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

Organizations increasingly rely on algorithm-based HR decision-making to monitor their employees. This trend is reinforced by the technology industry claiming that its decision-making tools are efficient and objective, downplaying their potential biases. In our manuscript, we identify an important challenge arising from the efficiency-driven logic of algorithm-based HR decision-making, namely that it may shift the delicate balance between employees’ personal integrity and compliance more in the direction of compliance. We suggest that critical data literacy, ethical awareness, the (...) use of participatory design methods, and private regulatory regimes within civil society can help overcome these challenges. Our paper contributes to literature on workplace monitoring, critical data studies, personal integrity, and literature at the intersection between HR management and corporate responsibility. (shrink)

The state of the art of contemporary philosophy and psychiatry is reviewed. Section 1 describes the new field as an international open society of ideas. Section 2 introduces values-based practice. Although originally a philosophy-into-practice initiative, values-based practice is now developing more strongly in areas of bodily medicine such as surgery. An example from surgery illustrates how values-based practice has been implemented as a partner to evidence-based practice in supporting shared clinical decision-making as the basis of best practice in contemporary (...) person-centered clinical care. Section 3 explores the difficulties presented by implementing values-based practice in mental health as illustrated by a case example of anorexia. This shows that these difficulties derive from the particularly intense challenges of values pluralism presented by anorexia. The resources of phenomenology provide the basis for an effective response to these challenges. Section 4 generalizes the argument of Section 3 showing that an effective response to the wider range of challenges of values pluralism arising across the board in mental health is available from the resources of the international open society of ideas of contemporary philosophy and psychiatry. The article concludes with a promissory note on values and a cautionary note on science. (shrink)

According to L. A. Paul (2014), transformative experiences pose a challenge for decision theory, as their subjective value is not epistemically accessible. However, several authors propose that the subjective values of options are often irrelevant to their ranking; in many cases, all we need for rational transformative decision-making are the known non-subjective values. This stance is in conflict with Paul’s argument that the subjective value can always swamp the non-subjective value. The approach presented in this paper takes Paul’s (...) argument into account and shows how potential swamping can be controlled given that one desires the transformative outcome: If one knows from previous decisions that desired transformative outcomes are associated with positive subjective value and if, in addition, testimony confirms this association for the current decision situation, one can infer that a desired outcome’s expected subjective value has a positive valence. Accordingly, one can rationally choose the desired transformative option if its non-subjective value is no lower than the overall value of any other option. (shrink)

This paper describes a cross-cultural research project on the relation between how people conceptualize nature and how they act in it. Mental models of nature differ dramatically among and within populations living in the same area and engaged in more or less the same activities. This has novel implications for environmental decision making and management, including dealing with commons problems. Our research also offers a distinct perspective on models of culture, and a unified approach to the study of culture (...) and cognition. We argue that cultural transmission and formation does not consist primarily in shared rules or norms, but in complex distributions of causally-connected representations across minds in interaction with the environment. The cultural stability and diversity of these representations often derives from rich, biologically-prepared mental mechanisms that limit variation to readily transmissible psychological forms. This framework addresses a series of methodological issues, such as the limitations of conceiving culture to be a well-defined system or bounded entity, an independent variable, or an internalized component of minds. (shrink)

Most of the academic research in the field of consumer ethics has focused on the cognitive antecedents and processes of unethical consumer behavior. However, the specific roles of discrete emotions such as fear have not yet been investigated thoroughly. This research examines the role of the need for cognition, the three affective responses—fear, power, and excitement—and perceived issue importance on moral intensity, ethical perceptions, and ethical intentions for four types of unethical consumer behaviors. A sample of consumers from the two (...) cities of Alexandria and Cairo, Egypt participated in the survey. Most research hypotheses were supported. NFC, issue importance, and affect variables were all predictors of moral intensity, ethical perceptions, and ethical intentions in four different consumer ethics scenarios. The specific predictors varied from one consumer ethics scenario to another, however. (shrink)

