The aim of this paper is to argue that intuitive methods of moral decision making are objective tools on the grounds that they are reasons based. First, I will conduct a preliminary analysis in which I highlight the acceptance of methodological pluralism in the practice of medical ethics. Here, the point is to show the possibility of using intuitive methods given the pluralism framework. Second, I will argue that the best starting point of elaborating such methods is (...) a bottom-up perspective. Third, I will address the worry of subjectivism. Under the influence of certain rationalist positions and recent developments in cognitive science and moral psychology, one might think that intuitive methods of moral decision making are essentially subjective and emotion based. If moral intuitions are the result of emotional reactions and intuitive reasoning is emotionally driven, then there are reasons to believe intuitive methods are subjective and relative to particular psychological constitution. Against this picture, I will argue that intuitive methods of moral decision making are essentially reasons-based. A Wittgensteinian approach will show that intuitive methods of moral decision making are conceptually linked with criteria of morality. (shrink)

Background: Moral decision-making consists of a complex process requiring individuals to evaluate potential consequences of personal and social decisions, including applied organizational contexts.Methods: This research aims to investigate the behavioral (offer responses and reaction times, RTs) and electrophysiological (EEG) correlates underlying moral decision-making during three different choice conditions (professional fit, company fit, and social fit) and offers (fair, unfair, and neutral).Results: An increase of delta and theta frontal activity (related to emotional behavior and processes) (...) and beta frontal and central activity (linked to cognitive and attentional processes) was found. A left beta, delta, and theta frontal activity was observed for fair offers in professional fit conditions, while increased right frontal delta and theta activity was found in response to unfair offers in company fit conditions. Also, an increase of left delta and theta parietal activity for unfair offers in social fit condition was detected. Finally, higher accepted responses were found for fair and neutral offers in professional and social fit conditions, with increased RTs for unfair offers suggesting decisions’ cognitive load and complexity.Conclusions: By revealing a greater involvement of left and right frontal areas in decision-making processes based on choices and offers, personal interest evaluations and emotional values, and of parietal areas in more prosocial and altruistic moral behavior, current findings provide information about the neural and behavioral correlates underlying company moral behavior. (shrink)

The use of visual attention for evaluating consumer behavior has become a relevant field in recent years, allowing researchers to understand the decision-making processes beyond classical self-reports. In our research, we focused on using eye-tracking as a method to understand consumer preferences in children. Twenty-eight subjects with ages between seven and twelve years participated in the experiment. Participants were involved in two consecutive phases. The initial phase consisted of the visualization of a set of stimuli for (...) class='Hi'>decision-making in an eight-position layout called Alternative Forced-choice. Then the subjects were asked to freely analyze the set of stimuli, they needed to choose the best in terms of preference. The sample was randomly divided into two groups balanced by gender. One group visualized a set of icons and the other a set of toys. The final phase was an independent assessment of each stimulus viewed in the initial phase in terms of liking/disliking using a 7-point Likert scale. Sixty-four stimuli were designed for each of the groups. The visual attention was measured using a non-obstructive eye-tracking device. The results revealed two novel insights. Firstly, the time of fixation during the last 4 visits to each stimulus before the decision-making instant allows us to recognize the icon or toy chosen from the eight alternatives with a 71.2% and 67.2% of accuracy respectively. The result supports the use of visual attention measurements as an implicit tool to analyze decision-making and preferences in children. Secondly, eye movement and the choice of liking/disliking choice are influenced by stimuli design dimensions. The icon observation results revealed how gender samples have different fixation and different visit times which depend on stimuli design dimension. The toy observations results revealed how the materials determinate the largest amount fixations, also, the visit times were differentiated by gender. This research presents a relevant empirical data to understand the decision-making phenomenon by analyzing eye movement behavior. The presented method can be applied to recognize the choice likelihood between several alternatives. Finally, children's opinions represent an extra difficulty judgment to be determined, and the eye-tracking technique seen as an implicit measure to tackle it. (shrink)

Background This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making.Methods A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and (...) then quantitatively and qualitatively analyzed to identify actions associated with preference-concordant treatment.Results Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment.Conclusions Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care. (shrink)

