The question of decision-making capacity for informed consent to experimental brain surgery for severely ill anorectic patients is about as dramatic an ethical issue one can imagine. Sabine Muller and her co-authors (2015) should be commended for this extremely timely and original clinical and ethical discussion of decision-making capacity in relation to the issues raised by informed consent to such therapies. In this commentary, I elaborate on the new account of the nature of anorexia nervosa that the authors allude to (...) in order to frame their discussion. This is the hypothesis that anorexia nervosa is a passion: a view with important implications for how we think about decision-making capacity in anorexia nervosa and elsewhere. (shrink)

Personal values have long been associated with individual decision behavior. The role played by personal values in decision making within an organization is less clear. Past research has found that managers tend to respond to ethical dilemmas situationally. This study examines the relationship between personal values and the ethical dimension of decision making using Partial Least Squares (PLS) analysis. The study examines personal values as they relate to five types of ethical dilemmas. We found a significant positive contribution of altruistic (...) values to ethical decision making and a significant negative contribution of self-enhancement values to ethical decision making. (shrink)

People disagree about whether “moral facts” are objective facts like mathematical truths (moral realism) or simply products of the human mind (moral antirealism). What is the impact of different meta-ethical views on actual behavior? In Experiment 1, a street canvasser, soliciting donations for a charitable organization dedicated to helping impoverished children, primed passersby with realism or antirealism. Participants primed with realism were twice as likely to be donors, compared to control participants and participants primed with antirealism. In Experiment 2, online (...) participants primed with realism as opposed to antirealism reported being willing to donate more money to a charity of their choice. Considering the existence of non-negotiable moral facts may have raised the stakes and motivated participants to behave better. These results therefore reveal the impact of meta-ethics on everyday decision-making: priming a belief in moral realism improved moral behavior. (shrink)

Ethical decision making in medicine has recently seen calls to move towards less prescriptive- based approaches that consider the particularities of each case. The main alternative call from the literature is for better understanding of phronesis concepts applied to decision making. A well-cited phronesis-based approach is Kaldjian’s five-stage theoretical framework: goals, concrete circumstances, virtues, deliberation and motivation to act. We build on Kaldjian’s theory after using his framework to analyse data collected from a three-year empirical study of phronesis and the (...) medical community. The data are a set of narratives collected in response to asking a medical community what making ethically wise decisions means to them. We found that Kaldjian’s five concepts are present in the accounts to some extent but that one of the elements, motivation, is constructed as playing a different, though still crucial role. Rather than being an end-stage of the process as Kaldjian’s framework suggests, motivation was constructed as initiating the process and maintaining the momentum of taking a phronesis-based approach. The implications for medical ethics decision-making education are significant as motivation itself is a highly complex concept. We therefore theorise that motivation is required for leading in, continuing and completing the actions of the ethical decision taken. Appreciating the central importance of motivation through the whole of Kaldjian’s framework has implications for cultivating the virtues of phronesis and courage to take the right course of action. (shrink)

In many real-world gambles, a non-trivial amount of time passes before the uncertainty is resolved but after a choice is made. An individual may have a preference between gambles with identical probability distributions over final outcomes if they differ in the timing of resolution of uncertainty. In this domain, utility consists not only of the consumption of outcomes, but also the psychological utility induced by an unresolved gamble. We term this utility anxiety. Since a reflective decision maker may want to (...) include anxiety explicitly in analysis of unresolved lotteries, a multiple-outcome model for evaluating lotteries with delayed resolution of uncertainty is developed. The result is a rank-dependent utility representation (e.g., Quiggin, 1982), in which period weighting functions are related iteratively. Substitution rules are proposed for evaluating compound temporal lotteries. The representation is appealing for a number of reasons. First, probability weights can be interpreted as the cognitive attention allocated to certain outcomes. Second, the model disaggregates strength of preference from temporal risk aversion and thus provides some insight into the old debate about the relationship between von Neumann–Morgenstern utility functions and strength of preference value functions. (shrink)

