This chapter contains sections titled: Analogy and the Principle of Justice The Logical Form of Analogical Inference Limitations of Analogical Reasoning Challenges to Traditional Theory Analogical Reasoning and Normative Legal Theory References.

In this paper I argue that the rationality of law and legal decision making would be enhanced by a systematic attempt to recognize and respond to the implications of empirical uncertainty for policy making and decision making. Admission of uncertainty about the accuracy of facts and the validity of assumptions relied on to make inferences of fact is commonly avoided in law because it raises the spectre of paralysis of the capacity to decide issues (...) authoritatively. The roots of this short-sighted view are found in primitive mechanical models of relationships in the empirical and social world – those of objective causality and determinism. Insofar as it is believed that if we had sufficient data a clear and unequivocal answer would be available to each question, admission of uncertainty is seen as a sign of insufficiency, incompetence, impotence, and is avoided whenever a decision that must be seen to be based on valid reasons, cannot be avoided. Avoidance of some decisions, duplicity in others, is the result. -/- Decision-making must be restructured to recognize the provisional and context-bound validity and relevance of the models we use to conceptualize and order our understanding of phenomena, and to utilize this awareness as an instrument in the production of legal policies and decisions that will be authoritative precisely because they are honestly accurate and socially responsible. The paper makes a start on such a re-structuring of the legal process by exploring the implications of the observation that if law is to be “just”: 1) legal policy must be based on accurate information and rationally related to social goals; and 2) decisions applying policy to individual fact situations must be based on assumptions that are both relevant and accurate. -/- Reasons for determinations of fact must be given, otherwise the presumption that the trier of fact is “reasonable” is an unconditional licence to use private modes of logic and theories of social and natural science. What is not disclosed cannot be challenged on grounds of invalidity or irrelevance. Use of “objective validity” as a standard to evaluate conclusions made by the trier of fact in contentious cases would only serve to beg all important questions by concealing: 1) fundamental normative conflict, and 2) the limited nature and applicability of many validity claims. -/- Our use of the phrases “undue risk,” “public interest,” “reasonable,” and “necessary,” reflects the weight we choose to give conflicting social values and goals when we must make decisions in relative ignorance of all the consequences. “Objective criteria” are of limited utility in legal decision-making because their social meaning is derivative. Policy generation in the absence of any coherent conceptual-normative framework, use of vague terminology in legislation stating policy, and the absence of rational means to distinguish between individual cases to which decision-makers are required by law to apply policy, make it inevitable that many legal “decisions” made in the guise of determinations of objective fact, are charades, an arbitrary, capricious, intuitive, subjective (and thus private) use of public decision-making power. -/- Law must alter its aspirations and recognize that rational decision-making is a process that can occur only within parameters set by present knowledge and societal preference structures. Only by working with the constraints imposed by these parameters is it possible to achieve “just” decisions. Where no rational basis for differentiating cases exists, “individualized justice” must be avoided and public policy articulated in law applied uniformly to all cases in a class. The terms “reasonable” and “necessary,” used to describe policy and its consequences for specific cases, must be understood to represent provisional societal assessments, attempts to implement societal preference structures in the face of limited knowledge. Heightened awareness of the limited nature of our knowledge can only result in legal policies that have a more explicit normative basis. (shrink)

The author stands that thinking by analogy is a natural instrument human have because of the mirror neurons in our brain. However, is it that infallible to rely on? How can we be sure that our hidden biases will not harm our reflections? Implicit Association Bias (IAB), for instance, is a powerful intruder that affects our understanding, actions, and decisions on the unconscious level by cherishing the stereotypes based on specific characteristics such as ethnicity, sex, race, and so on. To (...) check if there is a correlation between the IAB effect and the people’s capacity to reason logically, the author had created an online-survey. The focus was on analogical reasoning and IAB tests concerning the question of gender equality in science and everyday life and age prejudices. (shrink)

This paper will examine the effects of gender, age, work experience, academic status and legality on certain ethical decisions. Six scenarios representing ethical dilemmas were presented to both undergraduate and MBA students in an attempt to determine if various demographic factors influenced ethical decision making. While some past studies have suggested that gender has an important effect on ethical decision making, this study does not completely support this conclusion and suggests that age and/or length of (...) work experience should be included in any study of ethical decision making.The legality of the decisions was determined and compared to the reason given by the students for their decisions. In some cases the choice made by a majority of the students was not the one that was supported by the legal authorities which suggests that there may be conflicts between the ethical system of the respondents and the behavior expected of them by society. (shrink)

Nondirective genetic counseling developed as a means of promoting informed and independent decision-making. To the extent that it minimizes risks of coercion, this counseling approach effectively respects client autonomy. However, it also permits clients to make partially informed, poorly reasoned or ethically questionable choices, and denies counselors a means of demonstrating accountability for the use of their services. These practical and ethical tensions result from an excessive focus on noncoercion while neglecting the contribution of adequate information and deliberative (...) competence to autonomous decision-making. A counseling approach that emphasizes the role of deliberation may more reliably produce thoroughly reasoned decisions. In such an approach, characterized by dialogue, counselors are responsible for ensuring that decisions are fully informed and carefully deliberated. Counseling remains nonprescriptive, but in the course of discussion counselors may introduce unsolicited information and/or challenge what they believe are questionable choices. By this means clients can be better assured that the decisions they make are fully considered, while counselors demonstrate a limited degree of professional accountability. (shrink)

Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against (...) particular groups of patients and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures. -/- . (shrink)

