This paper introduces a refined single-valued neutrosophic set (RSVNS) and presents a similarity measure of RSVNSs. Then a multicriteria decision-making method with RSVNS information is developed based on the similarity measure of RSVNSs. By the similarity measure between each alternative and the ideal solution (ideal alternative), all the alternatives can be ranked and the best one can be selected as well. Finally, an actual example on the selecting problems of construction projects demonstrates the application and effectiveness of (...) the proposed method. (shrink)

Incorporation of the behavioral issues of the decision maker (DM) is among the aspects that each Multicriteria Decision Making (MCDM) method implicitly or explicitly takes into account. As postulated by regret theory, the feelings of regret and rejoice are among the behavioral issues associated with the entire decision making process. Within the context of MCDM, the DM may feel regret, when the chosen alternative is compared with another one having at least one better criterion (...) value. PROMETHEE II is a widely known MCDM method that makes no explicit incorporation of regret attitude of the DM. In this paper, we elaborate on the applicability of regret theory to MCDM context. In particular, we investigate the findings of regret theory and explore the parallel between regret theory and PROMETHEE II method. Relying on the concepts of regret theory, we demonstrate how a decision that is made using a PROMETHEE II based outranking method conforms to the regret attitude of the DM. (shrink)

We focus on a class of multicriteria methods that are commonly used in environmental decision making--those that employ the weighted linear average algorithm (and this includes the popular analytic hierarchy process (AHP)). While we do not doubt the potential benefits of using formal decision methods of this type, we draw attention to the consequences of not using them well. In particular, we highlight a property of these methods that should not be overlooked when they are applied (...) in environmental and wider decision-making contexts: the final decision or ranking of options is dependent on the choice of performance scoring scales for the criteria when the criteria weights are held constant. We compare this "sensitivity" to a well-known criticism of the AHP, and we go on to describe the more general lesson when it comes to using weighted linear average methods--a lesson concerning the relationship between criteria weights and performance scoring scales. (shrink)

In this study, we propose a new approach based on fuzzy TODIM (Portuguese acronym for interactive and multicriteria decision-making) for decision-making problems in uncertain environments. Our method incorporates group utility and individual regret, which are often ignored in traditional multicriteria decision-making (MCDM) methods. To enhance the analysis and application of fuzzy sets in decision-making processes, we introduce novel entropy and distance measures for q-rung picture fuzzy sets. These measures include an (...) entropy measure based on the sine function and a distance measure derived from the Jensen-Shannon divergence. In our methodology, incorporating the sine function into the entropy measure stands out as a distinctive decision, grounded in a profound understanding of the inherent characteristics of fuzzy sets. Utilizing the sine function proves especially advantageous when handling fuzzy sets that exhibit cyclical variations or fluctuations in their membership degrees. We effectively weight the criteria for an improved evaluation by using this new entropy measure. The introduced distance measure finds application in the TODIM approach, allowing the execution of TODIM method steps within a fuzzy environment until the determination of one alternative’s dominance over another—an advancement beyond traditional approaches. We apply our enhanced fuzzy TODIM method to a real-life construction project management problem from the literature and compare the results with those in the literature and obtained from other MCDM methods. Our proposed measures are robust, as demonstrated by the sensitivity analysis that varied the weights of group utility and individual regret, with the results visualized in a 3D sensitivity plot. The findings demonstrate the superiority of our method in providing a more comprehensive evaluation of alternatives, making it a useful tool for decision-makers facing complex and uncertain decision-making problems. (shrink)

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision (...) support service, based on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital. (shrink)

This paper proposes several concepts of efficient solutions for multicriteria decision problems under uncertainty. We show how alternative notions of efficiency may be grounded on different decision ‘contexts’, depending on what is known about the Decision Maker's (DM) preference structure and probabilistic anticipations. We define efficient sets arising naturally from polar decision contexts. We investigate these sets from the points of view of their relative inclusions and point out some particular subsets which may be especially (...) relevant to some decision situations. (shrink)

