What kinds of things can we be morally responsible for? Andrew Khoury offers an answer that includes (i) an argument for the impossibility of blameworthiness for overt action, and (ii) the assertion that “willings are the proper object of responsibility in the context of action”. After presenting an argument for the inconsistency of Khoury’s answer to our focal question, I defend the following partial answer that resembles, but differs importantly from, Khoury’s answer: one can be blameworthy for a practical (...) decision—that is, an essentially intentional momentary mental action of forming an intention to do something that resolves prior felt unsettledness about what to do. (shrink)

My colleagues and I in Birmingham are always on the lookout for an undergraduate textbook for our medical students, which was why I agreed to review this book. By and large it is pitched at an undergraduate audience and covers many of the areas that one might expect to find in a UK undergraduate medical course (consent, making decisions for the incompetent, end-of-life issues, beginning-of-life issues, research, transplantation and medical genetics). It also has a chapter on managed care, which is (...) less relevant to a UK audience but is interesting none the less. (The case study for the chapter on James Adams who, it is alleged, lost both his hands and feet as a …. (shrink)

Midwest Studies In Philosophy, EarlyView.

This is a new edition of a classic textbook in health care ethics, one that offers an alternative to the principle-based approach from Beauchamp and Childress (Principles of Biomedical Ethics, now in its seventh edition from OUP) and traditional Catholic approaches of Ashley and O'Rourke. In the early chapters Devettere spells out the meaning of ethics and the importance of prudential reasoning in seeking the good life. The rest of the book deals with issues and cases, including determinations of life (...) and death, reproduction and research and genetics, and the distribution of health care. In this fourth edition Devettere updates all chapters and adds new cases and new sections on the following: neuroscience, social psychology, overriding advance directives, studies on the fetus, the palliative care movement, cardiopulmonary resuscitation, pharmacists and reproductive issues, prenatal life and abortion, neonatal testing and mandatory vaccinations, the US governments' STD research in Guatemala, the emergence of biobanks, facial transplantations, genetic testing, legal issues around the Affordable Care Act, and more. This is an accessible and comprehensive textbook covering all aspects of the field. (shrink)

Say that a ‘practical decision’ is a momentary intentional mental action of intention formation. According to what I’ll call the ‘Decisional Prior Intention Thesis’, each practical decisio...

_ Source: _Page Count 19 This paper offers an account of practical decisions. The author argues that decisions do not need to be conscious, nor do they need to be settled by deliberation. Agents can be mistaken about what they decided and agents can decide by doing some intentional action besides deliberating. The author argues that the functional role of a decision is to put an end to practical uncertainty. A mental event is a decision to (...) the extent that it ends practical uncertainty and to the extent that awareness of this causal role tends to reinforce that fact. This role is causal, but has systematic connections to consciousness. (shrink)

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the (...) context of DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations. (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)

Presenting the most comprehensive and lucid account of the topic currently available, Robert Audi's "Practical Reasoning and Ethical Decision" is essential reading for anyone interested in the role of reason in ethics or the nature of human action. The first part of the book is a detailed critical overview of the influential theories of practical reasoning found in Aristotle, Hume and Kant, whilst the second part examines practical reasoning in the light of important topics in moral (...) psychology - weakness of will, self-deception, rationalization and others. In the third part, Audi describes the role of moral principles in practical reasoning and clarifies the way practical reasoning underlies ethical decisions. He formulates a comprehensive set of concrete ethical principles, explains how they apply to reasoning about what to do, and shows how practical reasoning guides moral conduct. (shrink)

Students face many important decisions: What college or university should I attend? What should I study? What kind of job should I try to get? Which people should I hang out with? Should I continue or break off a relationship? Should I get married? Should I have a baby? What kind of medical treatment should I use? A theory of practical reasoning should have something to say about how students and other people can improve their decision making.

In general, the technical apparatus of decision theory is well developed. It has loads of theorems, and they can be proved from axioms. Many of the theorems are interesting, and useful both from a philosophical and a practical perspective. But decision theory does not have a well agreed upon interpretation. Its technical terms, in particular, ‘utility’ and ‘preference’ do not have a single clear and uncontroversial meaning. How to interpret these terms depends, of course, on what purposes (...) in pursuit of which one wants to put decision theory to use. One might want to use it as a model of economic decision-making, in order to predict the behavior of corporations or of the stock market. In that case, it might be useful to interpret the technical term ‘utility’ as meaning money profit. Decision theory would then be an empirical theory. I want to look into the question of what ‘utility’ could mean, if we want decision theory to function as a theory of practical rationality. I want to know whether it makes good sense to think of practical rationality as fully or even partly accounted for by decision theory. I shall lay my cards on the table: I hope it does make good sense to think of it that way. For, I think, if Humeans are right about practical rationality, then decision theory must play a very large part in their account. And I think Humeanism has very strong attractions. (shrink)

_Aristotle on Prescription_ explores Aristotle’s deep reflections on rule-making as a process that is both distinct from that of particular deliberation and decision-making and fundamental to it, operating at the level both of the individual and of society as a whole.