: How do people make decisions? Previous psychological research consistently shed light on the fact that decisions are not the result of a pure rational reasoning, and that emotions can assume a crucial role. This is particularly true in the case of moral decision-making, which requires a complex integration of affective and cognitive processes. One question that is still open to debate concern the individual factors that can affect moral decisions. Gender has been consistently identified as a (...) possible variable of interest for the adoption of different strategic behaviors, with men using more rational processes and women more deontological principles. In the present study we aimed at exploring the presence of gender differences in different decision-making scenarios. Results showed that the moral scenario led to a similar acceptance rate in both genders, while economic and shopping offers were more likely to be accepted by men. Also, women were more inclined to refuse unfair offers, which included a higher personal benefit at the expense of the opponent, even if this meant a total loss for both parties. Finally, correlational analyses revealed a different relation between risk propensity and decision-making in men and women in different scenarios. Keywords: Decision-making; Utilitarianism; Altruism; Moral Decision-making; Economic Decision-making Decisioni morali, economiche e d’acquisto a confronto. Effetti di genere e utilitarismo Riassunto: Come prendiamo le decisioni? La letteratura psicologica disponibile ha chiarito in ampia misura come le decisioni non siano il risultato di un ragionamento puramente razionale e che le emozioni possono assumere un ruolo cruciale. Questo è particolarmente vero nel caso delle decisioni morali, che richiedono una complessa integrazione tra processi affettivi e cognitivi. Una questione ancora aperta riguarda i fattori individuali che possono incidere sulle decisioni morali. Il genere è stato identificato come una possibile variabile da considerare rispetto all’adozione di comportamenti strategici differenti, in cui gli uomini sembrano più inclini a far uso di processi razionali e le donne a considerare principi deontologici. In questo lavoro abbiamo provato a esplorare la presenza di differenze di genere in diversi contesti decisionali. I risultati hanno mostrano come in ambito morale entrambi i generi siano portati ad accettare opzioni simili, mentre offerte economiche e commerciali sono accettate in misura maggiore dagli uomini. Le donne sarebbero più inclini a rifiutare offerte inique che comprendono benefici personali maggiori a discapito di una controparte, anche se questo implica una perdita totale da ambo le parti. Infine, le analisi correlazionali hanno mostrato una diversa relazione tra propensione al rischio e processi decisionali tra uomini e donne in contesti diversi. Parole chiave: Processi decisionali; Utilitarismo; Altruismo; Processi decisionali morali; Processi decisionali economici. (shrink)

How do business leaders make ethical decisions? Given the significant and wide-spread impact of business people’s decisions on multiple constituents, how they make decisions matters. Unethical decisions harm the decision makers themselves as well as others, whereas ethical decisions have the opposite effect. Based on data from a study on strategic decision making by 16 effective chief executive officers, I propose a model for ethical decision making in business in which reasoning and intuition interact (...) through forming, recalling, and applying moral principles necessary for long-term success in business. Following the CEOs in the study, I employ a relatively new theory, rational egoism, as the substantive content of the model and argue it to be consistent with the requirements of long-term business success. Besides explaining the processes of forming and applying principles, I briefly describe rational egoism and illustrate the model with a contemporary moral dilemma of downsizing. I conclude with implications for further research and ethical decision making in business. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 28, Number 1, April 2002, pp. 113-130 Bayesianism, Analogy, and Hume's Dialogues concerning Natural Religion SALLY FERGUSON Introduction Analyses of the argument from design in Hume's Dialogues concerning Natural Religion have generally treated that argument as an example of reasoning by analogy.1 In this paper I examine whether it is in accord with Hume's thinking about the argument to subsume the version of it given (...) in the Dialogues under the model of probabilistic reasoning offered by Bayes's theorem. Wesley Salmon attempted this project in 1978.2 In related projects, David Owen3 as well as Philip Dawid and Donald Gillies4 have more recently attempted to construct Bayesian analyses of Hume's argument concerning testimony in "Of Miracles." I want to be careful at this stage to note exactly what I will claim. It is not that Bayesian reasoning sheds no light on the argument from design, or on arguments concerning testimony. All of the analyses mentioned above are beneficial in that they have been able to expose subtleties in these arguments that had previously gone unnoticed. Salmon's paper, in particular, contributes nicely to an understanding of just how the design argument may function in relation to contemporary scientific reasoning. In this paper I argue that, nonetheless, the attempt to apply Bayesian reasoning to the argument as presented in the Dialogues is not well supported as a reconstruction of Hume's own approach to the argument from design. Sally Ferguson is Assistant Professor of Philosophy, University of West Florida, UOOO University Parkway, Pensacola, FL 32514, USA. e-mail: [email protected] 114 Sally Ferguson There are two stages to my treatment of the issue. I begin by considering how much Hume knew of Bayes's theorem, and what consequence that knowledge might have had on his treatment of the argument in the Dialogues. This discussion includes a consideration of exactly what has been claimed by other authors on this subject, including what some have argued concerning Hume's reasonings in "Of Miracles," section 10 of An Enquiry concerning Human Understanding. I conclude that, based on the historical data, there is little reason to think of Hume's approach to the argument from design as anything more than proto-Bayesian at best. I then argue further, through a close textual analysis of the Dialogues, that there are good reasons for not treating Hume's reasoning there as even proto-Bayesian. In the end, the benefits that have been claimed for that approach, in terms of exposing both the subtleties of the argument and of Hume's reasoning about it, can equally well be derived from a careful analysis of the argument under a model of analogical reasoning, without need of Bayes's theorem. Section One Perhaps one might think that there is not much use for a consideration of the question whether Hume himself conceived of any of his arguments along specifically Bayesian lines. As Gower argues,5 Hume's knowledge of mathematics in general was fairly limited, and Bayes's theorem was not well known even up until Hume's death. It is important, therefore, for me to establish that there have not only been those who thought that Bayesian reasoning illuminates the arguments Hume gave, but also his own thinking about those arguments. It is also important for me to establish that it is not obvious that knowledge of Bayes's theorem did not affect Hume's reasonings. Each of these points will be addressed in the following. As to the first point, the claims of some authors on the subject are ambiguous. Dawid and Gillie, for example, make no statement to the effect that the probabilities involved in Bayes's theorem were in fact examined in "Of Miracles," nor do they attempt to produce any passages from Hume in support of that view. Thus it would be assumed that they see their attempt not as an attempt to provide an analysis that represents Hume's own approach to the argument, but rather simply as one that provides an illuminating method of analysis and support for an argument that Hume happened to give. Indeed, their conclusion, to the effect that a... (shrink)

