Decision-making capacity (DMC) is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that (...) fundamentally differs from existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and (...) triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

This work shows that on the most fundamental level, environmental problems are cuased by human management decisions rather than the commonly blamed culprits of environmental degradation, overpopulation, poor farming practices and lack of ...

The intellectual debates on wise entrepreneurship behavior such as decision making tend to focus on the relationship between economic rationality and morality, while overlooking the important role affect plays. To fill in this gap, this paper proposes a theoretical framework based on the Confucian concepts of ren and yi and studies their practical manifestation in qing and li 1 for decision making. Drawing from 32 in-depth interviews and 52 vignettes with Chinese SME entrepreneurs, this study has (...) found that qing plays an essential role in decision making. Chinese entrepreneurs had to deal with the dilemma relating to qing and li 1 holistically to reach a balanced outcome in their everyday business practices. As a major contribution, this study extends the study of Confucian ethics by highlighting ren-yi as an important perspective for understanding Chinese entrepreneurial decision making and also for promoting the affective dimensions for entrepreneurial ethical decision making in general. (shrink)

The book is exceptional because it applies the notion of foms of life to the context of human action. It provides answers to the following questions: Why do we act in a specific way? Why do we make particular decisions? Does one's form of life and language games determine our actions and decisions? Wittgenstein proposes a holistic method which enables us to give coherent answers to these questions. To answer the question of the contents of actions and decisions we (...) have to explain how we have institutionalized these actions or decisions. To this aim we shall reveal the frame within which language games are introduced and have come to function as practice and custom. The scheme of order underlying the language games is illustrated. Human actions and decisions follow particular rules. By highlighting the underlying scheme of order we may gain a perspicuous view of these rules. The aim of this book is to show that actions and decisions generate rational choice. This choice is explained by demonstrating the particular functions of the language games involved. (shrink)

Background: Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care. Research question and design: Our study researched what form the processes and degrees of latitude in decision-making take in practice when (...) questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory. Ethical considerations: The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent. Results: Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse’s individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse’s own style of administering care. The nurse’s decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework. Discussion: An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care – namely, physical, psychological, social and spiritual care – into the practice of her daily work. Conclusion: Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted. (shrink)

In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in (...) philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making. (shrink)

To tackle zoonotic disease threats, a One Health approach is currently commonplace and generally understood as an integrated effort of multiple disciplines to promote the health of humans, animals and the environment. To implement One Health strategies in zoonotic disease control, many countries set up early warning systems, in which human and veterinary health professionals cooperate. These systems, like the Dutch Zoonoses Structure, can be successful to detect emerging disease threats. However, these systems are not well equipped to handle moral (...) dilemmas that can arise in zoonotic disease control, like the culling of healthy animals. This research studies the role of normative presuppositions of professionals involved in zoonotic disease control policies in the Netherlands. We found that these professionals in general adhered to a holistic view of the One Health concept, however, in practice an anthropocentric approach was dominant. Public health was identified as the trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. The lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle which is frequently evoked to justify disease control measures. (shrink)

Despite the widespread use of automated decision-making (ADM) systems, they are often developed without involving the public or those directly affected, leading to concerns about systematic biases that may perpetuate structural injustices. Existing formal fairness approaches primarily focus on statistical outcomes across demographic groups or individual fairness, yet these methods reveal ambiguities and limitations in addressing fairness comprehensively. This paper argues for a holistic approach to algorithmic fairness that integrates procedural fairness, considering both decision-making processes (...) and their outcomes. Procedural fairness emphasizes the importance of fair decision-making procedures, which aligns with theories of relational justice that stress the quality of social relations and power dynamics. We highlight the need for substantive procedural fairness to ensure better outcomes and address forward-looking responsibilities. Additionally, we propose leveraging Public Engagement, a core dimension within the well-established Responsible Research and Innovation framework, to enhance procedural fairness in ADM systems. Our contribution underscores the value of Public Engagement in fostering fairer ADM processes, thereby expanding the current focus beyond technical outcome-based approaches to encompass broader procedural considerations. (shrink)