This study aimed to investigate the relationship between cognitive abilities and age differences in information search and the moderating role of task self-relevance by measuring the decision-making process of participants in both high and low self-relevance decision tasks. The participants were 57 young adults and 65 older adults who viewed five alternatives ☓ five attributes decision matrices in which they needed to open the information cells they wanted to explore by clicking the mouse. Processing speed, verbal fluency, working memory and (...) vocabulary were measured as cognitive abilities. The dependent variables were search engagement (including time-related engagement and frequency-related engagement) and search pattern (calculated based on alternative-based or attribute-based search). Results from a structured equation model showed that age negatively predicted these cognitive abilities (processing speed, verbal fluency, working memory and vocabulary), and positively predicted information searching engagement. Processing speed mediated the impact of age on study time per cell under tasks with both high and low self-relevance; whereas verbal fluency mediates total searching time and searching time per check only when the task is highly self-related, but not in the task with low self-relevance. These results suggested that self-relevance could moderate the mediation effect of verbal fluency on the relationship between age and information searching time, which means that older adults whose verbal fluency was limited need relatively more time to search information to make an informed decision. However, this impact is only sufficient when the decision task is highly self-related and draws more engagement motivation into it. (shrink)

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six (...) interviews were undertaken with fifty-seven participants across three states in Australia. Interpretative Phenomenological Analysis was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants’ experiences with decision-making: “the person in relationship over time” and “maintaining involvement.” Participant views on the practical issues associated with supported decision-making are addressed under the themes of “facilitating decision-making,” “supported decision-making arrangements,” “constraints on decision-making,” and “safeguarding decision-making.” While participants endorsed the principles of supported decision-making as part of their overarching strategy of “maintaining involvement” in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual “constraints on decision-making” also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a “spectrum approach” to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. (shrink)

o privacy regarding family matters, common law rule, and a general presumption that parents or guardians will act in the best interest of their incompetent child. However, over the years, the courts have gradually recognized that children younger than 18 years who show maturity and competence deserve a voice in determining their course of medical treatment. This article will explore the rights and interests of minors, parents, and the state in medical decision making and will address implications for nursing administrators (...) and leaders.... (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support (...) the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

This article reviews recent developments within a number of academic disciplines pointing toward an increasing importance of imagination for understanding morality and cognition. Using elements from hermeneutics and metaphor theory, it works toward a framework for a more context-sensitive understanding of human agency, especially focusing on moral deliberation and change. The analytic framework is used to analyze the story of a patient making tough decisions in the context of prenatal diagnosis. We show how a relatively stable outlook on the world, (...) here called the “baseline of choice,” is challenged by unexpected events and how imaginative processes enter into the active creation of a new moral order. The ensuing interpretation is then placed within a broader philosophical landscape. John Dewey’s notion of “dramatic rehearsal” is put forward as one particularly promising way of understanding moral imagination, deliberation, and decision-making. (shrink)

In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end-of-life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end-of-life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end-of-life decisions clearly shorten lives. The second is that the doctrine of double (...) effect is not recognized in UK law ; therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician-assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double-effect doctrine's distinction between foresight and intention. (shrink)

Normative accounts in terms of similarity can be deployed in order to provide semantics for systems of context-free default rules and other sophisticated conditionals. In contrast, procedural accounts of decision in terms of similarity (Rubinstein 1997) are hard to reconcile with the normative rules of rationality used in decision-making, even when suitably weakened.

The standard by which we apply decision-making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision-making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by providing (...) the truth-conditions for the substituted judgement in terms of counterfactual reasoning using a possible worlds semantics. In this paper, I show how these underpinnings fail to support the substituted judgement approach as a reasonable standard for decision-making. Firstly, I show how this counterfactual element has been poorly interpreted. I then explain how various accounts have failed to reflect problems and limitations associated with providing an interpretation of their truth-conditions using counterfactuals. Finally, I argue that, even when we attend to the initial problems of providing a counterfactual analysis, it still deeply problematic as a means of determining the validity of substituted judgements for two main reasons. Firstly, making determinate judgements as to the truth-value of these judgements will often not be possible and, secondly, there is a strong requirement when interpreting many counterfactual claims to charitably accede to their being true. I conclude that substituted judgements, as interpreted through counterfactual reasoning and possible worlds semantics, do not therefore provide an adequate standard for surrogate decision-making. (shrink)