Building artificial moral agents (AMAs) underscores the fragmentary character of presently available models of human ethical behavior. It is a distinctly different enterprise from either the attempt by moral philosophers to illuminate the “ought” of ethics or the research by cognitive scientists directed at revealing the mechanisms that influence moral psychology, and yet it draws on both. Philosophers and cognitive scientists have tended to stress the importance of particular cognitive mechanisms, e.g., reasoning, moral sentiments, heuristics, intuitions, (...) or a moral grammar, in the making of moral decisions. However, assembling a system from the bottom-up which is capable of accommodating moral considerations draws attention to the importance of a much wider array of mechanisms in honing moral intelligence. Moral machines need not emulate human cognitive faculties in order to function satisfactorily in responding to morally significant situations. But working through methods for building AMAs will have a profound effect in deepening an appreciation for the many mechanisms that contribute to a moral acumen, and the manner in which these mechanisms work together. Building AMAs highlights the need for a comprehensive model of how humans arrive at satisfactory moral judgments. (shrink)

Fourteen experienced psychiatric nurses participated in a pilot study aimed at describing the experiential aspect of making decisions for the patient. In-depth interviews focused on conflicts, were transcribed, coded, and categorized according to the Grounded Theory method. The theoretical construct, 'modifying autonomy' and its dimensions, such as being aware of the patient's vulnerability, caring for and caring about the patient, were identified. The findings in this study make clear the need for further research into the experiential aspect of (...) ethical decision-making in psychiatric practice. (shrink)

The failure of medical codes to provide adequate guidance for physicians' moral dilemmas points to the fact that some rules of analysis, informed by moral theory, are needed to assist in resolving perplexing ethical problems occurring with increasing frequency as medical technology advances. Initially, deontological and teleological theories appear more helpful, but critcisms can be lodged against both, and neither proves to be sufficient in itself. This paper suggests that to elude the limitations of previous approaches, a (...) class='Hi'>method of moral decision making must be developed incorporating both coherence methodology and some independently supported theoretical foundations. Wide Reflective Equilibrium is offered, and its process described along with a theory of the person which is used to animate the process. Steps are outlined to be used in the process, leading to the application of the method to an actual case. (shrink)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical (...) pragmatism for the use of principles in moral problem solving are discussed. (shrink)

This study involved using a mixed method research design to examine the moral philosophy difference between the ethical decision-making process of CEOs in U.S.-led and non-U.S.-led within the luxury goods industry. The study employed a MANOVA to compare the ethical profiles between the two leader types and a phenomenological qualitative process to locate themes that give indication as to the compatibility of the luxury strategy values and practices with the principles and concepts of responsible leadership and (...) conscious capitalism. As the luxury goods industry is facing the first slowdown since 2000, pressure to achieve sales targets in the U.S. to make up for losses in other markets will place these CEOs under extreme pressure from their headquarters. These leaders must possess the ethical decision-making capability to balance legal and moral dilemmas unique to multinational luxury goods organizations while delivering business results in a challenging environment. Results of the study show no evidence of difference in the ethical decision-making profiles between the two groups of leaders. The themes and emergent findings resulting from the qualitative analysis indicate a profound incompatibility between the values informing decision-makers using the luxury strategy and those employed by leaders operating within the principles and parameters of responsible leadership and conscious capitalism. Recommendations for future research include replicating the study with a larger sample, within a different geographic region or comparing leaders using the luxury strategy to those using conscious capitalism. (shrink)

This paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main problems usually keep us form acting and judging in a morally decent way: firstly, we make mistakes in moral reasoning. Secondly, even when we know how to act (...) and judge, we still fail to meet the requirements due to personal weaknesses. This discussion naturally leads us to another question: can we narrow the gap between what people are morally required to do and what they actually do? We discuss findings from neuroscience, economics, and psychology, considering how we might bring our moral behavior better in line with moral theory. Potentially fruitful means include nudging, training, pharmacological enhancement, and brain stimulation. We conclude by raising the question of whether such methods could and should be implemented. (shrink)

Objective—To determine the objectivity, consistency and professional unanimity in the initiation, continuation and withdrawal of life-prolonging procedures in intensive care–to determine methods, time-scale for withdrawal and communication with both staff and relatives–to explore any professional unease about legality, morality or professional defensibility.Design—A structured questionnaire directed at clinical nurse managers for intensive care.Setting—All intensive care units in the Yorkshire region.Results—The survey reported a lack of consistency and objectivity in decision making in this area, with accompanying unease amongst staff.Conclusions—There is (...) a need to work towards more consistent care, both before and during admission, for the protection of the individual patient and to allow rational assessment of intensive care need. Comprehensive audit should lead to objective defensible decisions and facilitate informed choice. More open debate and better communication should minimise this issue as a source of stress amongst staff in intensive care. (shrink)

Recent theories of decision making are characterised by a growing emphasis on understanding the cognitive mechanisms that produce decisions. This has seen a growth in methods that allow for the con...