Norton has argued for the salience of deliberative strategies for making environmental decisions which is supposed to be preferable to formal decision analysis. This paper argues that formal multicriteria decision analysis, when deployed with care, has the flexibility to absorb the advantages of deliberative decision making. It can also be used for decision support during a deliberative process. This feature of decision analysis is illustrated using a case study from Merauke in Papua (...) province of Indonesian New Guinea. (shrink)

Evidence suggests that men are more confident and less risk averse in financial decision making. Researchers did not address how men and women respond differently to goals in financial decision situations, however. In the present study, men set more challenging personal goals and risked more resources than women in a complex financial decision task. Men did not report higher self-efficacy versus women. As expected, gender interacted with assigned goals to predict self-efficacy, risk behavior, and personal goals. (...) Results concur with recent financial decision research that suggests men and women differ in their use of externally-provided information such as assigned goals. Suggestions for future research are offered and limitations are discussed. (shrink)

We are sceptical of concerns over the opacity of algorithmic decision tools. While transparency and explainability are certainly important desiderata in algorithmic governance, we worry that automated decision-making is being held to an unrealistically high standard, possibly owing to an unrealistically high estimate of the degree of transparency attainable from human decision-makers. In this paper, we review evidence demonstrating that much human decision-making is fraught with transparency problems, show in what respects AI fares little (...) worse or better and argue that at least some regulatory proposals for explainable AI could end up setting the bar higher than is necessary or indeed helpful. The demands of practical reason require the justification of action to be pitched at the level of practical reason. Decision tools that support or supplant practical reasoning should not be expected to aim higher than this. We cast this desideratum in terms of Daniel Dennett’s theory of the “intentional stance” and argue that since the justification of action for human purposes takes the form of intentional stance explanation, the justification of algorithmic decisions should take the same form. In practice, this means that the sorts of explanations for algorithmic decisions that are analogous to intentional stance explanations should be preferred over ones that aim at the architectural innards of a decision tool. (shrink)

This study focuses on the application of multicriteria decision-making techniques, specifically the analytic hierarchy process (AHP), to identify corporate socialresponsibility information which both companies and stakeholders consider relevant and material. This work explains how the AHP methodology was applied in the selection of material indicators in corporate social responsibility reporting, the interpretation of these indicators and their relative importance. The results of this study are summarized in 60 indicators distributed in four areas: environment, economy, corporate governance and (...) social. As this last area contains the greatest number of indicators, it was divided into four sub-areas (human resources, human rights, product responsibility and society). (shrink)

A structured collection of tools for engineering resilience and a research approach to improve the resilience of a power grid are described in this paper. The collection is organized by a two-dimensional array formed from typologies of power grid components and business processes. These two dimensions provide physical and operational outlooks, respectively, for a power grid. The approach for resilience research is based on building a simulation model of a power grid which utilizes a resilience assessment equation to assess baseline (...) resilience to a hazards’ profile, then iteratively selects a subset of tools from the collection, and introduces these as interventions in the power grid simulation model. Calculating the difference in resilience associated with each subset supports multicriteria decision-making to find the most convenient subset of interventions for a power grid and hazards’ profile. Resilience is an emergent quality of a power grid system, and therefore resilience research and interventions must be system-driven. This paper outlines further research required prior to the practical application of this approach. (shrink)

