This study analyses joint decisions. Drawing on video-recorded planning meetings in a workplace context as data, and on conversation analysis as a method, I investigate what is needed for a proposal to get turned into a joint decision: How do people negotiate the outcome of the decision-making processes in terms of whether they indeed comprise new decisions and whether these decisions are really joint ones? This study identifies three essential components in arriving at (...) class='Hi'>joint decisions, and discusses two other possible outcomes of decision-making processes – non-decisions and unilateral decisions – as being a direct result of the deployment of the same components. These observations help explain the exact mechanisms involved in approving and rejecting proposals in joint decision-making settings, as well as the ways in which people may negotiate their rights and obligations to participate in decision-making processes. (shrink)

Background Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples for health care and the circumstances under which such a practice should be respected as (...) compatible with autonomous decision-making. Discussion We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples’ joint decision-making, and the ethics of couples’ joint decision-making. We believe that the extent to which couples’ joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples’ joint decision-making about a woman’s own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman’s autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples’ joint decision-making should be viewed as consistent with the principle of respect for the woman’s autonomy. At the other end of the spectrum are decisions made by the man without the woman’s input, representing domination of one partner by the other. Conclusions We recommend viewing the dynamics of couples’ joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples’ joint decision-making should not be taken at face value but should be assessed against the specific cultural, ethnic, and religious backgrounds and personal circumstances of the individuals in question. (shrink)

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples for health care and the circumstances under which such a practice should be respected as compatible (...) with autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples’ joint decision-making, and the ethics of couples’ joint decision-making. We believe that the extent to which couples’ joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples’ joint decision-making about a woman’s own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman’s autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples’ joint decision-making should be viewed as consistent with the principle of respect for the woman’s autonomy. At the other end of the spectrum are decisions made by the man without the woman’s input, representing domination of one partner by the other. We recommend viewing the dynamics of couples’ joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples’ joint decision-making should not be taken at face value but should be assessed against the specific cultural, ethnic, and religious backgrounds and personal circumstances of the individuals in question. (shrink)

We defend the claim that there can be testimonial transfer of reasons against Steinig’s recent objections. In addition, we argue that the literature on testimony about moral reasons misunderstands what is at stake in the possibility of second-hand orientation towards moral reasons. A moral community faces two different but related tasks: one theoretical (working out what things are of genuine value and how to rank goods and ends) and one practical (engaging in joint action and social coordination). In between, (...) simultaneously theoretical and practical, lies the activity of co-deliberation. Virtuous participation in co-deliberation can require limited moral deference. Refusal to recognize this, combined with excess self-trust, can derail co-deliberation. (shrink)

Expertise is commonly viewed as a professionalized competence in a specific field. Expert professional identities are produced and reproduced through professional training and other socialization mechanisms, which work to generate for a specific group of individuals a specific set of expert skills and knowledge. In this paper, I examine participants’ orientations to their distinct expert professional identities from the perspective of deontic authority. Drawing on 15 video-recorded church workplace meetings between pastors and cantors as data, and conversation analysis as a (...) theoretical and methodological framework, I analyze situations where a non-expert participant makes a proposal that the expert participant orients to as reasonable to comply with. Specifically, I demonstrate how the expert participants respond to these proposals with displays of deontic authority, arguably in an attempt to maintain their expert identities in the face of their de facto compliance with the proposals. In these situations, the expert participants are shown to invoke a past decision of their own, a future decision of their own, or a pattern that is beyond both participants’ control. Each of these practices involves the expert participant balancing resistance and compliance by minimally acknowledging the content of the non-expert participant’s proposal, while excluding the non-expert from those who have deontic authority in the matter. In so doing, the expert speaker implies that the non-expert proposal speaker lacks procedural knowledge about the specific matters about which it is relevant to make proposals to experts and access to the distinct experiential perspective that characterizes expert perception of things. It is thus argued that, in this context, the mere claims of deontic authority, produced without any substantial displays of expert knowledge, can serve the maintenance of expert professional identities. (shrink)

We defend the claim that there can be testimonial transfer of reasons against Steinig’s recent objections. In addition, we argue that the literature on testimony about moral reasons misunderstands what is at stake in the possibility of second-hand orientation towards moral reasons. A moral community faces two different but related tasks: one theoretical (working out what things are of genuine value and how to rank goods and ends) and one practical (engaging in joint action and social coordination). In between, (...) simultaneously theoretical and practical, lies the activity of co-deliberation. Virtuous participation in co-deliberation can require limited moral deference. Refusal to recognize this, combined with excess self-trust, can derail co-deliberation. (shrink)