Purpose. The study seeks to clarify the preconditions for moral and legal decision-making based on the identification of axiological foundations that correlate with the moral perceptions of good and evil and psychological phenomena such as emotions. Theoretical basis of the study is to apply comparative, axiological, systemic methods. This methodological approach allows us to analyze and disclose the essence of the process of moral and legal decision-making on the basis of certain axiological prerequisites (...) and enables to substantiate the connection between the axiological and psychological aspects of taking moral and legal decisions. Originality of the work is to broaden the perceptions of the processes and mechanisms for making moral and legal decisions, which are based on the axiological dimension, in particular on the system of reference individual and social values. The study shows that every necessary moral and legal decision taken by a person is futurologically balanced in the emotional sense, rationally reasoned and morally perceptible in the context of man’s beliefs about good and evil, and realized with necessity in the personal system of reference values that determines the style and manner of individual and social behaviour in the context of material and spiritual values and is an axiological foundation for making all types of moral and legal decisions. Conclusions. Moral and legal decision-making is a social process that is connected with such a social essence of a person as rationality, which gives an opportunity to act axiologically. A person makes moral and legal decisions in a complex way, based on the unity of the moral, axiological and psychological aspects of his worldview, which are grounded on the system of reference values. (shrink)

Objective To compare assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool.Methods This study was carried out at the psychiatry clinic of Kocaeli University Hospital from June 2007 to February 2008. The decision-making competence of the 83 patients who participated in the study was assessed by physicians, nurses, relatives and MacCAT-T.Results Of the 83 patients, the relatives of 73.8% of them, including the parents of 47.7%, were interviewed (...) during the study. A moderately good consistency between the competency assessments of the nurses versus those of the physicians, but a poor consistency between the assessments of the physicians and nurses versus those of the patients’ relatives, was determined. The differences in the competency assessment obtained with the MacCAT-T versus the evaluations of the physicians, nurses and patients’ relatives were statistically significant.Conclusions Our findings demonstrate those physicians, nurses and the patients’ relatives have difficulty in identifying patients lacking decision-making competence. Therefore, an objective competence assessment tool should be used along with the assessments of physicians and nurses, both of whom can provide clinical data, as well as those of relatives, who can offer insights into the patient's moral values and expectations. (shrink)

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

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

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

Background The birth plan is a tool that allows the self-learning and thoughtful analysis of the women during the birthing process, facilitating their making of decisions and participation, in agreement with the bioethical principles of autonomy and no malfeasance. Goal: To understand the perception and satisfaction of women who presented a birth plan. Methodology: Qualitative, descriptive, observational, retrospective and cross-sectional study. The population of the study was composed of 21 women who presented a birth plan regulated in a Hospital (...) ever since the recording of the presentation of the birth plan was started until 2015. Place: Cartagena. Techniques/methods: Semistructured interview. Results-Discussion: Most women considered the plan as a useful self-learning tool on the meaning of the birthing process, as it favored the communication between the expectant mothers/health professionals. Our informants sought information related to the birthing process from informal sources; most perceived a level of respect of their wishes during the process of giving birth. The use of the birth plan did not imply the perception of loss of the degree of control during the birth, although attention to the written document could be improved. Conclusions The use of the birth plan is a very satisfactory and useful experience for their involvement in their self-care, although in some cases, the births did not proceed according to their plans. Nevertheless, the prevalence of the principle of Non-Malfeasance over Autonomy was evidenced. (shrink)

This introduction just aims to be a fast foreword to the special topic now turned into an e-book. The Editorial "Decision-Making Experiments under a Philosophical Analysis: Human Choice as a Challenge for Neuroscience" alongside with my opinion article "Neurophilosophical considerations on decision making: Pushing-up the frontiers without disregarding their foundations" play the real role of considering in more details the articles and the whole purpose of this e-book. What I must highlight in this foreword is that (...) our intention with such a project was to deepen into the very foundations of our current paradigms in decision neuroscience and to philosophically moot its foundations and repercussions. Normal Science (a term coined by Philosopher Thomas Kuhn) works under a research consensus among a scientific community: A shared paradigm, consolidated methods, widespread convictions. Pragmatically, winning formulas must be kept, although, not at any cost. What differentiates a gifted and revolutionary scientist from a more bureaucratic colleague is the capacity and willingness of constantly reevaluating, depurating and refining his/her own paradigm. That is best strategy to avoid that a paradigm itself would gradually come under challenge. In my view, some achievements, in this sense, were brought about in our project. The e-book will be inspiring and informative for both neuroscientists that are concerned with the very foundations of their works and for philosophers that are not blind to empirical evidence. Kant once said: “Thoughts without content are empty, intuitions without concepts are blind”. Paraphrasing Kant we could say: Philosophy without science is empty, science without philosophy is blind. (shrink)