The text is extensively referenced, but practical in its approach, giving real life examples and cases based on therapeutic practice.

The family of decision analysis techniques can be applied effectively to support practical negotiators in international settings. These techniques are most appropriate in support of the prenegotiation phase, when parties are diagnosing the situation, assessing their own plans and strategies, and evaluating likely reactions and outcomes. The paper identifies how these approaches have and can be used to assist negotiation practitioners, offers a rationale for the application of decision analytic approaches in terms of the particular analytical requirements (...) of the prenegotiation period, suggests how these process-oriented tools can be integrated with substantive tools, and discusses ways in which these tools can be presented and delivered to practitioners in a practical and confidence-building manner. (shrink)

Can quite different values be rationally weighed against one another? Can the value of one thing always be ranked as greater than, equal to, or less than the value of something else? If the answer to these questions is no, then in what areas do we find commensurability and comparability unavailable? And what are the implications for moral and legal decision making? This book struggles with these questions, and arrives at distinctly different answers.".

BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care (...) in an acute hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)

Decision-making is a complex action requiring efficient information processing. Specifically, in movement in which performance efficiency depends on reaction time, e.g., open-loop controlled movements, these processes may play a crucial role. Information processing includes three distinct stages, stimulus identification, response selection, and response programming. Mainly, response selection may play a substantial contribution to the reaction time and appropriate decision making. The duration of this stage depends on the number of possible choices an individual has to “screen” to make (...) a proper decision. Given that reaction time is crucial in many sports, the possibilities of reducing it through practice are very tempting. The information processing and its relationship to the manner an individual is practicing are discussed. Especially the variability of practice issues will be explored. In variable practice conditions, an individual has to react to one or more stimuli and has to produce one of the many variations of the same movement or different movements they learned. One has to identify a stimulus appropriately and has to select a response optimally, i.e., choosing from as few choices as possible to reduce the reaction time. On the other hand, in constant practice conditions, an individual can be exposed to one or many stimuli. Still, there is only one variation of the movement that can be executed in the presence of a learned stimulus. Based on the information processing theory and the results of the research focusing on variability of practice, I discuss how the practice conditions may affect reaction time and, as a result, the decision-making process. I conceptually frame the possible implications of practice conditions on decision making related to information processing. In this review, a possible mechanism and relationship between practice conditions and decision-making are presented. Future research directions are presented. (shrink)

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues (...) for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

Critical care nurses are key providers in a high acuity environment. This qualitative research study explored ethical decision making in a critical care practice setting. Fifteen critical care nurses with varying experience and education levels were purposively sampled to assure the representativeness of the data. The theoretical concepts of experiential learning, perspective transformation, reflection-in-action and principle-based ethics were used as a framework for eliciting information from the participants. A new model of focused reflection in ethical decision making was (...) developed. Findings showed that having a role model or mentor to help guide the ethical decision-making process was critical for focused ethical discourse and the decision making. (shrink)

Any theory of practical irrationality necessarily imposes a division of labour between an account of the agent's intentional states and how these are formed, and an account of how these intentional states get applied in particular circumstances to choose a particular action. Nevertheless, questions that concern the content of the agent's beliefs and desires are still routinely lumped together with questions that deal with the way the agent chooses in the light of these beliefs and desires. This generates a (...) number of pseudoproblems. Seeks to clarify some of them, by considering the internal structure of decision theory. (shrink)

Regulatory science, which generates knowledge relevant for regulatory decision?making, is different from standard academic science in that it is oriented mainly towards the attainment of non?epistemic (practical) aims. The role of uncertainty and the limits to the relevance of academic science are being recognized more and more explicitly in regulatory decision?making. This has led to the introduction of regulation?specific scientific methodologies in order to generate decision?relevant data. However, recent practical experience with such non?standard methodologies indicates (...) that they, too, may be subject to important limitations. We argue that the attainment of non?epistemic values and aims (like the protection of human health and the environment) requires not only control of the quality of the data and the methodologies, but also the selection of the level of regulation deemed adequate in each specific case (including a decision about which of the two, under?regulation or over?regulation, would be more acceptable). (shrink)

Food safety is a preoccupation of the European Commission, but there are major shortcomings in its governance. Reviewing legislation and practice, this paper explores the background of EU food safety institutions, and develops recommendations to make the EU decision process more transparent, accountable, and democratic.