Definition of the problemFrom an ethical point of view we analyse the ruling of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA) of September 2019 to revise the guidelines about the coverage of noninvasive prenatal tests (NIPT) by mandatory health insurance, in order to include them under specified conditions. The decision contains four essential elements: a definition of the aim of NIPT testing (to avoid invasive testing), a criterion of access (test must be “necessary” for the pregnant woman to (...) tackle her individual situation), statements about the process of decision-making (after counselling by a physician and case by case) and a normative contextualization (termination of pregnancy under § 218 a German penal law) which is to be found in its explanations. There are tensions in the proposed model that oscillate about two axes: (1) The suffering that results from a possible birth of a child with trisomy or from not knowing about the genetic condition of the fetus can ultimately only be evaluated subjectively, from the perspective of the pregnant woman. (2) The meaning of an individual decision in the case-by-case model remains unclear because when judging about individual cases general points of view also need to be considered. However, we argue that the model of the G‑BA could be a sociopolitically and ultimately also ethically defensible pragmatic solution, exactly because of its paradoxes and its inherent flexibility. (shrink)

Summary Principles Timely support for patients and people close to them, and effective, sensitive communication are essential. Decisions must be based on the individual patient's circumstances and reviewed regularly. Sensitive advance discussion should always be encouraged, but not forced. Information about CPR and the chances of a successful outcome needs to be realistic. Practical matters Information about CPR policies should be displayed for patients and staff. Leaflets should be available for patients and people close to them explaining about CPR, (...) how decisions are made and their involvement in decisions. Decisions about attempting CPR must be communicated effectively to relevant health professionals. In emergencies If no advance decision has been made or is known, CPR should be attempted unless: the patient has refused CPR; the patient is clearly in the terminal phase of illness; or the burdens of the treatment outweigh the benefits. Advance decision making Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be. Where patients lack competence to participate, people close to them can be helpful in reflecting their views. Legal issues Patients' rights under the Human Rights Act must be taken into account in decision making. Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences. In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient. In Scotland, adults may appoint a health care proxy to give consent to medical treatment. Health professionals need to be aware of the law in relation to decision making for children and young people.IntroductionWhy policies are neededCardiopulmonary resuscitation can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …. (shrink)

The isolation requirements of the coronavirus epidemic and the intuitive display advantages of live-streaming have led to an increasing number of retailers shifting to social live-streaming platforms and e-commerce live-streaming platforms to promote and sell their products in real time. However, the provision of live-streaming services will also incur high live-streaming effort costs. In this paper, we develop two decision models for retailers to sell goods through a single online shop and both online shop and live-streaming room; we also present (...) the optimal decisions of pricing and live-streaming efforts. Furthermore, we identify the profitability conditions for retailers to determine when to provide live-streaming services. In addition, we examine the impact of the provision of live-streaming services on the optimal price and live-streaming effort. We obtain three findings. First, there is a unique optimal decision on the price and live-streaming effort under certain conditions. Second, when the effect coefficient of the live-streaming room reaches a certain threshold, there are enough customers who enter the live-streaming room to watch and buy and it is profitable for retailers to provide live-streaming service. Finally, the optimal price and live-streaming effort increase with the increase in average return loss, the effect coefficient of live-streaming effort, and the extra return rate and decrease with the increase in the proportion of customers who choose to buy in the online shop and the price discount coefficient in the live-streaming room. (shrink)

Joint acceptance accounts of group belief hold that groups can form a belief in virtue of the group members jointly accepting a proposition. Recently, Jennifer Lackey (2020, 2021) proposed a challenge to these accounts. If group beliefs can be based on joint acceptance, then it seems difficult to account for all instances of a group telling a lie. Given that groups can and do lie, our accounts of group belief better not result in us misidentifying some group lies (...) as normal assertions. I argue that Lackey’s argument is not decisive. The cases she proposes as challenges for joint acceptance accounts can be dealt with in the joint acceptance framework. I present two different readings of Lackey’s central case, showing that in both readings Lackey’s example of a problematic group lie should not be identified as a lie, but rather as an epistemic mistake by the group. What kind of mistake the group makes depends on the exact reading of Lackey’s case, but either way the group is not telling a lie. (shrink)

Dialog is a joint action at different levels. At the highest level, the goal of interlocutors is to align their mental representations. This emerges from joint activity at lower levels, both concerned with linguistic decisions (e.g., choice of words) and nonlinguistic processes (e.g., alignment of posture or speech rate). Because of the high‐level goal, the interlocutors are particularly concerned with close coupling at these lower levels. As we illustrate with examples, this means that imitation and entrainment are (...) particularly pronounced during interactive communication. We then argue that the mechanisms underlying such processes involve covert imitation of interlocutors’ communicative behavior, leading to emulation of their expected behavior. In other words, communication provides a very good example of predictive emulation, in a way that leads to successful joint activity. (shrink)

Dialog is a joint action at different levels. At the highest level, the goal of interlocutors is to align their mental representations. This emerges from joint activity at lower levels, both concerned with linguistic decisions (e.g., choice of words) and nonlinguistic processes (e.g., alignment of posture or speech rate). Because of the high‐level goal, the interlocutors are particularly concerned with close coupling at these lower levels. As we illustrate with examples, this means that imitation and entrainment are (...) particularly pronounced during interactive communication. We then argue that the mechanisms underlying such processes involve covert imitation of interlocutors’ communicative behavior, leading to emulation of their expected behavior. In other words, communication provides a very good example of predictive emulation, in a way that leads to successful joint activity. (shrink)