Diffusion models are widely-used and successful accounts of the time course of two-choice decision making. Most diffusion models assume constant boundaries, which are the threshold levels of evidence that must be sampled from a stimulus to reach a decision. We summarize theoretical results from statistics that relate distributions of decisions and response times to diffusion models with time-varying boundaries. We then develop a computational method for finding time-varying boundaries from empirical data, and apply our new method to two (...) problems. The first problem involves finding the time-varying boundaries that make diffusion models equivalent to the alternative sequential sampling class of accumulator models. The second problem involves finding the time-varying boundaries, at the individual level, that best fit empirical data for perceptual stimuli that provide equal evidence for both decision alternatives. We discuss the theoretical and modeling implications of using time-varying boundaries in diffusion models, as well as the limitations and potential of our approach to their inference. (shrink)

Integrated approaches in the ethical decision-making (EDM) and practically wise decision-making literature are emerging as alternative perspectives to management theories that conceptualize decision-making in a rationalist and value-free manner. However, more dialogue between both perspectives and qualitative research that applies them is required. In addition, there is a need for empirical analysis on business engagement in the face of grand challenges in developing countries. This paper proposes an integrated practically wise EDM framework to study how Colombian councilors (...) who, in 2013, voted for or against the merger between the Colombian state-owned company UNE and the Swedish multinational Millicom interpret this decision and its public impact. Qualitative semi-structured interviews were conducted with a voluntary sample of 18 of 21 councilors. Supporters of the UNE-Millicom merger expressed open-mindedness, seeing the merger as a means to achieve justice. On the contrary, the merger’s opponents expressed circumspection, doubting that Millicom’s intentions really leaned toward justice. We conclude that practical wisdom—embodied by both supporters and detractors—fosters an understanding of EDM beyond what leaders should not do. It also includes a democratic and balanced deliberation on what leaders think they should do to promote the common good. (shrink)

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Can transparency contribute to restoring accountability for such systems? Several objections are examined: the loss of privacy when data sets become public, the perverse effects of disclosure of the very algorithms themselves, the potential loss of competitive edge, and the limited gains in answerability to be expected since sophisticated algorithms are inherently opaque. It is concluded that transparency (...) is certainly useful, but only up to a point: extending it to the public at large is normally not to be advised. Moreover, in order to make algorithmic decisions understandable, models of machine learning to be used should either be interpreted ex post or be interpretable by design ex ante. (shrink)

It is often said that there are three great traditions of normative ethics: consequentialism, deontology and virtue ethics. Each is based around a compelling intuition about the nature of ethics: that what is ultimately important is that we produce the best possible outcome, that ethics is a system of rules which govern our behaviour, and that ethics is about living a life that instantiates the virtues, such as honesty, compassion and loyalty. This essay is about how best to interpret consequentialism. (...) I show that if we take consequentialism beyond the assessment of acts, using a consequentialist criterion to assess decision making, motivation, and character, then the resulting theory can also capture many of the intuitions about systems of moral rules and excellences of character that lead people to deontology and virtue ethics. I begin by considering the argument that consequentialism is self-defeating because its adoption would produce bad outcomes. I take up the response offered by the classical utilitarians: when properly construed, consequentialism does not require us to make our decisions by a form of naïve calculation, or to be motivated purely by universal benevolence. Instead it requires us to use the decision procedure that will produce the best outcome and to have the motives that lead to the best outcome. I take this idea as my starting point, and spend the thesis developing it and considering its implications. I demonstrate that neither act-consequentialism nor rule-consequentialism has the resources to adequately assess decision making and motivation. I therefore turn to the idea of global consequentialism, which assesses everything in terms of its consequences. I then spend the greater part of the essay exploring how best to set up such a theory and how best to apply it to decision making and motivation. I overcome some important objections to the approach, and conclude by showing how the resulting approach to consequentialism helps to bridge the divide between the three traditions. (shrink)

To advance current knowledge on ethical decision-making in organizations, we integrate two perspectives that have thus far developed independently: the organizational identification perspective and the ethical climate perspective. We illustrate the interaction between these perspectives in two studies, in which we presented participants with moral business dilemmas. Specifically, we found that organizational identification increased moral decision-making only when the organization’s climate was perceived to be ethical. In addition, we disentangle this effect in Study 2 from participants’ moral identity. (...) We argue that the interactive influence of organizational identification and ethical climate, rather than the independent influence of either of these perspectives, is crucial for understanding moral decision-making in organizations. (shrink)

As complicated as decision-making in pediatrics is, we should be grateful that most of the time, it works. The inherently dyadic or triadic nature of interactions between clinicians, pediatric pati...