Per definition business sustainability demands the integration of environmental, social, and economic outcomes. Yet, managerial decision-making involving sustainability objectives is fraught with tension and the way managerial decision-makers frame sustainability issues in their mindset influences how sustainability tensions are managed at the organisational level. In the bid to better understand what types of managerial mindsets, or cognitive frames, foster integrative business sustainability practices that simultaneously advance environmental, social, and economic objectives, extant research has focussed on the underlying (...) logics that drive the acknowledgement of sustainability tensions. However, the existing logics-based constructs do not sufficiently explain this link, and it has been suggested that managers perceive and manage sustainability tensions based on the values that they hold. To clarify the roles of managerial values and logics as antecedents in business sustainability decision-making, we integrate Keeney’s value-focussed thinking approach with managerial and organisational cognition perspectives. Drawing on data from a survey with 169 senior procurement managers in Australia we found three types of cognitive frames which demonstrate that stronger sustainability values are associated with a more holistic perception of sustainability tensions and vice versa. We also found that managers’ cognitive framing of sustainability is strengthened by more holistic organisational cognitive frames and discuss according implications for managerial decision-making in theory and practice. (shrink)

A shift from top-down, hierarchical decision-making toward collaborative, consensus-oriented decision-making is taking place across many settings, leading to meetings in which diverse participants seek to reach agreement on issues of significance. This article proposes a new approach to analyzing such meetings that integrates conversation analysis and issue framing. While CA and IF have both been applied to collaborative decision-making, each approach, on its own, suffers from significant limitations. Combined, they allow negotiation talk in meetings (...) to be examined holistically, integrating a consideration of both process and content. New relationships among interactional sequences and framing processes are revealed, leading to the discovery of patterns across the decision-making activity as a whole. These patterns, in turn, can be situated in the context of the institutions within which the negotiations take place. This novel integrative approach is illuminated through application to a 162-turn decision-making activity. (shrink)

When considering the introduction of AI to support medical decision-making, one must take an end-to-end, holistic approach to development, evaluation, integration and governance. (Cabitza and Zeito...

Resnik and Pugh recently explored the ethical implications of routinely integrating environmental concerns into clinical decision-making. While we share their concern for the holistic well-being of patients, our response offers a different clinical and bioethical stance on green informed consent and patient autonomy. Contrary to the authors’ lack of data to support their concerns about provider and patient willingness to engage in climate-related conversations, we provide evidence supporting their sustainability engagement and stress the importance of a proactive, (...) anticipatory approach in healthcare to align with evolving societal values. If climate change is perceived as a politicised issue, though it is not inherently so, healthcare providers are professionally trained to address sensitive subjects and have a duty to inform patients about potential health risks. Recognising the environmental crisis as a health crisis underscores the direct connection between environmental hazards and patients’ well-being. Our perspective advocates for integrating individual considerations, societal responsibilities and systemic changes to promote environmentally sustainable healthcare. (shrink)

Self-driving vehicles will need to make decisions that carry ethical dimensions and manufacturers have (the responsibility) to pre-determine this underlying, deliberate decision-making process. With the rise of self-driving vehicles, scholars have simultaneously started investigating what ethical theories should guide machine behavior, but have not concluded as to which theory should be preferred and adopted. We aim to address this matter by providing a holistic and analytical review of the autonomous driving ethics literature. Based on this review, we (...) summarize the social, moral/legal, and functional advantages and disadvantages of applying particular (traditional) ethical theories to the decision-making of self-driving vehicles. Furthermore, we derive an integrated model that shows how each identified ethical theory could be technically implemented and guide the decision-making of self-driving vehicles. Overall, this article aims to set the groundwork for reflected, successful integration of ethical behavior within self-driving vehicles and deduce an updated research agenda. (shrink)