In recent years, the amount of data in the world is growing rapidly. Data growth also occurs in the government sector. All ministries and institutions at every level are data producers. These government-owned data have a high potential if they can be used properly. Open government data can stimulate innovation and economic growth and enhance business models. In order to increase the willingness of citizens to use open government data and enjoy the benefits mentioned, the quality of open government data (...) needs to be improved. The quality of open government data encompasses a variety of dimensions and criteria. Also, the importance of each dimension and criterion in increasing the quality of open government data is different. Therefore, we are faced with a complex system that requires proper decision-making and management. In fact, we are dealing with decision-making in the complex management system. Given the importance of this issue, the purpose of this study is to provide a new and comprehensive method to improve the quality of open government data and increase the willingness of citizens to use the data by considering the complex network of citizens and organizations. For this purpose, library studies have been used to extract comprehensive and effective dimensions and criteria. The statistical population includes all articles related to the criteria of improving the quality of open government data and increasing the willingness of citizens to use the data. The probabilistic sampling method of simple random samples has been used, and 10 articles in this field have been reviewed. After extracting the criteria as well as the data of 112 governmental organizations and institutions related to each criterion from the open data portal, the complex network of citizens and governmental organizations and institutions has been analyzed in order to identify high-degree centrality organizations. Then, the data characteristics of the organizations that were most desired by the citizens were extracted using data mining techniques including the regression model. Also, field method and multicriteria decision-making technique including the DEMATEL technique have been used to express the solutions and identify the cause-and-effect relationships between the solutions. The criteria extracted in improving the quality of open government data and increasing the willingness of citizens to use the data are included: “data originality,” “license openness,” “up-to-datedness,” “data access,” “metadata completeness,” “number of data sets,” “format openness,” “nondiscrimination,” “understandable,” “number of categories of data sets,” “free,” “lack of missing data,” “data request ability,” “visualization,” “feedback,” and “data subject matter.” Based on the results obtained from the analysis of the complex network and the regression model, the criterion of “society subject” with a coefficient of 72.564 and a positive sign has the greatest impact on increasing the number of citizens' visits to open government data. After that, the criterion of “format openness” with a coefficient of 52.682 and a positive sign has the second rank in increasing the number of visits. Extracting comprehensive and effective criteria in improving the quality of open government data and increasing citizens' willingness to use data, calculating the weight and importance of each criterion by analyzing the complex network of citizens and organizations, as well as providing solutions, can help managers in decision-making and proper management in the complex system of citizens and government organizations. (shrink)

Sports officials, players, and fans are concerned about overseas player rankings for the IPL auction. These rankings are becoming progressively essential to investors when premium leagues are commercialized. The decision-makers of the Indian Premier League choose cricketers based on their own experience in sports and based on performance statistics on several criteria. This paper presents a scientific way to rank the players. Our research examines and contrasts different multicriteria decision-making algorithms for ranking foreign players under various (...) criteria to assess their performance and efficiency. The paper uses three MCDM algorithms, TOPSIS, TODIM, and NR-TOPSIS, for foreign players ranking in the Indian Premier League. Our analysis is limited to the batsmen and bowlers only. We perform the analysis using Python language, a popular high-level programming language. Finally, we perform a sensitivity analysis to determine the stability of each method when the weights of the criterion or the value of a parameter was changed. Our analysis exhibits the superiority of TODIM over TOPSIS and NR-TOPSIS. (shrink)

The purpose of this paper is to develop an approach to multiattribute group decision making under interval-valued hesitant fuzzy environment. To do this, this paper defines some new operations on interval-valued hesitant fuzzy elements, which eliminate the disadvantages of the existing operations. Considering the fact that elements in a set may be interdependent, two generalized interval-valued hesitant fuzzy operators based on the generalized Shapley function and the Choquet integral are defined. Then, some models for calculating the optimal fuzzy (...) measures on the expert set and the ordered position set are established. Because fuzzy measures are defined on the power set, it makes the problem exponentially complex. To simplify the complexity of solving a fuzzy measure, models for the optimal 2-additive measures are constructed. Finally, an investment problem is offered to show the practicality and efficiency of the new method. (shrink)

Artificial intelligence (AI) systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision- (...) class='Hi'>making around cardiopulmonary resuscitation and the determination of a patient’s Do Not Attempt to Resuscitate status (also known as code status). The COVID-19 pandemic has made us keenly aware of the difficulties physicians encounter when they have to act quickly in stressful situations without knowing what their patient would have wanted. We discuss the results of an interview study conducted with healthcare professionals in a university hospital aimed at understanding the status quo of resuscitation decision processes while exploring a potential role for AI systems in decision-making around code status. Our data suggest that (1) current practices are fraught with challenges such as insufficient knowledge regarding patient preferences, time pressure and personal bias guiding care considerations and (2) there is considerable openness among clinicians to consider the use of AI-based decision support. We suggest a model for how AI can contribute to improve decision-making around resuscitation and propose a set of ethically relevant preconditions—conceptual, methodological and procedural—that need to be considered in further development and implementation efforts. (shrink)