This paper examines the relationship of ethical decision-making by individuals to corporate business ethics and organizational performance of three groups: SMEs, Outstanding SMEs and Large Enterprises, in order to provide a reference for Taiwanese entrepreneurs to practice better business ethics. The survey method involved random sampling of 132 enterprises within three groups. Some 524 out of 1320 questionnaires were valid. The survey results demonstrated that ethical decision-making by individuals, corporate business ethics and organizational performance are highly related. In (...) summary, then, high levels of organizational performance were directly attributable to high levels of applied corporate and individual ethics. Furthermore, there is a demonstrable tendency for Outstanding SMEs to reject ethically unsound practices such as padded expense accounts, tax evasion and misleading advertising. The measurement criteria used to assess organizational performance, however, did not include an objective evaluation of financial performance. (shrink)

In this paper I examine the debate between ‘protectionists’ and ‘liberationists’ concerning the appropriate role of minors in decision-making about their health care, focusing particularly on disagreements between the two sides regarding adolescents. Protectionists advocate a more traditional, paternalistic approach in which minors have relatively little input into the healthcare decision-making process, and decisions are made for them by parents or other adults, guided by a commitment to the patient's best interests. Liberationists, on the other hand, argue in (...) favour of expanded participation by minors in treatment decisions, and decision-making authority for at least some adolescents. My examination of the debate includes discussion of liberationist shifts that have taken place in the medical community as well as in legal policy and practice, and consideration of recent research on adolescent development. In the final section of the paper, I propose a moderate position that addresses both liberationist and protectionist concerns. (shrink)

Substantial literature has investigated the relationship between religiosity and ethical decision-making (the what), while lesser consideration has been given to exploring why decisions are made. As part of a larger study, this paper aims to delve beyond the descriptive relationship between religiosity and ethical decision-making of Muslim employees in Malaysia. We analyse the qualitative data received from 160 employees by using thematic analysis. Our results reveal that, while religious values are important for Muslims in Malaysia, there are other (...) factors that are also pertinent when making decisions at work, namely the organization’s interest and the context of the decision. We also found that individuals’ reasoning based on Islamic teachings is embedded in rules and regulations, which suggests lower levels of ethical reasoning. This study extends the current understanding of the processes of ethical reasoning in highly religious contexts by individuals at their workplace. Implications and suggestions for future research are discussed. (shrink)

While algorithmic decision-making (ADM) is projected to increase exponentially in the coming decades, the academic debate on whether people are ready to accept, trust, and use ADM as opposed to human decision-making is ongoing. The current research aims at reconciling conflicting findings on ‘algorithmic aversion’ in the literature. It does so by investigating algorithmic aversion while controlling for two important characteristics that are often associated with ADM: increased benefits (monetary and accuracy) and decreased user control. Across three high-powered (...) (Ntotal = 1192), preregistered 2 (agent: algorithm/human) × 2 (benefits: high/low) × 2 (control: user control/no control) between-subjects experiments, and two domains (finance and dating), the results were quite consistent: there is little evidence for a default aversion against algorithms and in favor of human decision makers. Instead, users accept or reject decisions and decisional agents based on their predicted benefits and the ability to exercise control over the decision. (shrink)