This thesis addresses two enduring issues in legal theory-- rationality and its association with rule of law values--by offering detailed models of two patterns of legal reasoning. One is reasoning by analogy. The other is the inference process that legal reasoners use when they defer epistemically to scientific experts in the course of reaching legal decisions. Discussions in both chapters reveal that the inference pattern known as "abduction" is a deeply important element of many (...) legal inferences, including analogy and epistemic deference to experts--something that has been largely unrecognized in legal theory. After presenting a detailed model of analogy, Chapter 1 argues that legal reasoning by analogy, like analogical argument in logic, mathematics, and the natural sciences, possesses a great deal of rational force when properly executed. Chapter 2 investigates the reasoning process by which non-expert legal reasoners defer epistemically to the judgments of scientists. It presents five main conclusions or explanations. Every practical syllogism actually consists of two distinct chains of inference, and what is usually considered in writings on practical reasoning to be the minor premise of a practical syllogism is actually the conclusion of a separate chain of argument. When a practical reasoner defers epistemically to a theoretical expert, this separate chain of argument has a special structure, which is modeled in Chapter 2. The non-expert legal reasoner must always make a prescriptive practical judgment about the standard of epistemic appraisal and level of epistemic confidence that the reasoner requires of scientific evidence before it may be relied upon in reaching a legal decision. Legal systems should be committed to an emergent rule of law ideal identified and referred to as "intellectual due process" which condemns epistemically arbitrary reasoning processes insofar as they play a role in legal decisionmaking. Since non-arbitrariness is a necessary condition of both epistemic and legal legitimacy, we have compelling reason to doubt that the non-arbitrariness condition can be met when non-experts defer epistemically to scientific experts. (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the “single greatest category of problems” encountered in bioethics consultation. Moreover, (...) the scope of the problem continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia.Unfortunately, most U.S. jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. “Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform.” Most providers are “muddling through on an ad hoc basis.” Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two define the problem of medical decision making for the unbefriended. The remaining 12 categories describe different solutions to the problem. The first six of these solutions are discussed in this article (Part 1). The last eight solutions will be covered in the Summer 2012 issue of JCE (Part 2). 1. Who are the unbefriended?2. Risks and problems of the unbefriended3. Prevention: advance care planning, diligent searching, and careful capacity assessment4. Decision-making mechanisms and standards5. Emergency exception to informed consent6. Expanded default surrogate lists: close friends7. Private guardians8. Volunteer guardians9. Public guardians10. Temporary and emergency guardians11. Attending physicians12. Other clinicians, individuals, and entities13. Institutional committees14. External committees. (shrink)

Background Decisions on limiting life-sustaining treatment for patients in the vegetative state (VS) are emotionally and morally challenging. In Germany, doctors have to discuss, together with the legal surrogate (often a family member), whether the proposed treatment is in accordance with the patient's will. However, it is unknown whether family members of the patient in the VS actually base their decisions on the patient's wishes. Objective To examine the role of advance directives, orally expressed wishes, or the presumed will (...) of patients in a VS for family caregivers' decisions on life-sustaining treatment. Methods and sample A qualitative interview study with 14 next of kin of patients in a VS in a long-term care setting was conducted; 13 participants were the patient's legal surrogates. Interviews were analysed according to qualitative content analysis. Results The majority of family caregivers said that they were aware of aforementioned wishes of the patient that could be applied to the VS condition, but did not base their decisions primarily on these wishes. They gave three reasons for this: (a) the expectation of clinical improvement, (b) the caregivers' definition of life-sustaining treatments and (c) the moral obligation not to harm the patient. If the patient's wishes were not known or not revealed, the caregivers interpreted a will to live into the patient's survival and non-verbal behaviour. Conclusions Whether or not prior treatment wishes of patients in a VS are respected depends on their applicability, and also on the medical assumptions and moral attitudes of the surrogates. We recommend repeated communication, support for the caregivers and advance care planning. (shrink)

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

Rationality and reasonableness can be illustrated as Janus-faced concepts, not only in a descriptive diagnosis but also in a normative construction of adjudication, and in the analysis of its practical and rhetorical effects. Considering such an illustration, the present reflection returns to the discussion on the relevance of rationality and reasonableness in legal interpretation, aiming at distinguishing and/or connecting principles and criteria, beyond formally logical and/or procedurally argumentative decision-making, and, thus, within a normatively practical adjudication. Such (...) an approach will be presented in two main steps. In a first step, the rationality/reasonableness dichotomy will be discussed within a constitutive connection between principles and criteria in adjudication, and understanding legal principles as normatively substantial foundations to legal criteria—the former as axiological references filtered into the juridical system and the latter as their concretizations, and whose practical adequacy is rhetorically assigned by the interpretive communities involved in/by adjudication, and normatively referred both to their practical accordance to the axiological normativity of the principles they shall presuppose and to their suitability as practical operators to the problematic relevance of the sub judice cases. In a second step, and consequently, encompassing the projection of legal interpretation, in semiotic and in practical-normative perspectives, in order to discuss their constituting practical relevance in adjudication, the rationality/reasonableness dichotomy will be experimented within formal-logical procedures and within practical-dialectical connections between juridical problem and juridical system—therefore stating a discussion on the foundations, the intentionality and the consequences of adjudication, amongst deduction and analogy. (shrink)

The present study describes the mechanism of need regulation, which accompanies the so-called “biased” decisions. We hypothesized an unconscious urge for psychological need satisfaction as the trigger for cognitive biases. In an experimental study (N = 106), participants had the opportunity to win money in a functionality test. In the test, they could either use the solution they had developed (sunk cost) or an alternative solution that offered a higher probability of winning. The selection of the sunk-cost option was the (...) most chosen option, supporting the hypothesis of this study. The reason behind the majority of participants choosing the sunk-cost option seemed to be the satisfaction of psychological needs, despite a reduced chance of winning money. An intervention, which aimed at triggering self-reflection, had no impact on the decision. The findings of this study contribute to the discussion on the reasons for cognitive biases and their formation in the human mind. Moreover, it discusses the application of the label “irrational” for biased decisions and proposes reasons for instrumental rationality, which exist at an unconscious, need-regulative level. (shrink)

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves, the potential loss of companies’ competitive edge, and the limited gains in answerability to be expected since (...) sophisticated algorithms usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante. (shrink)