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

Operational psychology is an emerging subdiscipline that has enhanced the U.S. military's combat capabilities during the Global War on Terrorism. What makes this subdiscipline unique is its use of psychological principles and skills to improve a commander's decision making as it pertains to conducting combat (or related operations). Due to psychology's expanding role in combat support, psychologists are being confronted with challenges that require the application of their professional ethics in areas in which little if any guidance has been provided. (...) Operational psychologists are at the forefront of this expansion. Accordingly, they need a decision model to assist them in this complex dynamic environment. To this end, this article reviews various decision models and ethical frameworks, selects the most appropriate, and then applies it to the challenges faced by operational psychologists. A naturalistic decision model that integrates rational and intuitive elements is recommended. (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)

Questions concerning moral problems caused by the lifesciences and concerning the adequate methods and instruments to solve these are timely and urgent; especially in the face of intense debates on the acceptability of research on human embryonic stem cells and preimplantation diagnostics, to name only two applications developed from research in the life-sciences. Unfortunately, the constant and accusing demand that life-scientists must behave morally does not give us a clue on how ethics may help in establishing guidelines for moral behaviour. (...) In this heated situation the foundation of ethics-committees seems to be the motto of the day. But instead of functioning as necessary and fruitful scientific advisory boards, these committees run the risk of being misused as a fashionable (and soon forgotten) weapon in the battle for political opinion-leadership. In the following article, the view is defended that ethics is a scientific enterprise and has an important role to play in political decision making on lifesciences issues. Content Type Journal Article Pages 29-31 Authors Felix Thiele, Bad Neuenahr-Ahrweiler GmbH, Wilhelmstrasse 56, D-53474 Bad Neuenahr-Ahrweiler, Germany Journal Human Reproduction & Genetic Ethics Online ISSN 2043-0469 Print ISSN 1028-7825 Journal Volume Volume 8 Journal Issue Volume 8, Number 2 / 2002. (shrink)

This article explores areas of law loosely within English equity and trusts law that have not conventionally been subject to feminist debate, and within the context of a discussion about feminist method. The particular areas examined are whistleblowing and trustees’ powers of investment, each of which calls for consideration of decision-making processes which have an ethical content. These sites are chosen because they take debate outside the all too familiar locations of woman or ‘the body of woman’, including the family (...) home, where feminist analysis in relation to equity and trusts tends to stray. In exploring these chosen fields, Hobby’s (Feminist Perspectives on Equity and Trusts, Cavendish Publishing, 2001, pp. 219–255) critique of gender dimensions in relation to whistleblowing and Dunn’s (Feminist Perspectives on Equity and Trusts, Cavendish Publishing, 2001, pp. 179–196) account of women trustees’ investment decisions are evaluated and developed. The debate within feminist legal criticism of the possibility of integrating an ‘ethics of care’ and an ‘ethics of rights’ is acknowledged. Whilst acknowledging of the difficulty of adopting an approach that recognises ‘mixed logics’, it is concluded that women (and men) do integrate the ethics of care and the ethics of rights in their decision-making. It is argued that the effort should be made to trace the specific weave in particular circumstances, thereby paying suspicious attention to the values that underlie courts’ analyses of ethical choices. (shrink)

Simonet, Emanuel Nicolas Cortes Victoria's new Powers of Attorney Act 2014 came into operation on 1 September 2015. Following recommendations by the Victorian Parliament Law Reform Committee, changes have been introduced in the new Act to simplify the process of making an enduring power of attorney. Reforms include the addition of a section on capacity, the introduction of a supportive attorney role distinct from the enduring power of attorney role, and the enhancement of safeguards. This article analyses how the new (...) Powers of Attorney Act 2014 empowers persons with impaired decision-making capacity and also strengthens the mechanisms which protect them from abuse. (shrink)

The Pathways Commission calls on accounting educators to develop students’ skills in ethical judgment and decision making, but there is uncertainty about how best to accomplish this task. We test if participation in Volunteer Income Tax Assistance programs is positively associated with students’ ethical judgment and decision making. Using a questionnaire administered to students participating in VITA and students not participating in VITA at seven universities, we form multiple measures of students’ ethical judgment and students’ ethical decision making. Regression analyses (...) reveal that VITA participation is positively and significantly associated with ethical judgment and, in certain cases, is also positively and significantly associated with ethical decision making, even after controlling for other determinants including completion of ethics courses. We conclude that VITA programs can be effective educational interventions to promote ethical development in students. Our study adds to the growing literature on positive student outcomes associated with VITA participation, provides empirical evidence to support the tenets of situated learning and service-learning theories, and contributes to the development of effective ethics education. (shrink)

Open peer commentary on the article “Radical Constructivist Structural Design Education for Large Cohorts of Chinese Learners” by Christiane M. Herr. Upshot: In this comment, I take Herr’s proposition for a constructivist-informed pedagogy for structural design education to extract initial ideas for a framework for a constructivist pedagogy, a framework focused on the decision-making of a constructivist teacher. I enhance this initial framework with initial findings of a study I conducted with a constructivist mathematics teacher.