This paper considers the trade-off between unanimity and anonymity in collective decision-making with an infinite population. This efficiency-equity trade-off is a fundamental difficulty in making a normative judgment in a conflict between generations. In particular, it is known that this trade-off is quite sensitive in the formulation of unanimity axioms. In this study, we consider the trade-off in a preference-aggregation framework instead of the standard utility-aggregation framework. We show that there exists a social welfare function that satisfies I-strong Pareto, (...) independence of irrelevant alternatives, and finite anonymity. This contrasts with an impossibility result in the standard utility-aggregation framework, and this means that the trade-off is also sensitive for background frameworks of aggregations. (shrink)

ABSTRACT This study examined how lifestyle factors and gender affect kidney allocation to transplant patients by 99 British and Singaporean participants. Thirty hypothetical patients were generated from a combination of six factors and randomly paired four times. Participants saw 60 patient pairings and, in each pair, chose which patient would receive treatment priority. A Bradley-Terry model was used to derive coefficients for each factor per participant. A mean factor score was then calculated across all participants for each factor. Participants gave (...) lower priority to patients who drank more, were overweight, smoked more and exercised less. A patient’s diet and gender had no significant effect on allocation. There were no significant cross-cultural differences. There were moderate correlations between participants’ self-reported pre- and post-experiment ordering of decision criteria, and these measures and factor coefficients, suggesting a modest level of decision-making consistency. Between participants, moderate levels of concordance with respect to factor importance were observed for self-reported orderings of factors, and weaker agreement for model-derived coefficients. Very similar results were obtained for both British and Singaporean participants, and the implications of the findings are discussed. (shrink)

Sometimes citizens disagree about political matters, but a decision must be made. We have two theoretical frameworks for resolving political disagreement. The first is the framework of social choice. In it, our goal is to treat parties to the dispute fairly, and there is no sense in which some are right and the others wrong. The second framework is that of collective decision-making. Here, we do believe that preferences are truth apt, and our moral consideration is owed not (...) to those who disagree but to the community that stands to benefit or suffer from the decision. In this chapter, I describe and explore these two frameworks. I conclude two things. First, analysis of real-world disagreement suggests that collective decision-making is the right way to model politics. In most, possibly even all, political disagreement, all parties believe (if implicitly) that there is an objective standard of correctness. Second, this matter is connected to the concept of pluralism. If pluralism is true, then collective decision-making cannot be applied to some political disagreements. More surprisingly, pluralism may rule out the applicability of social choice theory as well. (shrink)

As one approach to examining the way ethical decisions are made, we asked experts and novices to review a set of scenarios that depict some important ethical tensions in research. The method employed was “protocol analysis,” a talk-aloud technique pioneered by cognitive scientists for the analysis of expert performance. The participants were asked to verbalize their normally unexpressed thought processes as they responded to the scenarios, and to make recommendations for courses of action. We found that experts spent more time (...) working through the decision-making process than novices and also raised substantially more concerns than novices. Differences also exist among the three groups of experts. (shrink)

Background Ensuring individual free and informed decision‐making for research participation is challenging. It is thought that preliminarily informing communities through ‘community sensitization’ procedures may improve individual decision‐making. This study set out to assess the relevance of community sensitization for individual decision‐making in research participation in rural Gambia. Methods This anthropological mixed‐methods study triangulated qualitative methods and quantitative survey methods in the context of an observational study and a clinical trial on malaria carried out by the Medical Research (...) Council Unit Gambia. Results/discussion Although 38.7% of the respondents were present during sensitization sessions, 91.1% of the respondents were inclined to participate in the trial when surveyed after the sensitization and prior to the informed consent process. This difference can be explained by the informal transmission of information within the community after the community sensitization, expectations such as the benefits of participation based on previous research experiences, and the positive reputation of the research institute. Commonly mentioned barriers to participation were blood sampling and the potential disapproval of the household head. Conclusion Community sensitization is effective in providing first‐hand, reliable information to communities as the information is cascaded to those who could not attend the sessions. However, further research is needed to assess how the informal spread of information further shapes people's expectations, how the process engages with existing social relations and hierarchies (e.g. local political power structures; permissions of heads of households) and how this influences or changes individual consent. (shrink)