Taking an abductive, mixed-methods approach, we explore the content of people’s moral deliberations. In Study 1, we gather qualitative data from small groups of graduate business students discussing moral dilemmas. We analyze their conversations with a focus on how participants perceive others’ thoughts, opinions, and evaluations about the dilemmas and incorporate them into their reasoning. Ascribing such capacities to think and feel to others—i.e., mind perception—is central to morality. We use the conversations in Study 1 to identify whose (...) minds participants perceive. Study 1 also identifies how particular elements of deliberation—including the exploration of consequences, acknowledging ambivalence, seeking alternative options, the development of deep feelings, and the search for a moral compass—are linked to these perceptions of others’ minds. In Study 2 (an exploratory, online experiment with 378 participants), we find that priming individuals with specific forms of mind perception can influence the elements of moral reasoning they employ, and we find evidence that the presence of elements of reasoning are linked to participants’ final choices in a business-related ethical dilemma. (shrink)

The paper reflects on the methods democratic systems use for arriving at decisions. The most popular ones are elections where the majority rules and deliberative democracy. I argue that both of these do not measure up to the demands of democracy. Whether we use voting with majority rule or deliberative methods, only a portion of the citizenry is allowed to rule itself; minorities are always excluded. Instead of voting with majority ruler or deliberative methods, I suggest that we employ mediation (...) to reach agreement in democratic publics. (shrink)

The paper reflects on the methods democratic systems use for arriving at decisions. The most popular ones are elections where the majority rules and deliberative democracy. I argue that both of these do not measure up to the demands of democracy. Whether we use voting with majority rule or deliberative methods, only a portion of the citizenry is allowed to rule itself; minorities are always excluded. Instead of voting with majority ruler or deliberative methods, I suggest that we employ mediation (...) to reach agreement in democratic publics. (shrink)

In this paper I argue that the trolley method of moral philosophy has three shortcomings not yet adequately addressed in the literature. First, trolley problems highlight high stakes ethical decisions. These decisions do not represent the majority of ethical decisions made by most people, and thus, the trolley method ignores most of moral life. Second, the trolley method operates by way of a faux-anonymization of moral agents. This process leads to descriptions of moral (...) agents being unwittingly supplied by those to whom the problems are presented and thereby the formation of a paradigmatic moral agent which excludes a considerable number of real world moral persons. Lastly, the trolley method mischaracterizes what most moral decision-making is like by presenting a moral agent's decision as isolated, uninfluenced, and made with full self-awareness. (shrink)

The purpose of this study is to expand our understanding of the factors that influence ethical behavioral intentions of public accountants. Recent scandals have dominated the news and have caused legislators, regulators and the public to question the role of the accounting profession. Legislative changes have brought about major structural changes in the profession and continued scrutiny will surely lead to further changes. Thus, developing an understanding of the personal and contextual factors that influence ethical decisions is critical. An extension (...) of the theory of planned behavior [Ajzen, I.: 1985, Action Control-From Cognition to Behavior ], the model used in this study examined the influence of personal, social and organizational factors on ethical intentions. Specifically, the individual level model tested direct eects of attitudes, subjective norms, perceived behavioral control, moral sensitivity and ethical climate. Professionals from five accounting firms completed a survey that measured responses to ethical dilemmas related to the public accounting domain. To minimize the potential impact of common method bias, the survey instrument was administered in two phases. Hypotheses were evaluated using a structural modeling technique, partial least squares. Results show strong support for a direct relationship between attitudes and ethical intentions. The proposed direct eect of subjective norms was not supported. However, a significant relationship between subjective norms and attitudes was found. Professionals' attitudes towards ethical issues clearly influence intentions. Moreover, this study illustrates the potential influence of social factors in attitude formation. Future research should explore the factors in the public accounting domain that most strongly influence attitude formation. This study suggests that the theory of reasoned action oers a useful framework for exploring these issues. (shrink)

I analyze recent discussions about making moral decisions under normative uncertainty. I discuss whether this kind of uncertainty should have practical consequences for decisions and whether there are reliable methods of reasoning that deal with the possibility that we are wrong about some moral issues. I defend a limited use of the decision theory model of reasoning in cases of normative uncertainty.