Book reviewed in this article: Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. By Albert R. Jonsen, Mark Siegler, and William J. Winslade.

This article introduces the neologism ‘odegeology’ to encompass theological discussion concerning divine guidance, a significant issue for spiritual formation and discipleship in the church. Jesus’ promise of power and his commission to be witnesses in Acts 1:8 establish the theme for the book called Praxeis in the Greek text. Acts is replete with examples of guidance for completing that mission, particularly in the ministries of Peter and Paul. Can Paul’s experiences with guidance, whether natural or supernatural, be considered a matter (...) of praxis for Christians today? In answering that question, this study will use Paul’s missionary journeys in Acts as a heuristic model for decision-making. The article will discuss the place of divine guidance in publications by Pentecostal/charismatic publishers and whether it is a subject addressed in the faculties of practical theology in their theological schools. The article closes with a discussion whether odegeology as practised in Acts should be normative for Christians today. (shrink)

This paper is a study of the decisions that researchers take during the execution of a research plan: their researcher discretion. Flexible research methods are generally seen as undesirable, and many methodologists urge to eliminate these so-called ‘researcher degrees of freedom’ from the research practice. However, what this looks like in practice is unclear. Based on twelve months of ethnographic fieldwork in two end-of-life research groups in which we observed research practice, conducted interviews, and collected documents, we explore when researchers (...) are required to make decisions, and what these decisions entail.An abductive analysis of this data showed that researchers are constantly required to further interpret research plans, indicating that there is no clear division between planning and plan execution. This discretion emerges either when a research protocol is underdetermined or overdetermined, in which case they need to operationalise or adapt the plans respectively. In addition, we found that many of these instances of researcher discretion are exercised implicitly. Within the research groups it was occasionally not clear which topic merited an active decision, or which action could retroactively be categorised as one.Our ethnographic study of research practice suggests that researcher discretion is an integral and inevitable aspect of research practice, as many elements of a research protocol will either need to be further operationalised or adapted during its execution. Moreover, it may be difficult for researchers to identify their own discretion, limiting their effectivity in transparency. (shrink)

This book approaches ethical and legal issues in medicine from the patient's viewpoint and argues that many patients do not want the full burden of decision making that contemporary bioethics has thrust upon them.

Desire is a rich term meaning wish and want, willingness and relish, appetite and lust. This volume is an effort to analyze the concept of desire and its different practical contexts from a morally philosophic point of view. By analyzing multiple definitions and studying underlying motivations, the authors offer a variety of explanations and interpretations. The volume consists of three main parts. The first part, "Desire and Practice," examines desire as a mental state that seeks personal satisfaction. The second (...) part of the volume, "Desire and Moral Life," explores social, cultural, and literary facets of desire. Finally, in the third part, "Business Ethics and Other Contexts," the authors apply praxiological principles to the business world, examining the conflict between frugality and consumerist ideology, the role of intuition in decision-making, and the need for design education as the basis of effective planning. The contributors to this, the newest volume in Transaction's Praxiology series, seek to explore desire in praxiological terms, with an eye toward the three E's of praxiology: ethics, effectiveness, and efficiency. In doing so, they demonstrate that desire is central for practical activity in general and work in particular. (shrink)

This paper outlines an account of the ethics of lying, which accommodates two main ideas about lying. The first of these, Anti-Deceptionalism, is the view that lying does not necessarily involve intentions to deceive. The second, Anti-Absolutism, is the view that lying is not always morally wrong. It is argued that lying is not wrong in itself, but rather the wrong in lying is explained by different factors in different cases. In some cases such factors may include deceptive intentions on (...) the part of the liar. In other cases, where such intentions are not found, the wrong in lying may be explained by other factors. Moreover, it is argued that the interaction between considerations against lying and considerations against telling the truth are sensitive to the practical interests of those lied to. When the topic of the lie in question matters little to the victim's rational decision making, the threshold for when considerations against telling the truth can outweigh considerations against lying are lowered. This account is seen to explain why lying to avoid little harm is sometimes permissible, and sometimes not. (shrink)

Informed consent is at the core of the clinical relationship. With the introduction of machine learning (ML) in healthcare, the role of informed consent is challenged. This paper addresses the issue of whether patients must be informed about medical ML applications and asked for consent. It aims to expose the discrepancy between ethical and practical considerations, while arguing that this polarization is a false dichotomy: in reality, ethics is applied to specific contexts and situations. Bridging this gap and considering (...) the whole picture is essential for advancing the debate. In the light of the possible future developments of the situation and the technologies, as well as the benefits that informed consent for ML can bring to shared decision-making, the present analysis concludes that it is necessary to prepare the ground for a possible future requirement of informed consent for medical ML. (shrink)