Chance inevitably plays a role in law but it is not often that we consciously try to import an element of randomness into a legal process. Random Justice: On Lotteries and Legal Decision-Making explores the potential for the use of lotteries in social, and particularly legal, decision-making contexts. Utilizing a variety of disciplines and materials, Neil Duxbury considers in detail the history, advantages, and drawbacks of deciding issues of social significance by lot and (...) argues that the value of the lottery as a legal decision-making device has generally been underestimated. The very fact that there exists widespread resistance to the use of lotteries for legal decision-making purposes betrays a commonly held belief that legal processes are generally more important than are legal outcomes. Where, owing to the existence of indeterminacy, the process of reasoning is likely to be excessively protracted and the reasons provided strongly contestable, the most cost-efficient and impartial decision-making strategy may well be recourse to lot. Aversion to this strategy, while generally understandable, is not necessarily rational. Yet in law, as Professor Duxbury demonstrates, reason is generally valued more highly than is rationality. The lottery is often conceived to be a decision-making device that operates in isolation. Yet lotteries can frequently and profitably be incorporated into other decision-frameworks. The book concludes by controversially considering how lotteries might be so incorporated and also advances the thesis that it may sometimes be sensible to require that adjudication takes place in the shadow of a lottery. (shrink)

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves (“gaming the system” in particular), the potential loss of companies’ competitive edge, and the limited gains in (...) answerability to be expected since sophisticated algorithms usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante. (shrink)

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves, the potential loss of companies’ competitive edge, and the limited gains in answerability to be expected since (...) sophisticated algorithms usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante. (shrink)

Using an analogy in science and everyday life is a double-edged sword because they are accompanied by alternative ideas, in addition to scientific concepts. Schools and public education explain global warming by making a common analogy between this phenomenon and greenhouse effects. Unfortunately, this analogy sometimes produces various incorrect explanatory mental models. To construct a correct understanding of global warming, it is necessary: first, to investigate the attributes of analogical reasoning; second, to understand these features by (...) restructuring the greenhouse analogy; and third, to explore the problems and benefits of the greenhouse analogy. The characteristics of relations, rather than objects, must be mapped according to the principle of systematicity, but the public tends to preserve the attributes of the base domain, which is mapped relatively easily. In conclusion, certain facets of the prevailing greenhouse analogy cause a distorted public view of climate change. We must use the greenhouse analogy and yet simultaneously emphasize the relations and attributes highlighted and hidden in the analogy during evaluation. (shrink)

The computer revolution has had an enormous effect on all aspects of the practice of medicine, yet little thought has been given to the role of social media in identifying treatment choices for incompetent patients. We are currently living in the ?Internet age? and many people have integrated social media into all aspects of their lives. As use becomes more prevalent, and as users age, social media are more likely to be viewed as a source of information regarding medical care (...) preferences. This article explores the ethical and legal issues raised by the use of social media in surrogate decision making. (shrink)

Over the past few decades the pace of change in the business environment has been rapid, as the effects of electronic innovations and the acceptance of the globalisation mind-set have occurred. Communism has collapsed and the power of corporations has grown in the global community that has developed. It has become imperative that business decision-makers become aware that their decisions may limit the choices of future generations by irretrievably destroying the currently existing physical and social environment. Decision- (...) class='Hi'>making in today's business environment will have a profound affect on human well-being in general and specifically on the breadth of options that are provided to the business decision-makers of tomorrow. Against this background it is argued that senior managers should adopt a new paradigm through which to view the world and assess the import of their decisions. Managers need to consider the effects of their decisions not only on the economy but also on the environment and the social world, which the economy is meant to serve. Managers must ensure their ways of doing business are sustainable. (shrink)

Information is a force multiplier. Knowledge of the enemy's capability and intentions may be of far more value to a military force than additional troops or firepower. Situation assessment is the ongoing process of inferring relevant information about the forces of concern in a military situation. Relevant information can include force types, firepower, location, and past, present and future course of action. Situation assessment involves the incorporation of uncertain evidence from diverse sources. These include photographs, radar scans, and other forms (...) of image intelligence, or IMINT; electronics intelligence, or ELINT, derived from characteristics (e.g., wavelength) of emissions generated by enemy equipment; communications intelligence, or COMINT, derived from the characteristics of messages sent by the enemy; and reports from human informants (HUMINT). These sources must be combined to form a model of the situation. The sheer volume of data, the ubiquity of uncertainty, the number and complexity of hypotheses to consider, the high-stakes environment, the compressed time frame, and deception and damage from hostile forces, combine to present a staggeringly complex problem. Even if one could formulate a decision problem in reasonable time, explicit determination of an optimal decision policy exceeds any reasonable computational resources. While it is tempting to drop any attempt at rational analysis and rely purely on simple heuristics, we argue that this can lead to catastrophic outcomes. We present an architecture for a ``complex decision machine'' that performs rational deliberation to make decisions in real time. We argue that resource limits require such an architecture to be grounded in simple heuristic reactive processes. We thus argue that both simple heuristics and complex decision machines are required for effective decision making in real time for complex problems. We describe an implementation of our architecture applied to the problem of military situation assessment. (shrink)

Differences across fields and experience levels are frequently considered in discussions of ethical decision making and ethical behavior. In the present study, doctoral students in the health, biological, and social sciences completed measures of ethical decision making. The effects of field and level of experience with respect to ethical decision making, metacognitive reasoning strategies, social-behavioral responses, and exposure to unethical events were examined. Social and biological scientists performed better than health scientists with (...) respect to ethical decision making. Furthermore, the ethical decision making of health science students decreased as experience increased. Moreover, these effects appeared to be linked to the specific strategies underlying participants' ethical decision making. The implications of these findings for ethical decision making are discussed. (shrink)