Aristotle’s ethical system was guided by his vision of human flourishing (also, but potentially misleadingly, translated as happiness). For Aristotle, human flourishing was a rich holistic concept about a life lived well until its ending. Both living a long life and dying well were integral to the Aristotelian ideal of human flourishing. Using Aristotle’s concept of human flourishing to inform the goals of medicine has the potential to provide guidance to clinical decision-makers regarding the provision of burdensome treatments, (...) such as intensive care treatment, where pursuing a chance of survival must be balanced against the risk of exposing patients to a negative dying experience. By conceptually uniting potentially competing goals of medicine, such as prolonging life and the promotion of peaceful deaths, Aristotle’s understanding of human flourishing creates an argument for the integration of palliative care considerations into intensive care decision-making and for advanced care planning with healthy patients. (shrink)

With the desired outcome of social good within the wider robotics ecosystem, trust is identified as the central adhesive of the human–robot interaction (HRI) interface. However, building trust between humans and robots involves more than improving the machine’s technical reliability or trustworthiness in function. This paper presents a holistic, community-based approach to trust-building, where trust is understood as a multifaceted and multi-staged looped relation that depends heavily on context and human perceptions. Building on past literature that identifies dispositional and (...) learned stages of trust, our proposed decision to trust model considers more extensively the human and situational factors influencing how trust manifests within social relations. Priority is given to the human user of technology—the initiator of human—robot trust relations—at all stages of decision-making. The envisioned formation of optimal conditions in which trust emerges requires the collective participation of practitioners, policymakers, and members of the community. With trust facilitating the smooth transition of robots into more socially embedded roles, positive receptivity of the best engineering project arises from the presence of harmonious robot-human trust relations in community spaces. (shrink)

The purpose of this paper is to provide a holistic examination of local food entrepreneurs (LFE) across the local food system (LFS) of a specific U.S. geographic region, including the drivers and barriers to their success. Over the past few decades, there has been a surge in entrepreneurs becoming involved in the LFS which includes the production (farming and manufacturing), distribution, and retail of local ag-related products and services. The LFS is complex and entrepreneurs operating within the system are (...) often met with steep barriers of entry and have trouble maintaining long-term success. Through recorded semi-structured interviews of LFEs (producers, processors, and purveyors) in the Missouri Ozark region, data was gathered and coded according to grounded theory methodologies. From the data collection, 24 emergent themes were identified using thematic clustering. These were further consolidated into eight categorical themes (strategy, skills development, financially sustainable model, differentiation drivers, operational drivers, external drivers, internal constraints, and external constraints) and three over-riding themes (approach, drivers, and barriers). This cross-sectional approach in examining entrepreneurs across the value chain in an LFS provides new insights into the unique entrepreneurial mindset of LFEs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 39.1 (2005) 31-47 [Access article in PDF] Holistic Integrated Design Education: Art Education in a Complex and Uncertain World Christopher Nokes Egosystem All art is the solution to an initiating design problem that must be articulated, even if the problem is this: to create something without meaning. As such, all art is a literary process, whereby the idea is articulated before that idea (...) is re-presented as an art form. And this is precisely what I attempt to do in the classroom when I assign highly challenging, universal, socio-cultural based and interpretive design problems. Both intent and solutions are implicit in the design assignments given to students. In each case the design process is emphasised, and students define the problem, research (often collaboratively), brainstorm (diving deeply into the problem for potential solutions), develop alternative solutions, use free-hand sketches and storyboarding to track the design and decision-making process, and (finally) select the best design for development and evaluation. Definition of key terms, research and storyboarding are the initial steps in the process to solving each of the design problems. Some examples of problem solving performance tasks are provided below (Table 1).Regarding the last example, in my first year of teaching I accepted a position on agreement that I teach Grade 10 (sophomore) mathematics. Even though my teaching background favored art and history, this was not a hardship because my original degree was in architecture (University of Toronto, 1978). I realized quickly that my personal romance with D.N. Perkins's Knowledge as Design demanded that I attempt to teach mathematics as a design process (much to the dismay of the department head).1 Nevertheless, imaginative mathematical works of mind were explored, based on original "design problems." As well, collaborative math tests were developed (and structured as design problems), where students divided into groups or design teams, each team having a "competent mathematician" on [End Page 31] Click for larger viewTable 1 Works of Mind; Visual Arts as a Problem-Solving Design Process [End Page 32]board. Each team worked together to solve one challenging mathematical problem, or a series of challenging mathematical design problems, under a time limit. This ensured that each student had a role to play. A key group dynamic here is that students speak to each other as peers, in a way teachers cannot: "No! You don't do it that way, silly. It's like this!" says A. "Ok! Ok! Don't yell at me," says B tenderly. "It's like this?" "Yes!" says A. "See! You really are good at math!" It was a beautiful thing to watch. The so-called "stupid-at-math" students saw how the "brainy" math students interpreted and approached mathematics, while the "brainy" students pulled those students who always believed they were "stupid at math" up to their level. In the end (to say the least), it greatly increased the weaker students' comfort level entering the classroom, and (at best) it gave weaker math students confidence by dispelling some of the mystical mystery which mathematics seems to possess — mathematics is not a mystery, it is a problem waiting to be solved as any other design problem once you know the process. Click for larger viewTable 2 Components of the Egosystem This is holistic integrated design education (or HIDE). Transforming students from the traditional, isolated receiver of information to the holistic child requires a fundamental transformation of the associative-cognitive paradigm of learning behavior and psychology, based on the child's ego development in a kind of object-filled, symbolical, self-contained world.2 In actuality, the world is complex, multi-faceted, hyper-sensitive, with many people of different socio-cultural and intellectual frames of mind interacting; and it is (thus) hardly self-contained. The world has indeed evolved that far. Somehow, like all paradigms, the ego must undergo a similar evolution, a similar transformation.3 A new version of ego must be invented, one that takes into account all the stuff of objective reality — the... (shrink)