The present research examines whether individuation and categorization processes influence trust decisions about strangers at first and across repeated interactions. In a partial replication of the study reported by Cañadas et al. (2015), participants played an adaptation of the multi-round trust game paradigm and had to decide whether or not to cooperate with unknown partners. Gender (Study 1a) and ethnicity (Studies 1b, 2, and 3) served to create distinct social categories among the game partners, whose reciprocation rates were manipulated at (...) group and individual levels. At the group level, two social groups (i.e., ingroup vs. outgroup) were associated with opposite reciprocation rates (i.e., high vs. low reciprocation rate). At the individual level, consistency was manipulated by altering the reciprocation rate of one out of four members of each social group. That is, there was one inconsistent individual in each group showing a pattern of reciprocation opposite to the group reciprocation rate. Our data, contrary to Cañadas et al.’s (2015) findings, suggested that ingroup partners were individuated given that participants made their decisions to cooperate with the trustees according to their individual reciprocation rate and independently of the group reciprocation rate. In contrast, decisions about outgroup partners (i.e., men in Study 1a and Blacks in Studies 1b, 2, and 3) were affected by category-based thinking. At the same time, in comparison with ingroup, greater cooperation was observed with ethnic outgroups but not with gender outgroups. The consistency of our results with the previous literature on social categorization and across the three experiments seems to indicate they are reliable, supporting the hypothesis that categorization and individuation processes guide trust decision-making, promoting individuation mainly for ingroup and categorization among outgroup members. (shrink)

The article addresses the potential impact of functional brain imaging (functional magnetic resonance imaging and positron-emission tomography) on surrogate end-of-life decision-making in light of varying state-law definitions of consciousness, some of which define awareness behaviorally and others functionally. The article concludes that, in light of admonitions by neuroscientists that functional brain imaging cannot yet replace behavioral evaluation to determine the existence of consciousness, state legislatures, courts and drafters of written advance healthcare directives should consider treating behavior, not function, as (...) the touchstone for end-of-life decision-making. (shrink)

Considering the popular framing of an artificial intelligence as a rational agent that always seeks to maximise its expected utility, referred to as its goal, one of the features attributed to such rational agents is that they will never select an action which will change their goal. Therefore, if such an agent is to be friendly towards humanity, one argument goes, we must understand how to specify this friendliness in terms of a utility function. Wolfhart Totschnig, argues in contrast that (...) a fully autonomous agent will have the ability to change its utility function and will do so guided by its values. This commentary examines computational accounts of goals, values and decision-making. It rejects the idea that a rational agent will never select an action that changes its goal but also argues that an artificial intelligence is unlikely to be purely rational in terms of always acting to maximise a utility function. It nevertheless also challenges the idea that an agent which does not change its goal cannot be considered fully autonomous. It does agree that values are an important component of decision-making and explores a number of reasons why. (shrink)

While fairness is often mentioned as a determinant of ultimatum bargaining behavior, few data sets are available that can test theories that incorporate fairness considerations. This paper tests the reciprocal kindness theory in Rabin (1993 Incorporating fairness into game theory and economics, The American Economic Review 83: 1281-1302) as an application to the one-period ultimatum bargaining game. We report on data from 100 ultimatum games that vary the financial stakes of the game from 1 to 15. Responder behavior is strongly (...) in support of the kindness theory and proposer behavior weakly in support of it. Offer percentages and past offers influence behavior the most, whereas the size of the pie has a marginally significant effect on offer percentages. The data is more in support of reciprocal kindness than alternative theories of equal-split or learning behavior, although the data also weakly support a minimum percentage threshold hypothesis. As a whole, our results together with existing studies suggest that, for smaller stakes games, fairness considerations dominate monetary considerations. This has implications for more complicated naturally occurring bargaining environments in which the financial stakes can vary widely. (shrink)

The feedback arrow extending from the response to the distal state in the lens model, together with Brunswik's dictum that the organism is a stabiliser of systems, implies a dynamic view of behaviour. This paper describes the main problems in the study of dynamic decision making: feedback delays and the feedback structure of the tasks. It also describes microworlds, a methodology for studying dynamic decision making in the laboratory. The results from experiments with microworlds show that subjects have (...) problems compensating for feedback delays and side effects. These results are discussed in terms of Brunswik's distinction between perception and thinking. (shrink)