Background : researchers and sponsors increasingly confront the issue of whether participants in a clinical trial should have post-trial access (PTA) to the trial drug. Legislation and guidelines are inconsistent, ambiguous or silent about many aspects of PTA. Recent research highlights the potential importance of systematic reviews (SRs) of reason-based literatures in informing decision-making in medicine, medical research and health policy. Purpose: to systematically review reasons why drug trial participants should, or need not be ensured PTA to the (...) trial drug and the uses of such reasons. Data sources: databases in science/medicine, law and ethics, thesis databases, bibliographies, research ethics books and included publications’ notes/bibliographies. Publication selection: a publication was included if it included a reason as above. See article for detailed inclusion conditions. Data extraction and analysis: two reviewers extracted and analyzed data on publications and reasons. Results: of 2060 publications identified, 75 were included. These mentioned reasons based on morality, legality, interests/incentives, or practicality, comprising 36 broad (235 narrow) types of reason. None of the included publications, which included informal reviews and reports by official bodies, mentioned more than 22 broad (59 narrow) types. For many reasons, publications differed about the reason’s interpretation, implications and/or persuasiveness. Publications differed also regarding costs, feasibility and legality of PTA. Limitations: reason types could be applied differently. The quality of reasons was not measured. Conclusion: this review captured a greater variety of reasons and of their uses than any included publication. Decisions based on informal reviews or sub-sets of literature are likely to be biased. Research is needed on PTA ethics, costs, feasibility and legality and on assessing the quality of reason-based literature. (shrink)

One of the most fascinating topics of current investigation in the literature on judgment and decision-making concerns the exploration of foreign language effects (henceforth, FLE). Specifically, recent research suggests that presenting information in a foreign language helps reasoners make better choices. However, this piece aims at making scholars aware of a blind spot in this stream of research. In particular, research on FLE has imported only one view of judgment and decision-making, in which the (...) heuristics that people use are seen as conducive to biases and, in turn, to costly mistakes. But heuristics are not necessarily a liability, and this article indicates two routes to push forward research on FLE in judgment and decision-making. First, research on FLE should be expanded to explore also classes of fast and frugal heuristics, which have been shown to lead to accurate predictions in several contexts characterized by uncertainty. Second, research on FLE should be open to challenge the interpretations given to previous FLE findings, since alternative accounts are plausible and not ruled out by evidence. (shrink)

Information is a force multiplier. Knowledge of the enemy's capability and intentions may be of far more value to a military force than additional troops or firepower. Situation assessment is the ongoing process of inferring relevant information about the forces of concern in a military situation. Relevant information can include force types, firepower, location, and past, present and future course of action. Situation assessment involves the incorporation of uncertain evidence from diverse sources. These include photographs, radar scans, and other forms (...) of image intelligence, or IMINT; electronics intelligence, or ELINT, derived from characteristics (e.g., wavelength) of emissions generated by enemy equipment; communications intelligence, or COMINT, derived from the characteristics of messages sent by the enemy; and reports from human informants (HUMINT). These sources must be combined to form a model of the situation. The sheer volume of data, the ubiquity of uncertainty, the number and complexity of hypotheses to consider, the high-stakes environment, the compressed time frame, and deception and damage from hostile forces, combine to present a staggeringly complex problem. Even if one could formulate a decision problem in reasonable time, explicit determination of an optimal decision policy exceeds any reasonable computational resources. While it is tempting to drop any attempt at rational analysis and rely purely on simple heuristics, we argue that this can lead to catastrophic outcomes. We present an architecture for a ``complex decision machine'' that performs rational deliberation to make decisions in real time. We argue that resource limits require such an architecture to be grounded in simple heuristic reactive processes. We thus argue that both simple heuristics and complex decision machines are required for effective decision making in real time for complex problems. We describe an implementation of our architecture applied to the problem of military situation assessment. (shrink)

IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of (...) who might be suitable as a proxy in cases where there was no clear appointment of them by a still competent individual. and is now widely seen as a useful means through which we can exercise control over decisions that affect our lives when we have lost capacity to make these decisions for ourselves.I will here limit myself to discussion of proxy consent for adults appointed prior to the loss of competence by the person they are acting as proxy for. The issue of p. (shrink)

Religious considerations in medical decision-making have enjoyed newfound attention in recent years, challenging the assumption that the domains of biological and spiritual flourishing can be cleanly separated in clinical practice. A surprising majority of patients desire their physicians to engage their religious and spiritual concerns, yet most never receive such attention, particularly in cases near the end of life where such attention seems most warranted.1–3 As physicians Aparna Sajja and Christina Puchalski recently wrote in the AMA Journal of (...) Ethics theme issue on ‘Religion and Spirituality in Healthcare Practice’, modern medical training is ‘falling short of preparing physicians to help patients with the metaphysical needs of their illness’.4 It would seem then that both patients and physicians might challenge the conclusions proffered by philosophers Jake Greenblum and Ryan Hubbard in ‘Responding to Religious Patients: Why Physicians Have No Business Doing Theology’, in which they claim that physicians ought not to engage religious reasoning for medical decisions. Their conclusion relies on two core arguments: a ‘public reason’ argument and a ‘fiduciary argument’, both of which contend that theology and religious considerations have no place in medical reasoning. We find that two central errors undergird these arguments. First is the fraught notion of an epistemically and ethically normative public reason, and second is a fundamental mischaracterisation of the fiduciary nature of the patient–physician relationship and the nature of medicine itself. In response, we argue that all physicians essentially ‘do theology’ and that, rather than divorcing theology from medical practice, clinicians should make it their business to do theology well. To support the exclusion of religious reasoning from medical decision-making, the authors open with a ‘public reason argument’, suggesting that physicians serve in roles closely resembling those of public officials. As such, the physician as public official ought to limit himself …. (shrink)

Legal decision-making emphasizes, in a very self-conscious way, the justificatory significance of reasons. This paper argues that the obligation to provide reasons for choices, which must be articulated and structured around a set of generally shared and publicly comprehensible categories of thought, can serve to make the space of possible choices ‘concept sensitive’ in a very useful way. In particular, concept sensitivity has the effect of restricting certain movements within the choice space so that some of the (...) systematic difficulties in achieving an equilibrium in social choice which arise out of an excess of rational doing are avoided. The resulting equilibrium is path dependent. But because it is dependent on a choice path which ‘makes sense’ (or is ordered by thought precisely because it is concept sensitive), it is not the sort of arbitary path-dependent social choice which originally concerned Kenneth Arrow. This paper illustrates these points with examples from criminal law procedure, contract law and constitutional law. (shrink)