Background Abortion is one of the most common gynaecological procedures. It is related to personal, social, and economic reasons under a legal term that is recognised as a common sexual and reproductive right in most of countries. However, making the decision to abort is complex, because it is politicised and is often framed in public discourse related to moral or ethical issues beyond women’s experiences. Therefore, it is subject to medical criteria, religious evaluations, and sociological analysis. Purpouse (...) The aim of this synthesis of qualitative studies was to synthesise the decision-making experiences of women who legally aborted. Research design and method The Noblit and Hare’s interpretive meta‐ethnography was conducted, and it was written in accordance with the eMERGe meta‐ethnography reporting guidance. Ten studies met the research objective and inclusion criteria, after a comprehensive systematic search strategy in five databases. Findings The metaphor “The wrestling between why and what will happen next” and three themes emerged from the data analysis: (1) Forces that incite the arm wrestling; (2) Facing social stigma; and (3) Defeated by a greater rival. The metaphor provided interpretive experiences of the moral conflict experienced by women who decided to have an abortion and emerged from the confrontation of the reasons why they decided to abort and the social repercussions that making the decision entails. The result of the struggle was loneliness and vulnerability. Conclusion The lines of action impact policy makers, the media, and health professionals. Actions should focus on the de-stigmatisation and normalisation of abortion, the use of appropriate language, and the training and sensitisation of health professionals. (shrink)

Information on the factors influencing parents’ decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden’s thematic synthesis method was used (...) to synthesise data from identified studies. Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled ‘all life is precious’, described parents’ perception of the importance of the fetus’ life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 contained two sub-themes which considered the parent’s own imagined future and the influence of other people’s experiences. Finally, Theme 3 presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents’ decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other’s quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices. (shrink)

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

BackgroundIn order to achieve the goals of the healthcare system, nursing managers are required to comply with ethical principles in decision-making. In complex and challenging healthcare settings, it is shown that the managers’ mere awareness of ethics does not suffice and managers need to be sensitive toward making ethical decisions.AimTo explore nursing managers and their sensitivity toward ethical decision-making by analyzing their related experiences.MethodThe current study has been conducted in Iran in 2017 through a qualitative (...) content analysis approach. Nineteen nurse managers were selected purposefully from different hospitals in Tehran. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method.Ethical considerationsThe research was approved by the ethics committee of Tarbiat Modares University, Tehran, Iran. Participants were informed about the purpose of the study and submitted written informed consents regarding their participation. The principle of autonomy, confidentiality, and anonymity was taken into account in data collection.ResultsFifteen subcategories, three categories (assertiveness, commitment, and insight), and one theme of excellent decision-making were the results of data analysis.DiscussionFindings showed that nursing managers’ sensitivity to ethical decision-making allows them to make the best decision by insight, commitment, and assertiveness. Making a morally excellent decision ensures that ethical principles are followed in the healthcare system.ConclusionConsidering that most managers are committed to making ethical decisions, it is required to develop the scope of their insights even further using a professional management and ethical principles training program. Also, by addressing some of the ethical barriers at personal and organizational levels, the assertiveness in managers can be improved, which in turn can facilitate their ethical decision-making. (shrink)

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

Background: This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient’s decision-making capacity. The study aims to answer: 1) does concern about a patient’s treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and (...) the moral permissibility to refuse LST, and 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient’s treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers. (shrink)

Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a (...) practice-oriented ethics support tool to assist care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care. Results Care providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions. Discussion Developing an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support. (shrink)

Meta-moral cognitive skills consist of identifying reasons behind ethical decisions, potential criticisms for such reasons, and constructing counterarguments for these criticisms. We assessed the relationship among these three elements of ethical judgment justification using ethical dilemmas. A mixed-methods research design was used to investigate university students from India and Japan. Critical thinking skills, knowledge of professional ethics, discipline, perspective-taking, common sense, and culture influenced the respondents’ meta-moral cognitive skills. There was a correlation between the number/strength of reasons and (...) criticisms and between criticisms and counterarguments. The respondents had difficulty connecting the reasons for their decisions and their counterarguments. The results imply that incorporating personal and professional cases as part of the ethics curriculum can improve meta-moral cognitive skills. (shrink)