Obtaining informed consent from patients is a moral and legal duty and, thus, a key legitimation for medical treatment. The pivotal prerequisite for valid informed consent is decision-making capacity of the patient. Related to the question of whether and when consent should be morally and legally valid, there has been a long-lasting philosophical debate about freedom of will and the connection of freedom and responsibility. The scholarly discussion on decision-making capacity and its clinical evaluation does not (...) sufficiently take into account this fundamental debate. It is contended that the notion of free will must be reflected when evaluating decision-making capacity. Namely, it should be included as a part of the appreciation-criterion for decision-making capacity. The argumentation is mainly drawn on the compatibilism of Harry Frankfurt. A solution is proposed which at the same time takes the notion of free will seriously and enriches the traditional understanding of decision-making capacity, strengthening its justificatory force while remaining clinically applicable. (shrink)

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. (...) I analyze the impact that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions. (shrink)

Recent work has formally linked the traditional axiomatisation of incomplete preferences à la Anscombe-Aumann with the theory of desirability developed in the context of imprecise probability, by showing in particular that they are the very same theory. The equivalence has been established under the constraint that the set of possible prizes is finite. In this paper, we relax such a constraint, thus de facto creating one of the most general theories of rationality and decision making available today. We (...) provide the theory with a sound interpretation and with basic notions, and results, for the separation of beliefs and values, and for the case of complete preferences. Moreover, we discuss the role of conglomerability for the presented theory, arguing that it should be a rationality requirement under very broad conditions. (shrink)

How shall we decide for others who cannot decide for themselves? And who—or what, in the case of artificial intelligence — should make the decision? The present issue of the journal tackles several interrelated topics, many of them having to do with surrogate decision making. For example, the feature article by Jardas et al 1 explores the potential use of artificial intelligence to predict incapacitated patients’ likely treatment preferences based on their sociodemographic characteristics, raising questions about the (...) means by which we come to decide for others. And a clinical ethics round table led by Wilkinson and Pillay2 examines the case of a premature baby on life support whose primary surrogate is herself incapacitated. Together, these examples force us to think more deeply about the meaning and significance of taken-for-granted concepts: respect for autonomy, substituted judgement, best interests. We’ll consider the baby first and then turn to AI. “Baby T” is a critically ill newborn delivered prematurely by emergency caesarean section. The mother had entered into a surrogacy arrangement with a same-sex male couple, the intended parents, who were to take over the baby’s care after birth—just as soon as a formal parental order could be obtained through the court. Until then, the birth mother, who had used her own eggs to conceive Baby T along with sperm from an unidentified donor, would have legal and ethical responsibility to decide about the baby’s care. Unfortunately, she too was in critical condition, having fallen unconscious prior to delivery due to a sudden brain haemorrhage. She remained unconscious, and thus incapacitated, during a crucial period in which time-sensitive decisions about Baby T’s care needed to be made, including whether to continue life support. Given the mother’s incapacity, who should …. (shrink)

Persons with dementia often prefer to participate in decisions about their health care, but may be prevented from doing so because healthcare decision-making law facilitates use of advance directives or surrogate decision makers for persons with decisional impairments such as dementia. Federal and state disability law provide alternative decision-making models that do not prevent persons with mild to moderate dementia from making their own healthcare decisions at the time the decision needs to be (...) made. In order to better promote autonomy and wellbeing, persons with dementia should be accommodated and supported so they can make their own healthcare decisions. (shrink)

Stephanie Collins’ Group Duties offers interesting new arguments and brings together numerous interconnected issues that have hitherto been treated separately. My critical commentary focuses on two particularly original and central claims of the book: (1) Only groups that are united under a group-level decision-making procedure can bear duties. (2) Attributions of duties to other groups should be understood as attributions of “coordination duties” to each member of the group, duties to take steps responsive to the others with a (...) view to the group’s φ-ing or express willingness to do so. In support of the first claim, Collins argues that only groups that can make decisions can bear duties, and that the ability to make decisions requires the relevant sort of decision-making procedure. I suggest that both parts of this argument remain in need of further support. I furthermore argue that Collins’ account of coordination duties gets certain kinds of cases wrong, and suggest that attributions of duties to groups without decision-making procedures are more plausibly understood as attributing shared duties. (shrink)

Ethical decision making for pediatric populations is necessarily contextualized in a network of adult decision-makers, some of whom may be marginalized in complex systems of power, culture and gend...