Research based on the behavioral theory of the firm (BTOF) argues that firms will actively adopt strategic actions to respond to performance that falls below aspirations, that is performance shortfalls. However, most previous studies have focused on market-related strategic actions, paying less attention to the impact of performance shortfalls on non-market-related strategic actions, especially corporate social responsibility (CSR) and corporate social irresponsibility (CSI). In this study, we propose that firms facing performance shortfalls are likely to reduce CSR levels and increase (...) CSI levels. In addition, we also propose that board characteristics (board size, board age and board tenure) have a significant moderating effect on the above relationship. Empirical analyses based on an unbalanced panel data of China's listed firms from 2010 to 2018 show that our arguments are largely supported. (shrink)

Joint practical deliberation is the activity of deciding together what to do. In this dissertation, I argue that several speech acts that we can use to alter our moral obligations – promises, offers, requests, demands, commands, and agreements – are moves within joint practical deliberation. -/- The dissertation begins by investigating joint practical deliberation. The resulting account implies that joint deliberation is more flexible than we usually recognize, in two ways. First, we can make joint (...) decisions not only about what we will do together, but also about what you or I will do alone. Second, we can deliberate by means of two distinct methods: propose-and-ratify, in which a proposed joint decision must be explicitly accepted to come into effect, and propose-and-challenge, in which a proposed joint decision comes into force unless it is explicitly challenged. -/- Varying these parameters generates a botany of different kinds of proposals we can make within joint deliberation. When we look at these proposals more closely, we make a surprising discovery: for each kind of proposal we can make in joint practical deliberation, there is an everyday speech act with the very same properties. A certain kind of proposal to make a joint decision regarding one’s own actions has the same normative effects, under the same conditions, as a promise. One kind of proposal to make a joint decision regarding one’s addressee’s actions has all the essential features of a command; another kind of deliberative proposal – with the same content but a different method of evaluation – looks exactly like a request. And so on. -/- These similarities are too systematic to be coincidental. The only explanation, I argue, is that these ordinary speech acts are identical to their doppelgängers within joint practical deliberation. Promises and offers are proposals to make joint decisions about what I will do. Commands, demands, and requests are proposals to make joint decisions about what you will do. And agreements are joint decisions about what we will do. Call this the deliberative theory of these speech acts. -/- Considering each speech act in turn, I defend the deliberative theory by arguing that it provides a uniquely powerful explanation of its targets’ social and moral significance. Once we see how naturally these speech acts fall out of our practice of joint deliberation, theories that treat them as sui generis – as many moral philosophers now do – will come to seem redundant and nonexplanatory. Conversely, thinking of promises, offers, commands, demands, requests, and agreements as moves within joint practical deliberation allows us to give an elegant and generative theory of these phenomena that have confounded moral philosophers for so long. (shrink)

This paper argues that promises are proposals in joint practical deliberation, the activity of deciding together what to do. More precisely: to promise to ϕ is to propose (in a particular way) to decide together with your addressee(s) that you will ϕ. I defend this deliberative theory by showing that the activity of joint practical deliberation naturally gives rise to a speech act with exactly the same properties as promises. A certain kind of proposal to make a (...) class='Hi'>joint decision regarding one's own actions turns out to have the very same normative effects, under the very same conditions, as a promise. I submit that this cannot be a coincidence: we should conclude that promises and the relevant kind of proposals in joint practical deliberation are one and the same. (shrink)

Moral problems often prompt emotional responses that invoke intuitive judgments of right and wrong. While emotions inform judgment across many domains, they can also lead to ethical failures that could be avoided by using a more deliberative, analytical decision-making process. In this article, we describe joint evaluation as an effective tool to help decision makers manage their emotional assessments of morality.

Moral issues have been included in the studies of consumer misbehavior research, but little is known about the joint moderating effect of moral intensity and moral judgment on the consumer’s use intention of pirated software. This study aims to understand the consumer’s use intention of pirated software in Taiwan based on the theory of planned behavior (TPB) proposed by Ajzen (Organizational Behavior and Human Decision Processes, 50, 179, 1991). In addition, moral intensity and moral judgment are adopted as a (...) joint moderator to examine their combined influence on the proposed research framework. The results obtained from this Taiwan case reveal that the antecedent constructs proposed in the TPB model–an individual’s attitude and subjective norms toward using pirated software, and perceived behavioral control to use pirated software–indeed have positive impacts on the consumer’s use intention of pirated software. In addition, the joint moderating effect of moral intensity and moral judgment is manifested in the consumer’s use intention of pirated software. The results of this study not only could substantiate the results of consumer misbehavior research, but also could provide some managerial suggestions for Taiwanese government authorities concerned and the related software industries devoted to fighting pirated software. (shrink)

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (...) (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice. (shrink)