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

The purpose of this study is to expand our understanding of the factors that influence ethical behavioral intentions of public accountants. Recent scandals have dominated the news and have caused legislators, regulators and the public to question the role of the accounting profession. Legislative changes have brought about major structural changes in the profession and continued scrutiny will surely lead to further changes. Thus, developing an understanding of the personal and contextual factors that influence ethical decisions is critical. An extension (...) of the theory of planned behavior [Ajzen, I.: 1985, Action Control-From Cognition to Behavior (Springer, Heidelberg)], the model used in this study examined the influence of personal, social and organizational factors on ethical intentions. Specifically, the individual level model tested direct effects of attitudes, subjective norms, perceived behavioral control, moral sensitivity and ethical climate. Professionals from five accounting firms completed a survey that measured responses to ethical dilemmas related to the public accounting domain. To minimize the potential impact of common method bias, the survey instrument was administered in two phases. Hypotheses were evaluated using a structural modeling technique, partial least squares. Results show strong support for a direct relationship between attitudes and ethical intentions. The proposed direct effect of subjective norms was not supported. However, a significant relationship between subjective norms and attitudes was found. Professionals’ attitudes towards ethical issues clearly influence intentions. Moreover, this study illustrates the potential influence of social factors in attitude formation. Future research should explore the factors in the public accounting domain that most strongly influence attitude formation. This study suggests that the theory of reasoned action offers a useful framework for exploring these issues. (shrink)

Preference formation and choice are dynamic cognitive processes arising from interactions between decision-makers and their immediate choice environment. This thesis examines how preferences and decisions are played out in visual attention, captured by eye-movements, as well as in group contexts. Papers I-II make use of the Choice Blindness paradigm. Paper I compares participants’ eye movements and pupil dilation over the course of a trial when participants detect and fail to detect the false feedback concerning their choices. Results indicate objective (...) markers of detection with important implications for questions concerning possible demand effect or cognitive dissonance explanations of choice blindness. Paper II examines another aspect of the choice environment, namely, the social context. Choice blindness is demonstrated in small groups for the first time. It is shown that preferential change can be induced in dyads by manipulating the group’s beliefs about their choices, thus extending the preference change through choice effects beyond individuals for the first time. Paper III examines how visual attention differentially supports both decision and memory processes depending on the amount of task-relevant information available to participants. Participants’ performance and visual attention dynamics was found to vary depending on the amount of information available to them, and the results indicate that decision outcomes are heavily influenced by encoding prior to traditional choice phases used in decision research. Papers IV-VII concern decision-making in the moral domain. Paper IV investigates visual attention when participants choose between difficult moral dilemmas, showing asymmetries in how participants distribute their attention depending on making utilitarian or deontological choices. Paper V introduces a novel paradigm for influencing decision based manipulating the timing of decision by measuring the direction of gaze while the participant deliberates. Using this method participants’ moral decisions were biased without their knowledge to a randomly chosen alternative. This shows that moral decision and visual attention are highly coupled and that by simply knowing where someone is looking it is possible to influence their decision process. Papers VI&VII build on the links between gaze direction and moral choice and present the first computational decision models based on eye gaze applicable to the moral domain. Paper VI for choices between abstract principles and Paper VII for donations to charitable organizations. Together the papers advance novel methodological solutions to understanding preferences and decisions across a number of domains, both highlighting the important contributions of social and sensorimotor interactions to the content of our decisions as they develop over time, as well as demonstrating how decisions can be influenced by leveraging those interactions. (shrink)

Background Ethical decision-making confidence develops from clinical expertise and is a core competency for nurse leaders. No tool exists to measure confidence levels in nurse leaders based upon an ethical decision-making framework. Aims The objective of this research was to compare ethical decision-making among nurse leaders in the U.S. and three German-speaking countries in Europe by developing and testing a newly constructed Ethical Decision-Making Confidence (EDMC) scale. Methods The cross-sectional survey included 18 (...) theory-derived questions on ethical decision-making confidence which were used to develop the scale. Participants A convenience sample of nurse leaders from the U.S. and three German-speaking countries in Europe who self-identified as holding a leadership position. Ethical Considerations Ethical approval was given by the IRB Board of a U.S. university. Participation in the survey implied voluntary consent. Results The scale’s item structure dimensionality and subscale’s reliability were analyzed and compared between nurse leaders from all four countries. A principal component analysis (PCA) produced a 15-item bi-dimensional EDMC scale yielding a skill-related (9-item) and a behavior-related (6-item) confidence dimension. EDMC subscales showed good-to-excellent internal consistency. In both subscales, U.S. nurse leaders rated their mean EDMC score higher than their German-speaking counterparts in Europe. Discussion This exploratory study is the first of its kind to focus on nurse leaders’ confidence regarding ethical decision-making in an international context. An overarching factor structure was identified, which is shared by the two samples of nurse leaders and to examine (sub)scales’ psychometric properties. Conclusion This newly developed scale is an effective tool for measuring ethical decision-making confidence in nurse leaders. The promising results of this study should be replicated to ensure validity and reliability of the EDMC scale measuring skill-related and behavior-related concepts and include nurse leaders from various cultural, social, and demographic groups. (shrink)