People with cognitive impairments often have difficulties formulating, understanding, or articulating decisions that others judge reasonable. The frequent response shifts decision-making authority to substitutes through advance directives of the person or guardianship orders from a court. The Convention on the Rights of People with Disabilities defends supported decision-making as an alternative to such forms of supplanted decision-making. But supported decision-making raises both metaphysical questions—what is required for a decision to be the (...) person’s own?—and epistemological questions: how do we know what persons judge to be their good, when they have difficulty conceptualizing and articulating? It raises practical questions, too, such as protection against risks of exploitation. This article uses a non-discrimination account of legal personhood drawn from the CRPD to explore how common features of decisions employed by people without cognitive disabilities are important in supported decision-making too. These features include prostheses, guardrails, relationships, and social contexts. (shrink)

There is both individual and collective widespread concern in society about the impact of human activity and the effects of our decisions on the physical and social environment. This concern is included within the idea of sustainability. The meaning of the concept is still ambiguous and its practical effectiveness disputed. Like many other authors, this article uses as a starting point the definition proposed by the World Commission on Environment and Development, considering it to be a proposal for changing (...) the assessment of the effects of decisions, from at least two perspectives: what effects we should consider and how we should assess them. Based on this double perspective, sustainability is explored as a method for decision-making which both expands the assessment of the consequences, and also provides an objective criterion for such assessment. It will be argued that the idea of sustainability, seen from this perspective, brings to decision-making two qualities which had been partially lost: realism and impartiality. In turn, the criteria for realism and impartiality in decision-making can be used to identify the limitations of some partial approaches to sustainability, which suffer from insufficient realism, insufficient impartiality or both phenomena at once. The article concludes by demonstrating how realism and impartiality provide the basis for a new form of sustainable decision-making, which is dependent on the development of two moral virtues, prudence and benevolence, and which brings practical effectiveness and ethical sense to the concept of sustainability. (shrink)

Background: There are no universally agreed rules of healthcare ethics. Ethical decisions and standards tend to be linked to professional codes of practice when dealing with complex issues. Objectives: This paper aims to explore the ethical complexities on who should decide to give infants born on the borderline of viability lifesaving treatment, parents or the healthcare professionals. Method: The paper is a discussion using the principles of ethics, professional codes of practice from the UK, Nursing Midwifery Council and UK (...) class='Hi'>legal case law and statute. Healthcare professionals' experiences that influence parental decision are also considered. Findings & Discussion: There are considerable barriers to an effective discussion taking place in an environment where clinical decisions have to be made quickly once the baby is born. This is compounded by the need and respect for parental autonomy and the difficulties they face when making a best interest's decision knowing that this could cause more harm than good for their infant child and balancing any decision they make with quality of life. Conclusion: On deciding whether to give lifesaving treatment born at the borderline of viability, it should be a joint decision between the parents and the neonatal team. (shrink)

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)

This chapter summarizes research on free will. Progress has been made by discarding outmoded philosophical notions in favor of exploring how ordinary people understand and use the notion of free will. The concept of responsible autonomy captures many aspects of layperson concepts of free will, including acting on one's own (i.e., not driven by external forces), choosing, using reasons and personal values, conscious reflection, and knowing and accepting consequences and moral implications. Free will can thus be understood as form of (...) volition (action control) that evolved to enable people to live in cultural societies. Much work has shown that belief in free will (as opposed to disbelief) is associated with actions that are conducive to functioning well in culture, including helpfulness, restraint of aggression, learning via counterfactual analysis, thinking for oneself, effective job performance, and appropriate gratitude. Belief in free will increases in response to misdeeds by others, thus emphasizing the link to personal responsibility. Research on volition indicates that self-regulation, intelligent reasoning, decision making, and initiative all deplete a (common) limited energy source, akin to the folk notion of willpower and linked to the body's glucose supplies. Free will is thus not an absolute or constant property of persons but a variable, fluctuating capability—one that is nonetheless highly adaptive for individuals and society. -/- The notion that people have free will has been invoked in multiple contexts. Legally and morally, it explains why people can be held responsible for their actions. Theologically, it was used to explain why a supposedly kind and omniscient god would send most of the people he created to hell (Walker, 1964). Yet, for such an important concept, there remains wide-ranging disagreement and confusion over its existence and its nature. For example, philosophers still debate whether humans truly have free will and, if so, under what conditions human volition deserves to be considered free (Kane, 2011). In psychology, most theorists believe that humans engage in self-control, rational choice, planning, initiative, and related acts of volition. The debate is not whether these things occur but merely whether these should be called free will. -/- This chapter will provide an overview of recent psychology experiments concerned with free will. There are three main and quite distinct sets of problems, each with associated lines of research. The first is concerned with how people understand the idea of free will. The second concerns the causes and consequences of believing in free will. The third focuses on the actual volitional processes that guide human action. (shrink)

How can free and equal people cooperate to solve conflicts and common problems in a rational and legitimate way? In this article I deduce principles for doing so from the requirements of rational communication set out in the discourse theory of Jürgen Habermas. I apply them in defining a process of efficient decision making. What I call ‘communicative design’ denotes the design of a reason giving process in which the practice of proposing and assessing claims with regard to (...) rulemaking and problem solving is undertaken on an equal and autonomous basis. Two sets of prescriptions are given: organisational principles for the composition of groups and argumentative principles for deliberation. However, any procedure aimed at achieving a rational consensus in decision making in organisations has to deal in practice with limitations of time, participation and the information available. Communicative design may not guarantee strictly rational decisions, then, but the procedure it constructs does promise relatively ‘more valid’ decisions than might be expected if another procedure had been adopted. (shrink)

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

Background: The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - havebeen extremely influential in the field of medical ethics, and are fundamental for understanding the currentapproach to ethical assessment in health care. This study tests whether these principles can be quantitativelymeasured on an individual level, and then subsequently if they are used in the decision making process whenindividuals are faced with ethical dilemmas. Methods: The Analytic Hierarchy Process was used as a tool for (...) the measurement of the principles. Four scenarios, whichinvolved conflicts between the medical ethical principles, were presented to participants and they madejudgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if theywere in the situation. Results: Individual preferences for these medical ethical principles can be measured using the Analytic HierarchyProcess. This technique provides a useful tool in which to highlight individual medical ethical values. Onaverage individuals have a significant preference for non-maleficence over the other principles, however, andperhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specificethical dilemmas. Conclusions: People state they value these medical ethical principles but they do not actually seem to use them directly in thedecision making process. The reasons for this are explained through the lack of a behavioural model to accountfor the relevant situational factors not captured by the principles. The limitations of the principles in predictingethical decision making are discussed. (shrink)

