, however, lacks clear definition as well as consensus on its constitutive elements. ;Chapter one engages a basic controversy in the literature: whether 'quality of life' should be understood as a subjective concept, or whether objective "lists" can help us assess (...) a person's quality of life. Chapter two examines whether anthropological data might provide guidance. While it is often argued that anthropological data supports relativism, John Finnis argues that anthropological data supports universalism which, in turn, bolsters objectivist claims. I argue that anthropological data may plausibly be interpreted to support either subjective or objective accounts, and thus, does not settle our approach to quality of life. ;Chapter Three examines objective list theories, in particular those of Bernard Gert and John Finnis. I find Gert's account to be problematic because it seems incomplete. Finnis's criteria, too, seems ultimately indefensible. Thus, I conclude that while objectivist claims may offer insight into human values and motivations, existing accounts are flawed. Chapter Four examines subjective accounts of quality of life. I focus on "preference satisfaction" accounts. While these accounts provide intuitively plausible descriptions, they fall victim to a host of difficulties. Perhaps the best example of this is the "fleeting preferences" problem, which undermines our confidence in making life-and-death decisions on the basis of quality of life considerations. ;The concluding chapter offers that much progress can be made by understanding quality of life in terms of finding meaning in life. Thus, the quality of one's life is determined by how much purpose and meaning is found in that life. While this notion is not without its problems, it does capture the complex elements of the kinds of cases in which we are particularly interested, and combines some of the best features of both the objective and subjective accounts. (shrink)