The circumstances of a public health emergency shape reasoning and decision-making in ways that deviate from routine circumstances, where adherence to established values, principles, and methodologies is expected. Understanding what drives these deviations is critical to assessing their ethical consequences. In this paper we describe four conditions that influence decision-making during PHEs, in particular regarding the deployment and conduct of research on experimental or novel biomedical interventions. These four conditions are politicization, urgency, uncertainty, and fear. We argue that (...) taken together these four conditions create pressure to address the most visible targets of immediate crisis events, driving emphasis on research and development of biomedical interventions. However, this emphasis raises ethical concerns regarding the extent to which attention to and investment in the underlying causes of PHEs, particularly impoverished global public health infrastructure, is diminished as a result. (shrink)

The basic methodology of rough set theory depends on an equivalence relation induced from the generated partition by the classification of objects. However, the requirements of the equivalence relation restrict the field of applications of this philosophy. To begin, we describe two kinds of closure operators that are based on right and left adhesion neighbourhoods by any binary relation. Furthermore, we illustrate that the suggested techniques are an extension of previous methods that are already available in the literature. As a (...) result of these topological techniques, we propose extended rough sets as an extension of Pawlak’s models. We offer a novel topological strategy for making a topological reduction of an information system for COVID-19 based on these techniques. We provide this medical application to highlight the importance of the offered methodologies in the decision-making process to discover the important component for coronavirus infection. Furthermore, the findings obtained are congruent with those of the World Health Organization. Finally, we create an algorithm to implement the recommended ways in decision-making. (shrink)

Why do otherwise well-intentioned managers make decisions that have negative social or environmental consequences? To answer this question, the authors combine the literature on construal level theory with the compromise effect to explore the circumstances that lead to seemingly unethical decision-making. The results of two studies suggest that the degree to which managers make high-risk tradeoffs is highly influenced by how they mentally represent the decision context. The authors find that managers are more likely to make seemingly unethical (...) tradeoffs when psychological distance is high (rather than low) and when they are forced to choose between competing alternatives. However, when given the option not to choose, managers better reflect on the consequences of each alternative, and thus become more likely to choose options with less risk of negative consequences. The results suggest that simply offering managers the option not to choose may reduce psychological distance and help organizations avoid seemingly unethical decision-making. (shrink)

Shared decision-making is important and beneficial for patients. Practically, this requires that we explore the values of the patient and the clinician and then consider available treatment options. The aim is to maximize the good of the patient in the context of their illness. Hence, clinical consultations are situations in which we can, and should, draw upon moral philosophical precepts. One such precept, which can fortify the foundations of shared decision-making, is a process of inclusive, noncoercive, and reflective (...) dialogue, which aims at reaching a consensual decision as to what is best for the patient in their situation. Summary: Shared decision making is important and helpful for patients. This is based upon having a conversation about values and what is important. We can base that conversation on principles of moral philosophy, via a process termed “dialogic consensus”. (shrink)

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

Diagnosis theory reasons about incomplete knowledge and only considers the past. It distinguishes between violations and non-violations. Qualitative decision theory reasons about decision variables and considers the future. It distinguishes between fulfilled goals and unfulfilled goals. In this paper we formalize normative diagnoses and decisions in the special purpose formalism DIO(DE)2 as well as in extensions of the preference-based deontic logic PDL. The DIagnostic and DEcision-theoretic framework for DEontic reasoning DIO(DE)2 formalizes reasoning about violations and fulfillments, and (...) is used to characterize the distinction between normative diagnosis theory and (qualitative) decision theory. The extension of the preference-based deontic logic PDL shows how normative diagnostic and decision-theoretic reasoning — i.e. reasoning about violations and fulfillments — can be formalized as an extension of deontic reasoning. (shrink)

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the (...) patient and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)