In response to the Royal Society report’s claim that “the acceptability of geo­engineering will be determined as much by social, legal, and political issues as by scientific and technical factors” (Geoengineering the Climate: Science, Governance and Uncertainty [London: Royal Society, 2009], ix), a number of authors have suggested the key to this challenge is to engage the public in geoengineering decision-making. In effect, some have argued that inclusion of the public in geoengineering decision-making is necessary for (...) any geoengineering project to be morally permissible. Yet, while public engagement on geoengineering comes in various forms, the discussion in geoengineering governance and the ethics of geoengineering have too often conceptualized it exclusively in terms of public participation in decision-making, and supported it by various liberal democratic values. However, if the predominant understanding of public engagement on—or, the role of the public in—geoengineering decision-making is indeed only grounded on liberal democratic values, then its normative relevance could be challenged by and in other ethical-political traditions that do not share those values. In this paper, I shall explore these questions from a Confucian perspective. I argue that the liberal democratic values invoked in support of the normative importance of public participation are, at least, foreign to Confucian political philosophy. This presents a prima facie challenge to view public participation in geoengineering decision-making as a universal moral requirement, and invites us to reconsider the normative significance of this form of public engagement in Confucian societies. Yet, I contend that the role of the public remains normatively significant in geoengineering governance and the ethics of geoengineering from a Confucian perspective. Drawing from recent work on Confucian political philosophy, I illustrate the potential normative foundation for public engagement on geoengineering decision-making. (shrink)

There has been longstanding interest in the consistency of decisions made by research ethics committees in the UK, but most of the evidence has come from single studies submitted to multiple committees. A systematic comparison was carried out of the decisions made on 18 purposively selected applications, each of which was reviewed independently by three different RECs in a single strategic health authority. Decisions on 11 applications were consistent, but disparities were found among RECs on decisions on seven applications. An (...) analysis of the agreement between decisions of RECs yielded an overall measure of agreement of κ = 0.286 , indicating a level of agreement that, although probably better than chance, may be described as “slight”. The small sample size limits the robustness of these findings. Further research on reasons for inconsistencies in decision making between RECs, and on the importance of such inconsistencies for a range of arguments, is needed. (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)

Progress in neuroscience will allow us to reveal the neuronal correlates of psychological processes involved in ethically relevant notions such as informed consent. Informed consent involves decision making, the psychological and neural processes of which have been investigated extensively in neuroscience. The neuroscience of decision making may be able to contribute to an ethics of informed consent by providing empirical and thus descriptive criteria. Since, however, descriptive criteria must be distinguished from normative criteria, the neuroscience of (...) decision making cannot replace the ethics of informed consent. Instead, the neuroscience of decision making could complement the current ethics, resulting in what can be called neuroethics of informed consent. It is concluded that current progress in the neurosciences could complement and change the way in which we approach ethical problems in neuropsychiatry. (shrink)

The strength of emotions in moral judgment and decision-making under risk The focus of this paper is the role of emotions in judgments and choices associated with moral issues. Study 1 shows that depending on the strength of emotions when making a moral decision, people become sensitive to the severity and the probability of harm that their decisions can bring to others. A possible interpretation is that depending on the strength of emotions, people in their moral (...) judgments choose to be either utilitarian or deontologist. In Study 2, following the priority heuristic model, we found that in situations in which the violation of moral norms does not evoke strong negative emotions, people are sensitive to quantitative risk parameters, and the decision-making process requires a relatively longer time. In moral situations in which a violation of the moral norm evokes strong emotions, decision-making is based on arguments other than quantitative risk parameters, and the process takes a shorter time. (shrink)

In the target article, “Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose,” Kenneth D. Marshall and collaborators (2024) highlight important complexities in the care...