Errors and their consequences are typically studied by investigating changes in decision speed and accuracy in trials that follow an error, commonly referred to as “post-error adjustments”. Many studies have reported that subjects slow down following an error, a phenomenon called “post-error slowing” (PES). However, the functional significance of PES is still a matter of debate as it is not always adaptive. That is, it is not always associated with a gain in performance and can even occur with a decline (...) in accuracy. Here, we hypothesized that the nature of PES is influenced by one’s speed-accuracy tradeoff policy, which determines the overall level of choice accuracy in the task at hand. To test this hypothesis, we had subjects performing a task in two distinct contexts (separate days), which either promoted speed (hasty context) or cautiousness (cautious context), allowing us to consider post-error adjustments according to whether subjects performed choices with a low or high accuracy level, respectively. Accordingly, our data indicate that post-error adjustments varied according to the context in which subjects performed the task, with PES being solely significant in the hasty context (low accuracy). In addition, we only observed a gain in performance after errors in a specific trial type, suggesting that post-error adjustments depend on a complex combination of processes that affect the speed of ensuing actions as well as the degree to which such PES comes with a gain in performance. (shrink)

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

Drug use in the workplace can pose legal and ethical challenges for employers and their employees. In this case, Fred is a long-term employee of the James Bay Logging Company who recently returned to the workplace after extensive cancer treatment. Back on the job, he experienced debilitating joint pain, a side effect of his treatments. Fred’s decision to self-medicate with marijuana for pain management poses risks for people and property in his position as a logging truck operator and a (...) moral dilemma for his employer with their zero-tolerance drug policy. The purpose of this case is for students to examine the competing interests a company faces in trying to fairly enforce their drug policy in the context of medical marijuana in the workplace and showing care and compassion to a long-term employee who violated this policy. (shrink)

Decision theory aims at a general account of rationality covering humans but to begin makes idealizations about decision problems and agents' resources and circumstances. It treats inerrant agents with unlimited cognitive power facing tractable decision problems. This book systematically rolls back idealizations and without loss of precision treats errant agents with limited cognitive abilities facing decision problems without a stable top option. It recommends choices that maximize utility using quantizations of beliefs and desires in cases where probabilities and utilities are (...) indeterminate and using higher-order utility analysis in cases of limited access to probabilities and utilities. For agents burdened with mistakes, it advocates reasonable attempts to correct unacceptable mistakes before deciding. In decision problems without a stable top option, a topic of game theory, it proposes maximizing self-conditional utility among self-supporting options. In games of strategy, the new principles lead to solutions that are Pareto optimal among equilibria composed of jointly self-supporting strategies. Offering an account of bounded rationality, the bookmakes large strides toward realism in decision theory. (shrink)

Separated decision-making for maintenance and spare ordering is unrealistic in the industry, so this paper aims to optimize them together. A joint policy of inspection-based preventive maintenance and spare ordering considering two modes of spare ordering, namely, a regular order and an emergency order, is proposed for single-unit systems using a three-stage failure process. If the system is recognized to be in the minor defective stage, the original inspection interval is shortened and a regular order is placed. However, replacement (...) is undertaken preventively or correctively if the severe defective stage is identified or a failure occurs. Depending on the system state and the state of the regular ordered spare when replacement is needed, all possible scenarios are considered to construct optimization model I. The decision variables are the optimal inspection interval and the times of shortening the original inspection interval. Additionally, model II on the basis of an assumption that the spare is always ordered at time 0 is also developed. The results from a numerical example illustrated the applicability and the effectiveness of model I compared to model II, and the irregular inspection policy is validated to be cost-saving compared to the regular inspection policy. (shrink)

Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery.

The traditional solution concept for noncooperative game theory is the Nash equilibrium, which contains an implicit assumption that players’ probability distributions satisfy t probabilistic independence. However, in games with more than two players, relaxing this assumption results in a more general equilibrium concept based on joint beliefs. This article explores the implications of this joint-beliefs equilibrium concept for two kinds of conflictual coordination games: crisis bargaining and public goods provision. We find that, using updating consistent with Bayes’ rule, (...) players’ beliefs converge to equilibria in joint beliefs which do not satisfy probabilistic independence. In addition, joint beliefs greatly expand the set of mixed equilibria. On the face of it, allowing for joint beliefs might be expected to increase the prospects for coordination. However, we show that if players use joint beliefs, which may be more likely as the number of players increases, then the prospects for coordination in these games declines vis-à-vis independent beliefs. (shrink)

We present a general framework for representing belief-revision rules and use it to characterize Bayes's rule as a classical example and Jeffrey's rule as a non-classical one. In Jeffrey's rule, the input to a belief revision is not simply the information that some event has occurred, as in Bayes's rule, but a new assignment of probabilities to some events. Despite their differences, Bayes's and Jeffrey's rules can be characterized in terms of the same axioms: "responsiveness", which requires that revised beliefs (...) incorporate what has been learnt, and "conservativeness", which requires that beliefs on which the learnt input is "silent" do not change. To illustrate the use of non-Bayesian belief revision in economic theory, we sketch a simple decision-theoretic application. (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)