Walton offers a comprehensive, flexible model for physician-patient decision making, the first such tool designed to be applied at the level of each particular case. Based on Aristotelian practical reasoning, it develops a method of reasonable dialogue, a question- and-answer process of interaction leading to informed consent on the part of the patient, and to a decision--mutually arrived at--reflecting both high medical standards and the patient's felt needs. After setting forth his model, he applies it to (...) three vital ethical issues: acts of omission, the cessation of treatment, and possible side effects of treatments. In the final chapter, Walton shows how his method functions in light of the real-life complexities of the clinical encounter and how it bears on ethical questions concerning health-care policy, attitudes toward treatment and toward the medical profession, reasonableness of expectations, and the setting of realistic goals of treatment. (shrink)

According to a simple form of consequentialism, we should base decisions on our judgments about their consequences for achieving our goals. Our goals give us reason to endorse consequentialism as a standard of decision making. Alternative standards invariably lead to consequences that are less good in this sense. Yet some people knowingly follow decision rules that violate consequentialism. For example, they prefer harmful omissions to less harmful acts, they favor the status quo over alternatives they would otherwise (...) judge to be belter, they provide third-party compensation on the basis of the cause of an injury rather than the benefit from the compensation, they ignore deterrent effects in decisions about punishment, and they resist coercive reforms they judge to be beneficial. I suggest that nonconsequentialist principles arise from overgeneralizing rules that are consistent with consequentialism in a limited set of cases. Commitment to such rules is detached from their original purposes. The existence of such nonconsequentialist decision biases has implications for philosophical and experimental methodology, the relation between psychology and public policy, and education. (shrink)

Higher courts sometimes assess the constitutionality of law by working through a concrete case, other times by reasoning about the underlying question in a more abstract way. Prior research has found that the degree of concreteness or abstraction with which an issue is formulated can influence people's prescriptive views: For instance, people often endorse punishment for concrete misdeeds that they would oppose if the circumstances were described abstractly. We sought to understand whether the so-called ‘abstract/concrete paradox’ also jeopardizes the (...) consistency of judicial reasoning. In a series of experiments, both lay and professional judges sometimes reached opposite conclusions when reasoning about concrete cases versus the underlying issues formulated in abstract terms. This effect emerged whether participants reasoned with broad principles, such as human dignity, or narrow rules, and was largest among individuals high in trait empathy. Finally, to understand whether people reflectively endorse the discrepancy between abstract and concrete resolutions, we examined their reactions when evaluating both, either simultaneously or sequentially. These approaches revealed no single pattern across lay and expert populations, or exploratory and confirmatory studies. Taken together, our studies suggest that empathic concern plays a greater role in guiding the judicial resolution of concrete cases than in illuminating judges' professed standards—which may result in concrete decisions in violation of their own abstract principles. (shrink)

The United Nations Convention on the Rights of Persons with Disabilities urges and requires changes to how signatories discharge their duties to people with intellectual disabilities, in the direction of their greater recognition as legal persons with expanded decision-making rights. Australian jurisdictions are currently undertaking inquiries and pilot projects that explore how these imperatives should be implemented. One of the important changes advocated is to move from guardianship models to supported or assisted models of decision-making. (...) A driving force behind these developments is a strong allegiance to the social model of disability, in the formulation of the Convention, in inquiries and pilot projects, in implementation and in the related academic literature. Many of these instances suffer from confusing and misleading statements and conceptual misinterpretations of certain elements such as legal capacity, decision-making capacity, and support for decision-making. This paper analyses some of these confusions and their possible negative implications for supported decision-making instruments and those whose interests these instruments would serve, and advises a more incremental development of existing guardianship regimes. This provides a more realistic balance between neglecting the real limits of those with mental disabilities and thereby ignoring their identity and particularity, and continuing to bring them equally and fully into society. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special Issue on Pediatric Decision-MakingErica K. SalterUnlike in the traditional decisional dyad in adult-based care, pediatric decision-making typically involves a triadic relationship among the patient, their parents, and the health-care providers. This complex relationship raises questions and concerns regarding each party’s expectations, obligations, and authority. For example, should a parent be allowed to withhold a poor diagnosis from an adolescent patient? Should an (...) HLA-matched six-year-old sister be permitted to serve as a bone marrow donor for her older sibling with lysosomal storage disease? Or, should parents be given decisional authority to consent to gender-affirming care for an adolescent with gender dysphoria? Cases like these are among the most ethically challenging decisions faced by parents and health-care providers because they present competing interests and values, and it’s not always clear what is in the best interests of the child.In the context of American medicine, the best interest standard has been identified as the primary ethical and legal guide for decision-making. In its most prominent form, the best interest standard requires parents and pediatric practitioners to choose the medical treatment that maximizes benefits and minimizes harms to the particular child in question. However, over the past few decades, the standard has come under significant scrutiny, with discussions and debate in the academic bioethics literature asking whether the standard is able to serve the [End Page 181] purposes it is thought to serve and whether alternative standards might be better suited to the task(s). Despite vigorous interest in these issues, the academic literature did not seem to generate any sense of identifiable consensus about how others ought to make health-care decisions on behalf of children.Thus, in June 2022, 17 scholar-experts on pediatric decision-making standards gathered in St. Louis, MO, for a three-day symposium of discussion and consensus-building. The participating authors represented different disciplinary perspectives and different viewpoints in the debate about guidance principles that underlie pediatrics. Despite apparent disagreement about such standards in the literature, the group was able to generate a set of six consensus-based recommendations (see Table 1) for pediatric decision-making. These recommendations, as well as their application, justification, and limitations, were published as a special article in Pediatrics in August 2023 (Salter et al. 2023), which was composed with the primary goals of accessibility, teachability, and implementability for practicing pediatric clinicians. Click for larger view View full resolutionTable 1.Six consensus recommendations for pediatric decision-makingWhile the group was able to find agreement about these six central principles of pediatric decision-making, there remained several related issues that were outside of the scope of the symposium aims. For example, should these recommendations apply to neonates, children in state custody, or adolescents, and if so, how would their application be operationalized? What specific conditions should justify state intervention on parental authority? How should parents and health-care providers think about obligations to siblings in health-care decisions? This [End Page 182] special issue of Perspectives in Biology and Medicine provides a forum for our authors and collaborators to further explore these, and other, important questions.The issue opens with a piece by the symposium organizers and editors of this special issue, Erica Salter, Lainie Friedman Ross, and D. Micah Hester, describing the symposium’s inspiration and design, its execution, and the implications it might have for pediatric ethics. This contribution compares the six symposium recommendations with existing statements about pediatric decision-making, in particular the statements developed by the American Academy of Pediatrics (AAP). In “How We Found Consensus on Pediatric Decision-Making and Why It Matters,” readers will find a detailed account of the process engaged to develop the six consensus-based recommendations, as well as a discussion of the value and limitations of such a process, which may serve as a model of consensus-building useful for other unsettled topics of interest in the bioethics community.The issue’s second article, “Childhood Interests: What They Are, and Why It Matters,” by Johan Bester and Jeffrey Blustein, dives into the conceptual foundation of the symposium’s first two recommendations. This... (shrink)