In this essay I defend an institutional approach to democratic legitimacy against proceduralist approaches that are commonly endorsed by deliberative democrats. Although deliberative democrats defend a complex view of democratic legitimacy that aims to account for both the procedural and substantive dimensions of legitimacy, most accounts of the relationship between these dimensions currently on offer are too proceduralist to be plausible (I). By contrast, I argue that adopting an institutional approach helps provide a more convincing account of the interplay between (...) procedural and substantive aspects of democratic legitimacy which in turn illuminates the intricate relationship between public deliberation and decision-making procedures such as voting (II). This account also enables us to see what is wrong with interpreting the legitimacy of majoritarian and non-majoritarian institutions in terms of an alleged conflict between popular sovereignty and rights protections. In opposition to this view, I argue that the proper standard for judging the democratic legitimacy of both majoritarian and non-majoritarian institutions is whether they enable an ongoing recursive process of deliberative contestation or whether they generate antidemocratic shortcuts instead (III). (shrink)

Berger (forthcoming) states that moral intimacy is important in applying the best interests standard. But what he calls moral intimacy requires that someone has overcome epistemic burdens needed to represent the patient. We argue elsewhere that good surrogate decision-making is first and foremost a matter of overcoming epistemic burdens, or those obstacles that stand in the way of a surrogate decision-maker knowing what a patient wants and how to satisfy those preferences. Berger’s notion of moral intimacy depends (...) on epistemic intimacy: the fact that a surrogate's epistemic burdens with respect to the best interests of the incapacitated patient have been adequately surmounted, plus some other feature. Thus, where a particular patient-surrogate relationship fails to be morally intimate, what is lacking is either epistemic intimacy or this second feature. Furthermore, Berger uses the notion of moral intimacy as an explanans for the application of the best interests standard. We argue that the notions of epistemic intimacy and epistemic burdens not only help to explain the notion of moral intimacy, but also better explain the application of the best interests standard. Given the role of epistemic burdens and the epistemic intimacy that overcoming them enables, bioethicists and physicians should consider a surrogate’s epistemic standing relative to the patient’s best interests before pronouncing on the former’s ethical probity. (shrink)

As is evident from the other articles in this special issue, end-of-life treatment has engendered a vigorous dialogue in the United States over the past few decades because decision making at the end of life raises broad and difficult ethical issues that touch on health professionals, patients, and their families. This concern is exacerbated by the high cost related to the end of life in the U.S. Moreover, in light of demographic patterns, progressively scarce health care resources, and (...) an expanding array of life-saving technologies, decisions at the end of life are becoming problematic matters of public and, thus, scholarly concern in most countries. Issues at the end of life are central not only to bioethics but also raise important ancillary policy dimensions. (shrink)

The Iowa Gambling Task (IGT) simulates uncertain gains and losses in real life situations and thus is a good measure of uncertain decision making. The role of working memory (WM) in IGT performance still remains unclear. The present study aimed to examine the effect of WM on IGT performance. Three groups of participants matched on gender ratio were randomly assigned to no WM load, low WM load, and high WM load conditions. Initially the three groups did not show (...) significant difference in WM capacity. They finished a modified version of IGT and then their implicit learning effect and explicit cognition on IGT were assessed. Results indicated a linear increasing trend of IGT performance among high WM load, low WM load and no WM load groups; participants in the no WM load and low WM load groups revealed implicit learning effect, while participants in the high WM load group did not; all participants showed explicit cognition on IGT to the same level. These results suggested that participants in the high WM load group showed good explicit cognition to IGT but showed poor performance. This pattern is similar to frontal patients. Further studies should be conducted to explore this issue. (shrink)