I was in manufacturing for over thirty years and a manager for nearly twenty-five. During that time it never occurred to me that the consequentialist, utilitarian framework I used was inadequate as a conceptual framework for making decisions to ensure organisational viability and success.1 The framework gave three criteria which enabled me to construct a rational approach to issues associated with my role as a manager: To show that this framework is adequate as a basis for managerial decision making (...) I want to spell out the logical implications of the three criteria and show that they are necessary and jointly sufficient to provide an epistemically sound framework for managerial decisions. I will argue that we can look to managerial practice for examples which can serve as paradigms for constructing a pragmatic approach to management decision making, one that — when employed correctly — will result in the best moral outcome for all those affected by a decision.2 This approach is derived from, and ultimately justified by, the primary role responsibility of a manager to create and implement a healthy work environment. This is one designed to be viable so that the organisation can compete successfully in the marketplace and meet the morally minimal standard that we ought not to cause unnecessary and avoidable harm to innocent people. Because the approach is goal directed, it is teleological and consequential in nature. I maintain that a workplace, or organisation, is healthy when all the components that constitute it are working coherently together to achieve legitimate organisational goals designed to ensure the best chances of being viable and competitive. Such an organisation is what I term optimally functional.3. (shrink)

Background Preconception Expanded Carrier Screening is a genetic test offered to a general population or to couples who have no known risk of recessive and X-linked genetic diseases and are interested in becoming parents. A test may screen for carrier status of several autosomal recessive diseases at one go. Such a program has been piloted in the Netherlands and may become a reality in more European countries in the future. The ethical rationale for such tests is that they enhance reproductive (...) autonomy. The dominant conception of autonomy is individual-based. However, at the clinic, people deciding on preconception ECS will be counselled together and are expected to make a joint decision, as a couple. The aim of the present study was to develop an understanding of autonomous decisions made by couples in the context of reproductive technologies in general and of preconception ECS in particular. Further, to shed light on what occurs in reproductive clinics and suggest concrete implications for healthcare professionals. Main text Based on the shift in emphasis from individual autonomy to relational autonomy, a notion of couple autonomy was suggested and some features of this concept were outlined. First, that both partners are individually autonomous and that the decision is reached through a communicative process. In this process each partner should feel free to express his or her concerns and preferences, so no one partner dominates the discussion. Further, there should be adequate time for the couple to negotiate possible differences and conclude that the decision is right for them. The final decision should be reached through consensus of both partners without coercion, manipulation or miscommunication. Through concrete examples, the suggested notion of couple autonomy was applied to diverse clinical situations. Conclusions A notion of couple autonomy can be fruitful for healthcare professionals by structuring their attention to and support of a couple who is required to make an autonomous joint decision concerning preconception ECS. A normative implication for healthcare staff is to allow the necessary time for decision-making and to promote a dialogue that can increase the power of the weaker part in a relationship. (shrink)

BackgroundSystems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology ; “big data” statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems (...) medicine knowledge and clinicians working to apply it.DiscussionThis article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through “big data” approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the “death computer,” to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their “quantified self.”SummaryThis paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care. (shrink)

BackgroundFor children with life-limiting conditions who are unable to participate in decision-making, decisions are made for them by their parents and paediatricians. Shared decision-making is widely recommended in paediatric clinical care, with parents preferring a collaborative approach in the care of their child. Despite the increasing emphasis to adopt this approach, little is known about the roles and responsibilities taken by parents and paediatricians in this process. In this study, we describe how paediatricians approach decision-making for a child with (...) a life-limiting condition who is unable to participate in decision-making for his/herself.MethodsThis qualitative phenomenological study involved 25 purposively sampled paediatricians. Verbatim transcripts from individual semi-structured interviews, conducted between mid-2019 and mid-2020, underwent thematic analysis. Interviews were based around a case vignette matched to the clinical experience of each paediatrician.ResultsTwo key themes were identified in the exploration of paediatricians' approach to decision-making for children with life-limiting conditions: there is a spectrum of paediatricians’ roles and responsibilities in decision-making, and the specific influences on paediatricians’ choice of approach for end-of-life decisions. In relation to, analysis showed four distinct approaches: non-directed, joint, interpretative, and directed. In relation to, the common factors were: harm to the child, possible psychological harm to parents, parental preferences in decision-making, and resource allocation.ConclusionsDespite self-reporting shared decision-making practices, what paediatricians often described were physician-led decision-making approaches. Adopting these approaches was predominantly justified by paediatricians’ considerations of harm to the child and parents. Further research is needed to elucidate the issues identified in this study, particularly the communication within and parental responses to physician-led approaches. We also need to further study how parental needs are identified in family-led decision-making approaches. These nuances and complexities are needed for future practice guidance and training around paediatric decision-making.Trial registration: Not applicable. (shrink)