This chapter discusses the utility of cost-benefit analysis in decision making, specifically environmental decision making. For the purposes of the discussion here, it uses a type of CBA that incorporates two controversial characteristics, namely, the assumption of comparability and the willingness-to-pay measure. The chapter aims to show that the recognition of a well motivated holistic decision-making strategy can shed light on debates regarding CBA. This strategy is concerned with patterns of choices rather than (...) individual ones, and corresponds with two familiar phenomena—the “pricing” of alternatives and the “embedding effect” in willingness-to-pay studies. This chapter also differentiates CBA from cost-preparedness analysis, and concludes that there need not be any inconsistency in pricing alternatives deemed incomparable and that willingness-to-pay studies can be more accurately interpreted as tracking the “preparedness to pay.”. (shrink)

Holistic thinking involves four subconstructs: causality, contradiction, attention to the whole, and change. This holistic perspective varies across Eastern–Western cultures and genders. We theorize that holistic thinking reduces three domain-specific risk-taking behavioral intentions (ethical, financial, and health/safety) directly and indirectly through enhanced risk-taking attitudes. Our formative theoretical model treats the four subconstructs of holistic thinking as yoked antecedents and frames it in a proximal context of causes and consequences. We simultaneously explore the direct and indirect paths (...) and test our model across cultures, genders, and the combination of the two. For the entire sample (N = 531), holistic thinking negatively relates to risk intentions via enhanced risk perceptions. Across cultures, the indirect paths prevail among Chinese people (n = 284), and both direct and indirect paths triumph for Americans (n = 247). Across genders, the indirect paths exist for females, whereas the negative direct path (risk-raking attitudes → behavioral intentions) succeeds for males. Across cultures and genders, holistic thinking negatively relates to American males’ ethical risks the most but Chinese males’ financial risks the least. Risk-taking perceptions are negatively related to Chinese males’ ethical risks the most, but Chinese people’s (males/females) financial risks the least. Causality and change are vital for all contexts, attention to the whole for all males and Chinese males, and contradiction for Americans and all females. Holistic thinking has limits and is less robust than risk-taking perceptions in reducing risky behavioral intentions. Our practical implications help people make ethical, healthy, and wealthy decisions. (shrink)

Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care. Existing approaches to regulation, and research into how that regulation could be improved, have tended to (...) focus on a single regulatory instrument (e.g., just law or just ethical codes). As a result, there has been a failure to capture holistically the various forces that guide end-of-life care. This article proposes a response to address this, identifying “regulatory space” theory as a candidate to provide the much-needed holistic insight into improving regulation of end-of-life care. The article concludes with practical implications of this approach for regulators and researchers. (shrink)

A new trend in the production technology of solid biof uels has appeared. There is a wide consensus that most solid biofuels will be produced according to the new production methods within a few years. Numerous samples were manufactured from agro-residues according to conventional methods as well as new methods. Robust analyses that reviewed the hygienic, environmental, financial and ethical aspects were performed. The hygienic and environmental aspect was assessed by robust chemical and technical analyses. The financial aspect was assessed (...) by energy cost breakdown. The ethical point of view was built on the above stated findings, the survey questionnaire and critical discussion with the literature. It is concluded that the new production methods are significantly favourable from both the hygienic and environmental points of view. Financial indicators do not allow the expressing of any preference. Regarding the ethical aspect, it is concluded that the new methods are beneficial in terms of environmental responsibility. However, it showed that most of the customers that took part in the survey are price oriented and therefore they tend to prefer the cheaper—conventional alternative. In the long term it can be assumed that expansion of the new technology and competition among manufacturers will reduce the costs. (shrink)

We argue for the need for a new language for business – one that is capable of changing the current business decision-making frame of wins and losses to a frame of community and social learning. This paper outlines a classroom exercise about Nelson Mandela’s leadership, involving movies, case studies and poetry, and shows how the more holistic approach helps shift student views of the triple bottom line. Since neuroscience literature has shown that poetry can help enhance learning, (...) students carefully study “Invictus,” a poem written by Victorian-era poet Henley and revered by Mandela. As students dig deeper into the case study through classroom discussion, they begin to see Mandela’s leadership through a new frame, and in doing so broaden their own views. This more holistic approach to studying leadership may allow decision makers to adjust both their goals and the focus of their analysis to go beyond monetary outcomes to include socially and environmentally sustainable outcomes. (shrink)

BackgroundMachine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians’ practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians’ competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation (...) theory as an analytical lens for investigating how medical action at the micro level and the physician–patient relationship might be affected by the employment of ML_CDSS.Main textProfessionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient’s concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics.ConclusionsUsing ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient’s personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient’s concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making. (shrink)

Conscious but incapacitated patients need protection from both undertreatment and overtreatment, for they are exceptionally vulnerable, and dependent on others to act in their interests. In the United States, the law prioritizes autonomy over best interests in decision making. Yet U.S. courts, using both substituted judgment and best interests decision making standards, frequently prohibit the withdrawal of life-sustaining treatment from conscious but incapacitated patients, such as those in the minimally conscious state, even when ostensibly seeking to (...) determine what patients would have wanted. In the United Kingdom, under the Mental Capacity Act of 2005, courts decide on the best interests of incapacitated patients by, in part, taking into account the past wishes and values of the patient. This paper examines and compares those ethicolegal approaches to decision making on behalf of conscious but incapacitated patients. We argue for a limited interpretation of best interests such that the standard is properly used only when the preferences of a conscious, but incapacitated patient are unknown and unknowable. When patient preferences and values are known or can be reasonably inferred, using a holistic, all-things-considered substituted judgment standard respects patient autonomy. (shrink)