This study compares the neural substrate of moral decision making processes between Korean and American participants. By comparison with Americans, Korean participants showed increased activity in the right putamen associated with socio-intuitive processes and right superior frontal gyrus associated with cognitive control processes under a moral-personal condition, and in the right postcentral sulcus associated with mental calculation in familiar contexts under a moral-impersonal condition. On the other hand, American participants showed a significantly higher degree of (...) activity in the bilateral anterior cingulate cortex (ACC) associated with conflict resolution under the moral-personal condition, and in the right medial frontal gyrus (MFG) associated with simple cognitive branching in non-familiar contexts under the moral-impersonal condition when a more lenient threshold was applied, than Korean participants. These findings support the ideas of the interactions between the cultural background, education, and brain development, proposed in the field of cultural psychology and educational psychology. The study introduces educational implications relevant to moral psychologists and educators. (shrink)

In the present study business managers in Kabi Pharmacia Company were trained in the use of the autonomous method in their decision-making about solving real life business ethics problems. According to the psychological theories of Piaget, Vygotsky, and Kohlberg, it is possible to promote the acquisition of the autonomous ethical skill by instruction and training. Indeed, participation in a one-day educational programme which focused on the training of the autonomous cognitive ability and not on the transfer of (...) moral content, was sufficient to provide a shift in the mode of decision-making about business ethics problems towards the autonomous ethical function. This change was still stable one month later. A test was constructed by items representing current business ethics conflicts in order to assess ethical function. (shrink)

Recently, there has been a resurgence of interest in general, comprehensive models of human cognition. Such models aim to explain higher-order cognitive faculties, such as deliberation and planning. Given a computational representation, the validity of these models can be tested in computer simulations such as software agents or embodied robots. The push to implement computational models of this kind has created the field of artificial general intelligence (AGI). Moral decision making is arguably one of the most challenging (...) tasks for computational approaches to higher-order cognition. The need for increasingly autonomous artificial agents to factor moral considerations into their choices and actions has given rise to another new field of inquiry variously known as Machine Morality, Machine Ethics, Roboethics, or Friendly AI. In this study, we discuss how LIDA, an AGI model of human cognition, can be adapted to model both affective and rational features of moral decision making. Using the LIDA model, we will demonstrate how moral decisions can be made in many domains using the same mechanisms that enable general decision making. Comprehensive models of human cognition typically aim for compatibility with recent research in the cognitive and neural sciences. Global workspace theory, proposed by the neuropsychologist Bernard Baars (1988), is a highly regarded model of human cognition that is currently being computationally instantiated in several software implementations. LIDA (Franklin, Baars, Ramamurthy, & Ventura, 2005) is one such computational implementation. LIDA is both a set of computational tools and an underlying model of human cognition, which provides mechanisms that are capable of explaining how an agent’s selection of its next action arises from bottom-up collection of sensory data and top-down processes for making sense of its current situation. We will describe how the LIDA model helps integrate emotions into the human decision-making process, and we will elucidate a process whereby an agent can work through an ethical problem to reach a solution that takes account of ethically relevant factors. (shrink)

Ofsted requires UK schools to help students understand the working world and gain employability skills. However, the aims of education are much broader: Education should enable flourishing long after leaving school. Therefore, students’ career decisions should be conducive to long-term flourishing beyond career readiness and educational attainment. In this mixed-methods study, we asked a representative sample of UK adults to reflect on their career decision-making processes at school and at university. We also measured current levels of self-reported objective (...) (e.g., financial security) and subjective (e.g., subjective well-being) flourishing. The open-ended career decision reflections were coded for three moral reasoning strategies: virtue ethical, consequentialist, and deontological. Using correlations and structural equation modelling, we examined the association between the propensity for using each moral reasoning strategy in past career decisions and current flourishing. Virtue ethical moral reasoning in relation to career decision-making predicted aspects of flourishing most strongly and frequently. Consequentialist reasoning weakly and infrequently positively predicted aspects of flourishing. Deontological reasoning either did not predict flourishing at all, or negatively predicted flourishing. Our results suggest that the reasoning strategy behind career decisions people take in school or university is important to consider in UK careers provision, and current best practice. (shrink)