It is frequently demanded that AI-based Decision Support Tools (AI-DSTs) ought to be both explainable to, and trusted by, those who use them. The joint pursuit of these two principles is ordinarily believed to be uncontroversial. In fact, a common view is that AI systems should be made explainable so that they can be trusted, and in turn, accepted by decision-makers. However, the moral scope of these two principles extends far beyond this particular instrumental connection. This paper argues that (...) if we were to account for the rich and diverse moral reasons that ground the call for explainable AI, and fully consider what it means to “trust” AI in a descriptively rich sense of the term, we would uncover a deep and persistent tension between the two principles. For explainable AI to usefully serve the pursuit of normatively desirable goals, decision-makers must carefully monitor and critically reflect on the content of an AI-DST’s explanation. This entails a deliberative attitude. Conversely, calls for trust in AI-DSTs imply the disposition to put questions about their reliability out of mind. This entails an unquestioning attitude. As such, the joint pursuit of explainable and trusted AI calls on decision-makers to simultaneously adopt incompatible attitudes towards their AI-DST, which leads to an intractable implementation gap. We analyze this gap and explore its broader implications: suggesting that we may need alternate theoretical conceptualizations of what explainability and trust entail, and/or alternate decision-making arrangements that separate the requirements for trust and deliberation to different parties. (shrink)

Based on the assumption that the long-term value of a venture capital satisfies the algebraic Brownian motion, we develop a continuous-time exit model of venture capital under different exit modes, namely, initial public offering and mergers and acquisitions. The employee incentive problem is analyzed jointly with the exit decision of the firm in terms of the exit timing and the exit mode. Further, the problem of capital exit is considered from two perspectives, namely, optimal venture capital and social welfare maximization, (...) and the differences between these exit decisions are compared. Our model predicts that the timing of an IPO, the purpose of which is to maximize the utility of the capitalists, lags behind the exit timing, whose purpose is to maximize social welfare. Using a numerical analysis, this paper also proves that increasing the production efficiency, lowering the interest rates, and improving risk management can make the exit decision of venture capitalists converge with that of maximizing social welfare. (shrink)

Hanlester Network v. Shalala ) marks the first test of the application of the Medicare-Medicaid anti-kickback statute to physician self-referral joint ventures. The most recent development in this ongoing litigation was the April 6, 1995 decision of the Ninth Circuit Court of Appeals, holding the Hanlester Network vicariously liable for its marketing vice president's knowing and willful violation of the antikickback statute. The vice president had offered to pay physician-investors in order to induce their referrals of program-related business.The Hanlester (...) Network was a California general partnership comprised of corporations, clinical laboratories, and individual investors. In April 1987, it entered into a management agreement on behalf of the clinical laboratories with SmithKline BioScience Laboratories. (shrink)

This article reports results of an experiment designed to analyze the link between risky decisions made by couples and risky decisions made separately by each spouse. We estimate both the spouses and the couples’ degrees of risk aversion, we assess how the risk preferences of the two spouses aggregate when they make risky decisions, and we shed light on the dynamics of the decision process that takes place when couples make risky decisions. We find that, far (...) from being fixed, the balance of power within the household is malleable. In most couples, men have, initially, more decision-making power than women but women who ultimately implement the joint decisions gain more and more power over the course of decision making. (shrink)

Out of 288 Hong Kong cancer patients, 92.3% include themselves in decision-making, 71% prefer joint decision-making: with family, with doctor, with doctor plus family, with family minus doctor, and with doctor minus family. <5% want decision-making by “doctor-alone” and <1% desire decision-making by “family-alone”. Harmony, communication and responsibility are reasons for family participation. Most patients prefer “specialist” for information, followed by “family”, “friends”, and “GP”. Trust in doctors and prospects for controlling/curing disease are important factors in decision-making. Patients want (...) to participate and be listened to rather than make decisions. Doctors should not disclose information to family without patients’ permission, nor withhold information from patient [End Page 109] on family’s request. Only 25% of patients have discussed post-competent treatment with others and 7% have heard of Advance Directive ; 24% refuse to discuss it. After AD has been explained to them, 66% remain reluctant to sign one, preferring to leave oral instructions or appoint family as proxy decision-makers. The family’s decision-making role increases when patients become incompetent. The top reason for signing AD is to receive preferred post-competent treatments, and for not signing it, difficulty with making a prospective decision. The implications of these findings will be discussed. (shrink)

Freight transportation plays a critical role in improving company performance in the modern manufacturing industry. To reduce costs, companies must take advantage of the use of large vehicles. It caused fewer deliveries, but inventory costs and degradation quality are high. One of the joint economic lot size problems in supply chain is Integrated Single-Vendor Single-Buyer Inventory Problem. This study developed the I-SVSB-IP model that considers raw materials’ exponential quality degradation and transportation costs. The objective function of this research was (...) to maximize the Joint Total Profit. Three decision variables used were inventory cycle time, raw material ordering frequency, and frequency of delivery of finished products to buyers. This study proposed a sophisticated Chimp Optimization Algorithm procedure to solve the I-SVSB-IP problem. A case study on the food industry in Indonesia was presented to optimize the I-SVSB-IP. The results showed that the ChOA procedure had produced an optimal solution compared to the state-of-the-art algorithm. This study also demonstrated a sensitivity analysis of decision and transportation variables to cost, revenue, and JTP. The results show that increasing transport frequency of ordering raw materials and finished products to buyers enhances the total cost and reduces joint total profit. In addition, increasing the rate of quality degradation of raw materials reduces JTP. (shrink)