Analogy making from examples is a central task in intelligent system behavior. A lot of real world problems involve analogy making and generalization. Research investigates these questions by building computer models of human thinking concepts. These concepts can be divided into high level approaches as used in cognitive science and low level models as used in neural networks. Applications range over the spectrum of recognition, categorization and analogy reasoning. A major part of legal reasoning could (...) be formally interpreted as an analogy making process. Because it is not the same as reasoning in mathematics or the physical sciences, it is necessary to use a method, which incorporates first the ability to specify likelihood and second the opportunity of including known court decisions. We use for modelling the analogy making process in legal reasoning neural networks and fuzzy systems. In the first part of the paper a neural network is described to identify precedents of immaterial damages. The second application presents a fuzzy system for determining the required waiting period after traffic accidents. Both examples demonstrate how to model reasoning in legal applications analogous to recent decisions: first, by learning a system with court decisions, and second, by analyzing, modelling and testing the decision making with a fuzzy system. (shrink)

As clinicians, this case1 raises both personal and professional challenges. A key issue is who carries legal parental responsibility for the difficult decisions that may be required around life-sustaining care in baby T. Medicolegally, we understand that the surrogate mother holds legal parental responsibility for baby T until this can be transferred to the intended parents.2 But this process can take many months to complete, after the birth of baby. As M is now critically ill and unable to (...) engage in any discussion around the care of her baby, who becomes the legal guardian of the baby, for complex decision making that involves either reorientation of care away from intensive care with the inevitable consequence of death in this extremely premature baby, or continuing this life-sustaining treatment with a high likelihood for major neonatal morbidity and longer term disability? Does it pass onto one of the IPs as the genetic father, or does this responsibility fall on the neonatal consultant managing the baby in intensive care? And if an antenatal surrogacy agreement had existed, is it legally binding for inclusion of the IPs perspectives in the decision-making, especially if our medical decision making turns out to be at discord with the beliefs and wishes of the IPs for baby T? Box 1 ### Current surrogacy proceedings in the UK.2 6–8 The Law Commission UK5 is currently reviewing the decision on whether legal parenthood to intended parents can be effected immediately at the time of birth of the baby. Parental orders. (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)

HARWOOD L and CLARK AM. Nursing Inquiry 2012; 19: 29–38 Understanding health decisions using critical realism: home‐dialysis decision‐making during chronic kidney diseaseThis paper examines home‐dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self‐management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home‐dialysis has clear health, societal and economic benefits yet (...) service usage is low despite efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home‐dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re‐conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. (shrink)

The objective of this book is to produce a theory of rational decision making for realistically resource-bounded agents. My interest is not in “What should I do if I were an ideal agent?”, but rather, “What should I do given that I am who I am, with all my actual cognitive limitations?” The book has three parts. Part One addresses the question of where the values come from that agents use in rational decision making. The most (...) comon view among philosophers is that they are based on preferences, but I argue that this is computationally impossible. I propose an alternative theory somewhat reminiscent of Bentham, and explore how human beings actually arrive at values and how they use them in decision making. Part Two investigates the knowledge of probability that is required for decision-theoretic reasoning. I argue that subjective probability makes no sense as applied to realistic agents. I sketch a theory of objective probability to put in its place. Then I use that to define a variety of causal probability and argue that this is the kind of probability presupposed by rational decision making. So what is to be defended is a variety of causal decision theory. Part Three explores how these values and probabilities are to be used in decision making. In chapter eight, it is argued first that actions cannot be evaluated in terms of their expected values as ordinarily defined, because that does not take account of the fact that a cognizer may be unable to perform an action, and may even be unable to try to perform it. An alternative notion of “expected utility” is defined to be used in place of expected values. In chapter nine it is argued that individual actions cannot be the proper objects of decision-theoretic evaluation. We must instead choose plans, and select actions indirectly on the grounds that they are prescribed by the plans we adopt. However, our objective cannot be to find plans with maximal expected utilities. Plans cannot be meaningfully compared in that way. (shrink)

In this topical section, we highlight the next step of research on modeling aiming to contribute to the emerging literature that radically refrains from approaching modeling as a scientific endeavor. Modeling surpasses “doing science” because it is frequently incorporated into decision-making processes in politics and management, i.e., areas which are not solely epistemically oriented. We do not refer to the production of models in academia for abstract or imaginary applications in practical fields, but instead highlight the real entwinement (...) of science and policy and the real erosion of their boundaries. Models in decision making – due to their strong entwinement with policy and management – are utilized differently than models in science; they are employed for different purposes and with different constraints. We claim that “being a part of decision-making” implies that models are elements of a very particular situation, in which knowledge about the present and the future is limited but dependence of decisions on the future is distinct. Emphasis on the future indicates that decisions are made about actions that have severe and lasting consequences. In these specific situations, models enable not only the acquisition of knowledge (the primary goal of science) but also enable deciding upon actions that change the course of events. As a result, there are specific ways to construct effective models and justify their results. Although some studies have explored this topic, our understanding of how models contribute to decision making outside of science remains fragmentary. This topical section aims to fill this gap in research and formulate an agenda for additional and more systematic investigations in the field. (shrink)