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

CRISPR is currently viewed as the central tool for future gene therapy. Yet, many prominent scientists and bioethicists have expressed ethical concerns around CRISPR gene therapy. This paper provides a critical review of concerns about CRISPR gene therapy as expressed in the mainstream academic literature, paired with replies also generally found in that literature. The expressed concerns can be categorised into three types depending on whether they stress risk/benefit ratio, autonomy and informed consent, or concerns related to various aspects of (...) justice. In the reviewed literature, we found no intrinsic objections to CRISPR gene therapy, even though many such objections were present in discussions of gene editing in the 1990s. The paper then proposes a brief outline for a practically applicable moral framework for public decision-making about CRISPR gene therapy and suggests how such a framework might be supported. We also suggest that this framework should govern public engagement about CRISPR gene therapy in order to reduce the risk that we make decisions about CRISPR gene therapy based on misperceptions, inflated views of risk, or unreasonable moral or religious views. (shrink)

The consideration of gambling as a decision-making disorder may fail to explain why the majority of people gamble, yet only a small percentage of people lose control of their behaviour to the point where their gambling becomes problematic. The application of dual process theories to gambling addiction offers a means of explaining the differences between and gambling, augmenting the multiple vulnerabilities proposed by Redish et al.

This article reviews the strengths and limitations of five major paradigms of medical computer-assisted decision making (CADM): (1) clinical algorithms, (2) statistical analysis of collections of patient data, (3) mathematical models of physical processes, (4) decision analysis, and (5) symbolic reasoning or artificial intelligence (Al). No one technique is best for all applications, and there is recent promising work which combines two or more established techniques. We emphasize both the inherent power of symbolic reasoning and the promise (...) of artificial intelligence and the other techniques to complement each other. Keywords: Diagnosis, Computer Assisted Decision Making, Artificial Intelligence * Current address: Intelligenetics, 124 University Avenue, Palo Alto, CA. 94301, U.S.A. ** Dr. Shortliffe is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine and recipient of research career development award LM0048 from the National Library of Medicine. CiteULike Connotea Del.icio.us What's this? (shrink)

Currently, the number of patients diagnosed with impaired self-awareness of their own deficits after brain injury—anosognosia— is increasing. One reason is a growing understanding of this multifaceted phenomenon. Another is the development and accessibility of alternative measurements that allow more detailed diagnoses. Anosognosia can adversely affect successful rehabilitation, as often patients lack confidence in the need for treatment. Planning such treatment can become a complex process full of ethical dilemmas.To date, there is no systematic way to deal with different aspects (...) of anosognosia rehabilitation planning. This is the first article to present a framework for ethical decision making in establishing rehabilitation plans that are focused on increasing patients’ self-awareness of their own deficits after brain injury. It concentrates especially on addressing the ethical dilemmas that may arise, and describes stepwise procedures that can be applied to distinct theoretical approaches, as well as diagnostic and rehabilitation methods. To show the flexibility of the use of this framework, alternative approaches are discussed. (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)

Teacher emotion has become an important issue in English language teaching as it is a crucial construct in understanding teachers' responses to institutional policies. The study explored teachers' emotion labor and its impact on teachers' pedagogical decision-making in English for Specific Purposes teaching in a university of Traditional Chinese Medicine in China. Drawing on a poststructural perspective, the study examined data from two rounds of semi-structured interviews, policy documents and teaching artifacts. The analysis of data revealed that the (...) major emotion labor facing the participants revolved around students' disengagement in class. Teachers experienced mixed feelings of anticipation, disappointment, anger, and empathy toward students and distanced themselves from institutional feeling rules enforcing objective assessment of students' performance and punishing students for lack of engagement in class. The study found that teacher emotion labor served as the site for their pedagogical modifications. ESP teachers' beliefs in the importance of attending to students' needs become a powerful discourse in supporting teachers to strategically subvert institutional feeling rules and critically reflect on the dysfunctions of curriculum, orienting teachers' agentic actions in modifying pedagogical practices. We thus underscore this empowering discourse as the bridge to connect teachers' policy negotiation and their actual classroom practices. We also highlight teachers' pedagogical decision-making as a process of the interactions of teacher emotion, teachers' reflexive practices, and power relations. The study ended by suggesting more longitudinal research where teachers' beliefs as previously appropriated discourses could be examined comprehensively as they were both the construct of emotion labor and the potential subverting power in supporting teachers' pedagogical decision-making in policy negotiation. (shrink)

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

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)