Since the last generation medical ethics has seen a remarkable shift from benign medical paternalism to patient rights and autonomy. Whereas once it might have been acceptable for doctors to decide, largely on their own, what was in the best interests of their patients, today senior health professionals are expected to make decisions jointly both with patients or their carers and with other health professionals. Patient autonomy and justice, and not simply beneficence, are usually thought to be crucial to (...) medical ethics today.Although I strongly support this shift in medical ethics, I believe it is important to recognise that it has some cost to medical professionals, to patients and even at times to the National Health Service . Medical paternalism, when it was genuinely benign, did have some benefits both for doctors and for their patients. Yet precisely because most of us are no longer prepared to be at the receiving end of such paternalism, these particular benefits are now largely lost to us.The new joint statement, Decisions Relating to Cardiopulmonary Resuscitation,1 illustrates this point well. At the outset it admits that “health professionals are aware that decisions about attempting resuscitation raise very sensitive and potentially distressing issues for the patient and people emotionally close to the patient”. It was because of these sensitive and potentially distressing issues that it was once thought acceptable to make do not attempt resuscitation orders without consulting either patients or their families and with the knowledge that the latter would probably never discover that such orders had ever been made. Now, however, health workers are warned frankly that they “should remember …. (shrink)

In recent years, shared decision-making has become entrenched in the medical literature and the law as the ideal method for involving patients in decisions related to their health care. Shared decision-making represents a compromise between the opposed extremes of paternalistic interactions that limit patients’ control of their health care, and “informed choice” interactions that require physicians to provide technical expertise only, leaving patients to make all treatment decisions on their own. An implicit goal of shared decision-making is to (...) improve medical care by promoting joint participation of patients and physicians in clinical consultations. The model of shared decision-making may, however, inadequately address the health care needs of lower literate patients, a significant portion of the general population.As shared decision-making is widely held as a clinical ideal, we highlight the difficulties that physicians might have in implementing shared decision-making with lower literate patients. (shrink)

In recent years, shared decision-making has become entrenched in the medical literature and the law as the ideal method for involving patients in decisions related to their health care. Shared decision-making represents a compromise between the opposed extremes of paternalistic interactions that limit patients’ control of their health care, and “informed choice” interactions that require physicians to provide technical expertise only, leaving patients to make all treatment decisions on their own. An implicit goal of shared decision-making is to (...) improve medical care by promoting joint participation of patients and physicians in clinical consultations. The model of shared decision-making may, however, inadequately address the health care needs of lower literate patients, a significant portion of the general population.As shared decision-making is widely held as a clinical ideal, we highlight the difficulties that physicians might have in implementing shared decision-making with lower literate patients. (shrink)

Respecting the autonomy of agents grounds various obligations to others such as non-interference, deference to her authority over self-regarding decisions, limitations on paternalism, and so on. According to a broadly liberal moral sensibility, respecting others in this way implies accepting the valuesValue they autonomously hold even if they are judged problematic, immoral, self-destructive, or otherwise non-ideal. In discussions of such respect, it is generally assumed that persons expressing that respect have no direct bearing on whether the subject of that (...) respect is herself autonomous. However, in many situations, persons interact in a way that helps establish or re-establish the autonomy of one or both of these agents themselves.For example, the would-be paternalist may be a therapist whose professional obligationObligations is to facilitate the process of re-establishing autonomy for vulnerable victims of traumaTrauma. In such scenarios, the usual lines between hardPaternalismhard and softPaternalismsoft paternalism, as well as the standard liberal rejection of the former, do not apply. Still, it would be wrong for the aid workerAid workers to simply impose her views of a decent life on the struggling person. How, then, do we reformulate restrictions on paternalism and other such normative strictures grounded in respect forAutonomyrespect for autonomy in scenarios where the relationshipRelationships between client and aid workerAid workers is itself a crucial part of the process that results in the self-governingSelf-governing agency of the client?This paper explores these issues and argues that such scenarios indicate that conceptions of autonomy must view the self as diachronic as well as socially constituted but also must be sensitive to the ways that autonomy can sometimes be established only with others’ help. In particular, the obligationObligations to remain relatively neutralNeutral toward the content of others’ values in showing respect forPersonsrespect for their autonomy must be reformulated to take into account the way interpersonal dynamics themselves help establish the autonomy with which persons hold the values that they hold. These observations are applied to certain cases of aid and care where such questions are central. (shrink)

This study investigates the distinct and joint effects of corporate social performance, firm size, and visibility on a company’s decision to disclose sustainability-related information through sustainability reports. It seeks to provide more nuanced explanations for why certain companies tend to extensively report on their sustainability performance. First, while prior studies have predominantly focused on environmental reporting, the current analysis considers comprehensive sustainability reports that include both environmental and social issues. Second, the article argues that the effects of two important (...) antecedents of legitimacy pressure—firm size and organizational visibility—should be analyzed separately rather than restricting the analysis on the effects of legitimacy pressure per se. Third, it argues that the hypothesized effects are nonlinear because the marginal costs and benefits of sustainability reporting vary with a company’s CSP level, its size, and its visibility in the public. Finally, although there is a strong link between CSP and sustainability reporting, the strength of this link depends on its size and visibility. The study of 280 companies in environmentally and socially sensitive industries provides considerable support for these hypotheses, including evidence that size and visibility independently affect sustainability reporting and that the shape of the CSP/sustainability reporting link is contingent upon firm size and visibility. (shrink)