A school that adopts a curriculum, that aims for a holistic understanding of technology, does so because it produces a better educated person than a curriculum which does not. How do we know when we are teaching technology holistically and why must we do so? Increasingly, more is asked of technology educators to be holistic in the understanding conveyed to learners of technology itself in order to make better informed technical and design decisions in a wider range of (...) applied settings. The ability of the learner to naturally consider social and environmental factors, for example, when seeking solutions is seen by some State education systems in Australia as fundamental to a genuine education in technology (New South Wales Board of Studies, 2000 & 2002). In philosophy, the holist position asserts that to understand the particular one must understand its relation to the whole and that only through reflection of one's sensation based applications can genuine knowledge be critically affirmed (Matthews, 1980, p.87 & p.93). The combined apparently independent paths of the State and the Holist positions set a compelling scene not only for the socio-economic necessity for holistic technology education in the curriculum but also for Technology's status as a key curriculum agent in the knowledge formation process of educated individuals. -/- This paper asserts that the general elements of Applied Setting (including Time), Human (as Agent), Tool and Environment are well placed to be the necessary basics to any holistic human technological activity. How and why these elements work together, their schema, will be referred to in this paper as the 'Basic Principles'. The paper presents the thesis that Technology cannot be reduced to less than these general elements and as such, Technology is their product. We therefore may need to understand and teach these elements and their relations to each other explicitly, in ways that reveal the utility of such understanding when making technical choices and design decisions for all the genres of technology and at all their scales of application and discovery. The case is made for technology to not merely be a 'know how' learning experience, but necessarily also a holistic 'know why' learning experience essential for developing and transferring technological knowledge. (shrink)

Background Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim To describe ambulance clinicians’ understanding of older patients’ self-determination when the patient’s decision-making ability is impaired. Research design (...) A qualitative design with an inductive approach, guided by descriptive phenomenology. Participants In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination. Conclusion The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous. (shrink)

Often in insurance decision making, there are risk factors on which the insurer has an informational advantage over the consumer. But when the insurer sets and posts a premium for the consumer to consider, the consumer can potentially use the premium as an informational cue for the loss probability, and thereby to reduce the insurer’s informational advantage. We study, by means of a behavioral model, how consumers would use the premium as an informational cue in such contexts. The (...) belief formation process in our model assumes that both prior knowledge and the premium might have an impact on the consumer’s estimate of the loss probability. Moreover, the premium impacts the estimate through an anchoring-and-adjustment process. The model potentially leads to violations of rational expectations, with which the consumer overestimates the loss probability beyond what could be inferred from the premium, given the premise that the insurer must seek to break even or earn an expected profit. Our model analysis moreover implies that the frequency of such violations is non-increasing as the premium increases. Last, the model implies a generally inverted-U relationship between insurance demand and the premium so that the demand is upward sloping at low premium levels and downward sloping at high premium levels. A pilot field study and a laboratory experiment provide robust evidence for our model implications and calibrations for its parameters. (shrink)

Healthcare decision making for children has adopted the best interest of the child standard, a principle originally employed by judges to adjudicate child placement in the case of parental death, divorce, or incompetence. Philosophers and medical ethicists have argued whether the best interest principle is a guidance principle (informing parents on how they should make healthcare decisions for their child), an intervention principle (deciding the limits of parental autonomy in healthcare decision making), or both. Those who (...) defend it as only a guidance principle often cite the harm principle as the appropriate intervention principle. In this article, I challenge current use of the best interest principle in pediatric decision making as a guidance principle and as an intervention principle. I propose a model that I call constrained parental autonomy, which focuses on promoting and protecting the child’s primary goods or basic needs. I show that constrained parental autonomy can serve as both a guidance principle and an intervention principle in making decisions. I conclude by examining a case study involving bone marrow donation by a young child to her sister. (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...

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

Traditional, positivist assessment approaches generally fail to capture the nuances of learners’ clinical competence in medical programmes. This has led to the implementation of an alternate assessment approach known as ‘programmatic assessment’, which embraces subjectivity of human judgement in holistic decision making in clinical settings. Faculty and staff have found the introduction of programmatic assessment to be challenging because it is a major, complex change to the traditional way of carrying out assessment. Extending our previous work, where (...) we used critical realism to explore students’ experiences of programmatic assessment, we here unpack the underlying conditions and mechanisms triggered by programmatic assessment’s implementation. We applied Bhaskar’s concept of ontological stratification, retroduction and Archer’s theoretical accounts of morphogenesis/stasis to theorize the interplay between the socio-cultural entities that constrain and enable desired changes in assessment practices, and those that condition students and staff to accept or reject the new ‘non-traditional’ assessment processes. (shrink)