I review the recent case of Edna Folz, a 73 year-old woman who was suffering through the end stages of very advanced Alzheimer's dementia when her case was adjudicated by the Wisconsin Supreme Court. I consider this case as an example of how courts are increasingly misinterpreting the ethical and legal decision-making standards known as substituted judgment and best interests and thereby threatening individuals' treatment decision-making rights as developed by other courts over the past two decades and creating serious roadblocks (...) to health-care providers' ability to render appropriate patient care. The Wisconsin Supreme Court held that Edna's legal guardian could not authorize withdrawal of Edna's treatment, ruling that as a matter of law, if an incompetent person is not in a persistent vegetative state, it is not in his or her best interests for life-sustaining treatment to be withdrawn unless (s)he has executed an advance directive or other statement clearly indicating his or her desires. (shrink)

First responders to chemical, biological, radiological, or nuclear (CBRN) events face decisions having significant human consequences. Some operational decisions are supported by standard operating procedures, yet these may not suffice for ethical decisions. Responders will be forced to weigh their options, factoring-in contextual peculiarities; they will require guidance on how they can approach novel (indeed unique) ethical problems: they need strategies for “on the spot” ethical decision making. The primary aim of this paper is to examine how first responders should (...) approach on the spot ethical decision-making amid the stress and uncertainty of a CBRN event. Drawing on the long-term professional CBRN experience of one of the authors, this paper sets out a series of practical ethical dilemmas potentially arising in the context of a large-scale chemical incident. We propose a broadly consequentialist approach to on the spot ethical decision-making, but one which incorporates ethical values and rights as “side-constraints”. (shrink)

A systematic review was carried out on the production and publication of research papers related to the study of the variables Administrative Accounting, Innovation, Financial Management and Sustainability, the PRISMA approach (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The purpose of the analysis proposed in this document was to know the main characteristics of the publications registered in the Scopus and Wos databases and their scope in the study of the proposed variables, achieving the identification of 58 publications in (...) total. Thanks to this first identification, it was possible to refine the results through the keywords entered in the search button of both platforms, the following keywords: MANAGEMENT ACCOUNTING, INNOVATION, FINANCIAL MANAGEMENT, SUSTAINABILITY, reaching a total of 15 documents, excluding duplicates and those that did not meet the analysis criteria. From this analysis, it is expected to know the contributions of the scientific community to the study of the contributions of administrative accounting in sustainable financial management, in support of decision-making by senior management, always seeking the optimization of resources and increase profitability through innovation and the principles of sustainability. (shrink)

This work aims to increase the consumption of online tourism products and promote the development of the tourism economy. Based on this, it first analyses the Internet market under the guidance of consumer psychology. Then, the influencing factors of online product decision-making for the tourism economy are discussed. Finally, based on the above analysis, it discusses and evaluates the main factors affecting the consumption of online travel products. The research method of this work is set based on psychology so that (...) it can analyze the psychological state of consumers more deeply and promote the development of the consumer market. The results show that the main factors affecting the consumption of online travel products include online travel platforms and user characteristics. Specifically, approximately 80% of users consume online travel products based on platform reviews, approximately 10% of users consume online travel products based on platform recommended content, and approximately 5% of users consume online travel products based on platform search content. Users vary mainly by age, gender, and region and have different preferences for different platforms. Among the four major platforms, Ctrip occupies the most consumers. The conclusion is that the main way to develop the tourism economy is to build a better online travel platform. At the same time, it is necessary to promote online tourism according to the characteristics of users and increase the marketing of online tourism products. This work not only provides a reference for promoting online tourism product marketing but also helps to promote the development of the tourism economy. (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)