Environmental problems have an ethical dimension. They are not just about the efficient use of resources. Justice in the distribution of environmental goods and burdens, fairness in the processes of environmental decision-making, the moral claims of future generations and non-humans, these and other ethical values inform the responses of citizens to environmental problems. How can these concerns enter into good policy-making processes?Two expert-based approaches are commonly advocated for incorporating ethical values into environmental decision-making. One (...) is an 'economic capture' approach, according to which existing economic methods can be successfully extended to include ethical concerns. For example, stated preference methods, especially contingent valuation, have been developed to try and capture ethical responses as 'non-use values' of the environment, in particular 'existence values'. The other is a 'moral expert' approach which confines economic methods to the analysis of welfare gains, and assumes committees of ethical experts will complement economic expertise.Both approaches face problems in terms of addressing many widely held ethical values about the environment. Furthermore, both face problems concerning the democratic legitimacy of their procedures. How can policy-making be made responsive to different ethical values? What role is there for new deliberative and participatory methods? How far do existing decision-making institutions have the capacities to incorporate different modes of articulating environmental values?This policy brief examines the limitations of current attempts to capture ethical values within existing economic instruments and considers how these limitations might be overcome. Section 1 examines the assumptions that standard economic theory makes about individuals when they express values and make choices about the environment. The current models of agents that inform policy-making are seen to be ill-suited to incorporating the ethical responses of agents and this reveals some of the policy failures that may result. Section 2 shows how the physical and social properties of many environmental goods prevent their being treated as commodities. Section 3 considers the problems surrounding conceptions of fairness and legitimacy in processes for environmental valuation. Section 4 raises questions concerning the capacities of policy-making institutions to take cognisance of the results of different methods for articulating environmental values. (shrink)

On what basis should we judge whether a parent’s medical decision for their child is morally acceptable? In a recent article, Johan Bester attempts to answer this question by defending a version of the Best Interest Standard for parental decision making. The purpose of this paper is to identify a number of problems faced by Bester’s version of BIS and to suggest ways to redress these problems. Accordingly, we intend to advance the project of formulating a (...) class='Hi'>method for guiding parents’ medical decision making for their children. We argue that Bester’s standard fails to accommodate the autonomy of the child and that his criteria for assessing the reasonableness of the parents’ argument for their decision is too weak. We conclude that properly addressing these worries renders his test otiose and that it ought to be replaced with the three commonly held principles of bioethics—the principles of autonomy, beneficence, non-maleficence—and a standard of reasonableness. (shrink)

Environmental problems have an ethical dimension. They are not just about the efficient use of resources. Justice in the distribution of environmental goods and burdens, fairness in the processes of environmental decision-making, the moral claims of future generations and non-humans, these and other ethical values inform the responses of citizens to environmental problems. How can these concerns enter into good policy-making processes?Two expert-based approaches are commonly advocated for incorporating ethical values into environmental decision-making. One (...) is an 'economic capture' approach, according to which existing economic methods can be successfully extended to include ethical concerns. For example, stated preference methods, especially contingent valuation, have been developed to try and capture ethical responses as 'non-use values' of the environment, in particular 'existence values'. The other is a 'moral expert' approach which confines economic methods to the analysis of welfare gains, and assumes committees of ethical experts will complement economic expertise.Both approaches face problems in terms of addressing many widely held ethical values about the environment. Furthermore, both face problems concerning the democratic legitimacy of their procedures. How can policy-making be made responsive to different ethical values? What role is there for new deliberative and participatory methods? How far do existing decision-making institutions have the capacities to incorporate different modes of articulating environmental values?This policy brief examines the limitations of current attempts to capture ethical values within existing economic instruments and considers how these limitations might be overcome. Section 1 examines the assumptions that standard economic theory makes about individuals when they express values and make choices about the environment. The current models of agents that inform policy-making are seen to be ill-suited to incorporating the ethical responses of agents and this reveals some of the policy failures that may result. Section 2 shows how the physical and social properties of many environmental goods prevent their being treated as commodities. Section 3 considers the problems surrounding conceptions of fairness and legitimacy in processes for environmental valuation. Section 4 raises questions concerning the capacities of policy-making institutions to take cognisance of the results of different methods for articulating environmental values. (shrink)

Background:Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision.Objectives:The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel.Methods:In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were (...) collected by deep and semi-structured interviews. Finally, the data are analyzed using the content analysis approach.Ethical considerations:Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality.Findings:The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes.Conclusion:Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients’ moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them. (shrink)

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