One of us (Eells 1982) has defended traditional evidential decision theory against prima facie Newcomb counterexamples by assuming that a common cause forms a conjunctive fork with its joint effects. In this paper, the evidential theory is defended without this assumption. The suggested rationale shows that the theory's assumptions are not about the nature of causality, but about the nature of rational deliberation. These presuppositions are weak enough for the argument to count as a strong justification of the evidential (...) theory. (shrink)

In March of this year the British Medical Association , the Resuscitation Council and the Royal College of Nursing published guidelines outlining the legal and ethical standards for decision making in relation to cardiopulmonary resuscitation .1 The guidance follows a year of increasing public awareness and concern about the issue and builds upon joint guidance issued by these institutions in June 1999.In April 2000 Age Concern issued a press release stating that “some doctors are ignoring national guidelines on the (...) resuscitation of older people” and indicating that they had information on cases that had come to light in their campaign against age discrimination. Age Concern went on to say that older people have found “not for resuscitation” recorded in their medical notes without their agreement or knowledge.During the same month Professor Shah Ebrahim wrote a leader in the British Medical Journal stating that doctors regularly issue “do not resuscitate” orders for patients without their knowledge.2 He claimed that black people, alcohol mis-users, non-English speakers and those with HIV are more likely to get a “do not resuscitate” order, suggesting that prejudice is influencing medical decisions.This combination of events was followed by intense press and media interest in the way in which decisions were being made about cardiopulmonary resuscitation. Such was the level of concern that a health service circular was issued to all National Health Service trust chief executives in September 2000 asking that appropriate resuscitation policies be in place which respect patients' rights, are understood by …. (shrink)

Prior research indicates that time perspective (TP; views of past, present and future) is related to decision making style. By contrast, no prior study considered relations between time perspective and decision-making competence. We therefore investigated associations between dimensions of the Swedish Zimbardo Time Perspective Inventory (S-ZTPI) and performance on the Adult Decision-Making Competence (A-DMC) battery in a sample of older adults (60-90 years, N = 346). A structural equation model involving four A-DMC components as indicators of a general DMC factor (...) and the six TP dimensions as the predictors revealed a significant negative association between the Present Fatalistic dimension and DMC. Given that age-related differences were apparent in DMC and that Present Fatalistic orientation increased with age, we tested a model by which the age-related differences in DMC were mediated by age-related differences in Present Fatalistic attitudes and in working memory. The results were consistent with full mediation of the age effects, with Present Fatalistic and working memory jointly accounting for a substantial amount of the variance in DMC (51%). The finding that DMC among older adults, in particular more cognitively demanding aspects such as applying decision rules, can be undermined by increased present fatalistic attitudes and declines in working memory is discussed in terms of theoretical frameworks highlighting the contribution of both motivational and cognitive factors to effective decision making. (shrink)

One challenge that globalization has brought to business is that firms, as they expand their market globally through cross-border alliances, need to deal with partner firms from countries of different religious background. The impact of a country’s dominant religion on its firms’ international market entry mode choices has not been examined in traditional approaches. Focusing on hypothesizing the influence of Christian beliefs and atheism (i.e., the absence of belief in any deities), this research aims to fill the gap by exploring (...) religion’s role in providing moral restraint on managers’ propensity for opportunism, which in turn affects these managers’ choices of their firms’ international market entry via non-equity alliances or joint ventures. A study of 22,156 cross-border alliances formed in 48 industries world-wide over 9 years provides new insight toward understanding religion’s influence on firms’ international market entry mode decisions through the ethical dimension of strategic leadership. (shrink)

This article explores links between the modern theory of rational choice and ethics. Ethics allows us to answer an unsolved question in modern decision theory: the structuring problem in decisions. Such a problem cannot be solved coming from the principle of expected utility. This principle can solve the problem of ‚choosing’ among given alternatives, but does not establish which alternatives should be taken into account in decision. In order to understand the structuring problem, the act of ‚choosing’ has to (...) be completed with three human acts: operating, predicting and evaluating. At the same time, the subjective criteria of rational choice – probability and utility – have to be completed with three objective criteria: efficiency, truth and goodness. Utility is a subjective value of an alternative considered in relation to another. Efficiency, truth and goodness are objective qualities of the joint alternatives in relation to the reality: the real operating possibilities of the agent, the real possibilities of his environment and the true good produced. So, the rule that guarantees a decision to be optimal would be: “do that which most certainly maximises our preferences, according to real operative resources, true knowledge and the right will”. However, this rule cannot be applied without the development of virtues, which could be seen as the main moral competences in decision-making. (shrink)