According to logical theories of meaning, a meaning of an expression can be formalized and encoded in truth conditions. Vagueness of the language and individual differences between people are a challenge to incorporate into the meaning representations. In this paper, we propose a new approach to study truth-conditional representations of vague concepts. For a case study, we selected two natural language quantifiers most and more than half. We conducted two online experiments, each with 90 native English speakers. In the first (...) experiment, we tested between-subjects variability in meaning representations. In the second experiment, we tested the stability of meaning representations over time by testing the same group of participants in two experimental sessions. In both experiments, participants performed the verification task. They verified a sentence with a quantifier (e.g., “Most of the gleerbs are feezda.”) based on the numerical information provided in the second sentence, (e.g., “60% of the gleerbs are feezda”). To investigate between-subject and within-subject differences in meaning representations, we proposed an extended version of the Diffusion Decision Model with two parameters capturing truth conditions and vagueness. We fit the model to responses and reaction times data. In the first experiment, we found substantial between-subject differences in representations of most as reflected by the variability in the truth conditions. Moreover, we found that the verification of most is proportion-dependent as reflected in the reaction time effect and model parameter. In the second experiment, we showed that quantifier representations are stable over time as reflected in stable model parameters across two experimental sessions. These findings challenge semantic theories that assume the truth-conditional equivalence of most and more than half and contribute to the representational theory of vague concepts. The current study presents a promising approach to study semantic representations, which can have a wide application in experimental linguistics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Decision-Making as a Broader ConceptJacinta O. A. Tan (bio), Anne Stewart (bio), and Tony Hope (bio)KeywordsCompetence, decision-making, capacity, anorexia nervosa, autonomy, values, identityWe thank Demian Whiting for the thoughtful critique of aspects of our paper (Tan et al. 2006a). A primary aim of our research was to provide empirical grounds on which to stimulate discussion about the nature of decision-making capacity (DMC). Whiting (...) criticizes in particular the concept of 'pathological values' that we suggested might be relevant in the assessment of DMC and in the related issue of deciding when a patient's refusal of beneficial treatment should be overridden.Whiting's central concern is with DMC. Whiting argues that the absence of pathological values should not be a criterion for DMC. We are unclear whether he is also arguing that pathological values do not provide a reason of any kind for overriding treatment refusal. At the end of the paper he writes: "we cannot justify compulsory treatment of patients who have pathological values... on the grounds that these patients lack DMC" (2009, XX). This seems to leave open the possibility that we may be able to justify compulsory treatment of patients who have pathological values on grounds other than that they lack DMC. As we wrote in our response to the discussants of our original paper, "The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests" (Tan et al. 2006b, 300).In deciding on whether to use compulsory treatment, there are other relevant factors that may need to be considered, such as the seriousness of the decision, which determines the threshold for competence. However, in this response we consider three issues. First, we argue that the current concept of DMC is by no means so clear cut or generally agreed upon as Whiting implies, and that some of the lack of clarity relates to pathological values. Second, that the concept of DMC is itself dependent on accounts of autonomy, and that it is plausible that pathological values can affect autonomy. Third, we directly consider the question of whether a coherent account of pathological values might be given based on a concept of authenticity.The Current Criteria for DMCWhiting argues that the current criteria for DMC are correct and that an additional criterion along the lines of absence of pathological values should not be added. This argument assumes that there is a clear and agreed understanding of the current criteria. We believe this is not the case for three reasons.(i) Whiting begins his account of DMC by saying that it is normally taken to include: "(1) [End Page 345] understanding (and appreciation)" (2009, 341). Already there is an area of dispute, and the use of parentheses reflects this. The concept of 'appreciation' was developed by Grisso and Applebaum (Grisso, Appelbaum, and Hill-Fotouhi 1997). It is not included in either English common law development, for example (ReC), nor in the criteria specified in the Mental Capacity Act 2005. More important, Grisso and Appelbaum in their comment on our original paper (2006) argue that our work advances thinking about 'appreciation' rather than requiring that we add new elements. The implication is that they believe that what we have called pathological values are relevant to the assessment of capacity and are already included in an account of capacity that incorporates the criterion of 'appreciation.' In our response, we argued that pathological values are not entirely captured within the account of appreciation that Grisso and Appelbaum had previously given. We do not want to revisit that issue here, but the point of relevance is that on one view (that of Grisso and Appelbaum) pathological values are already included in the current criteria for DMC as part of the concept of appreciation, whereas on Whiting's view they are not.(ii) Even if there were agreement over the wording and concepts relevant to DMC there is a further important issue: how are those concepts... (shrink)

Contexte : Avec les multiples options disponibles aujourd’hui pour devenir parent, comment la question de la parenté génétique est-elle prise en compte dans la décision de préservation de la fertilité (PF) des adolescents atteints de cancer? Cette étude rend compte et analyse de manière normative cet aspect de la prise de décision en matière de PF.Méthodes : Un échantillon de commodité d’adolescents survivants israéliens du cancer et leurs parents a été invité à participer à des entretiens individuels semi-structurés.Résultats : En (...) discutant de l’importance de la parenté génétique des futurs enfants ou petits-enfants, les participants ont soulevé à plusieurs reprises les questions interdépendantes de la nature, de la normalité et de l’identité personnelle. Indépendamment de leur préférence ou de leur ambivalence à l’égard de la parenté génétique, la majorité des participants étaient conscients des autres options parentales et en ont noté les avantages et les inconvénients. Cependant, la connaissance des options parentales alternatives n’était pas uniforme.Conclusions : Afin de garantir que les patients adolescents et leurs parents prennent des décisions relatives à la PF qui répondent à leurs objectifs et valeurs personnels, il est important que les médecins discutent avec eux des options parentales alternatives en tenant compte de leur culture. Il faut également accorder plus de crédit à ceux qui remettent en question l’importance de la parenté génétique. (shrink)

The aim of the present research is studying the relationship between the salespersons’ ethical philosophy and their ethical decision-making process and seeks to answer two fundamental questions: first, what is the ethical philosophy of salespersons? And second, how does the salespersons’ ethical philosophy affect their ethical decision-making process? Statistical population of this research is salespersons who have passed the sales training course at the Department of Commerce Research Centre. One hundred thirty-seven questionnaires of total 300 accessible (...) populations were analyzed through path analysis method. The findings indicate that most salespersons are idealists. Although this idealism affects the ethical judgment directly, but the effect of relativism on ethical intention is more considerable. (shrink)

Over the past 50 years decision making research in team invasion sport has been dominated by three research perspectives,information processing,ecological dynamics, andnaturalistic decision making. Recently, attempts have been made to integrate perspectives, as conceptual similarities demonstrate the decision making process as an interaction between a players perception of game information and the individual and collective capability to act on it. Despite this, no common ground has been found regarding what connects perception and action during (...) performance. The differences between perspectives rest on the role of stored mental representations, that may, or may not facilitate the retrieval of appropriate responses in time pressured competitive environments. Additionally, in team invasion sports like rugby union, the time available to players to perceive, access memory and act, alters rapidly between specific game situations. Therefore, the aim of this study was to examine theoretical differences and the mechanisms that underpin them, through the vehicle of rugby union. Sixteen semi-elite rugby union players took part in two post-game procedures to explore the following research objectives; (i) to consider how game situations influence players perception of information; (ii) to consider how game situations influence the application of cognitive mechanisms whilst making decisions; and (iii) to identify the influence of tactics and/or strategy on player decision making. Deductive content analysis and elementary units of meaning derived from self-confrontation elicitation interviews indicate that specific game situations such as; the lineout, scrum or open phases of play or the tackle situation in attack or defence all provide players with varying complexity of perceptual information, formed through game information and time available to make decisions. As time increased, players were more likely to engage with task-specific declarative knowledge-of the game, stored as mental representations. As time diminished, players tended to diagnose and update their knowledge-in the game in a rapid fashion. Occasionally, when players described having no time, they verbalised reacting on instinct through a direct connection between perception and action. From these findings, clear practical implications and directions for future research and dissemination are discussed. (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)

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)

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)

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)