The literature on ethical decision-making is rooted in a cognitive perspective that emphasizes the role of moral judgment. Recent research in interpersonal dynamics, however, has suggested that ethics revolves around an individual’s perceptions and views of others. We draw from both literatures to propose and empirically examine a contingent model. We theorize that whether the individual relies on cognitions about the ethical issue or perceptions of others depends on the level of social consensus surrounding the issue. We test (...) our hypotheses in three studies. Results suggest that not only does social consensus determine whether an individual relies on ethical cognitions about the issue or perceptions of others, but also that an individual’s view of self is an important moderator in these relationships. We conclude by considering implications of this research for theory and practice. (shrink)

A recent interpretation of artificial intelligence (AI) (Floridi 2013, 2022) suggests that the implementation of AI demands the investigation of the binding conditions that make it possible to build and integrate artifacts into our lived world. Such artifacts can successfully interact with the world because our environment has been designed to be compatible with intelligent machines (such as robots). As the use of AI becomes ubiquitous in society, possibly leading to the formation of increasingly intelligent bio-technological unions, there will likely (...) be a coexistence of a plethora of micro-environments wrapped and tailored around humans and basic robots. The key element of this pervasive process will be the capacity to integrate biological realms in an infosphere suitable for the implementation of AI technologies. This process will require extensive datafication. This is because data is the basis of the logical-mathematical codes and models that drive and guide AI. This process will have huge consequences on workplaces, on workers, as well as on the decision-making processes required for the functioning of future societies. In this paper we will offer a comprehensive reflection on the moral and social implications of datafication as well as a set of considerations about its desirability, which will be informed by the following insights: (1) full protection of privacy may become structurally impossible, thus leading to undesirable forms of political and social control; (2) worker’s freedom may be reduced; (3) human creativity, imagination, and even divergence from AI logic might be channeled and possibly discouraged; (4) there will likely be a push towards efficiency and instrumental reason, which will become preeminent in production lines as well as in society. (shrink)

In this paper, we theorize that the anticipation of guilt plays an important role in ethically questionable consumer situations. We propose an ethical decision-making framework incorporating anticipated guilt as partial mediator between consumers’ ethical beliefs (anteceded by ethical ideology) and intentions. In the first study, we compared several models using structural equation modeling and found empirical support for our research model. A second experiment was set up to illustrate how these new insights may be applied to prevent consumers (...) from taking advantage of the seller. Results showed that enhancing the anticipation of guilt (by making the interpersonal consequences of the unethical act more salient) increased consumers’ ethical intentions, controlling for ethical beliefs. Together these two studies might have important theoretical and managerial contributions. (shrink)

The rise in the recent Western pattern of surrogate decision making is not a necessary result of an increase in the number of elderly with decreased competence; it may rather manifest the dominant Western vision of human life and relations. From a comparative philosophical standpoint, the Western pattern of medical decision making is individualistic, while the Chinese is familistic. These two distinct patterns may reflect two different comprehensive perspectives on human life and relations, disclosing a foundational (...) difference that can be seen in the Aristotelian account of friendship and the Confucian account of humanity. The contemporary development of surrogate decision making in the West may illustrate a general tendency toward the Aristotelian account, while the Chinese approaches are congruent with the Confucian view. Also explored are some merits of the Chinese approach to family decision making for health care. (shrink)

(2005). Freedom in Responsibility: On the Relevance of “Sin” As a Hermeneutic Guiding Principle in Bioethical Decision Making. Christian Bioethics: Vol. 11, No. 2, pp. 147-165.

The ‘best interests’ decision making standard is used in clinical care to make necessary health decisions for non-capacitated individuals for whom neither explicit nor inferred wishes are known. It has been also widely acknowledged as a basis for enrolling some non-capacitated adults into clinical research such as emergency, critical care, and dementia research. However, the best interests standard requires that choices provide the highest net benefit of available options, and clinical research rarely meets this criterion. In the context (...) of modern norms of bioethics, the best interests standard rarely supports surrogate consent for research and should not be accepted as a routine provision. (shrink)

This paper presents an integrated model of ethical decision‐making in business that incorporates teleological, deontological and existential theory. Existentialism has been curiously overlooked by many scholars in the field despite the fact that it is so fundamentally a theory of choice. We argue that it is possible to seek good organisational ends (teleology), through the use of right means (deontology), and enable the decision‐maker to do so authentically (existentialism). More specifically, we provide a framework that will enable (...) the decision‐maker to integrate the various ethical schools of thought available to them and to apply this framework in the ethical decision‐making process. The model presented makes explicit the existential position of choice and takes into account other contextual moderating factors. Negative Option Marketing is used as a running application to illustrate the role of existentialism in the decision‐making process. (shrink)

Making better choices about future technologies that are being researched or developed is an important motivator behind lay ethics interventions. However, in practice, they do not always succeed to serve that goal. Especially authors who have noted that lay ethicists sometimes take recourse to well-known themes which stem from old, even ‘archetypical’ stories, have been criticized for making too little room for agency and decision-making in their approach. This paper aims to contribute to a reflection on (...) how lay ethics can acquire more practical relevance. It will use resources in narrative ethics to suggest that in order to be relevant for action, facilitators of lay ethics interventions need to invite participants to engage in a narrative quest. As part of a quest, lay ethicists should be asked to reflect on a specific question or choice, use diverse input which is informative about the heterogeneity of viewpoints that are defended in society and argue for their standpoints. (shrink)

We consider human performance on an optimal stopping problem where people are presented with a list of numbers independently chosen from a uniform distribution. People are told how many numbers are in the list, and how they were chosen. People are then shown the numbers one at a time, and are instructed to choose the maximum, subject to the constraint that they must choose a number at the time it is presented, and any choice below the maximum is incorrect. We (...) present empirical evidence that suggests people use threshold-based models to make decisions, choosing the first currently maximal number that exceeds a fixed threshold for that position in the list. We then develop a hierarchical generative account of this model family, and use Bayesian methods to learn about the parameters of the generative process, making inferences about the threshold decision models people use. We discuss the interesting aspects of human performance on the task, including the lack of learning, and the presence of large individual differences, and consider the possibility of extending the modeling framework to account for individual differences. We also use the modeling results to discuss the merits of hierarchical, generative and Bayesian models of cognitive processes more generally. (shrink)

Among Bryan Norton’s most influential contributions to environmental philosophy has been his analysis and evaluation of democratic processes for environmental decision-making. He examines actual cases of environmental decision-making in their legal, political, ethical and scientific contexts, and, with contextual constraints and goals in mind, he theorizes concerning what they accomplish and how they can be improved. Informed by the political theories of both John Dewey and Jürgen Habermas, Norton’s pragmatist approach holds that appropriate democratic decision (...) procedures will generate broadly defensible decisions. Thus, his view of environmental decision-making is based in—and requires—inclusive, democratic, empirical inquiry. While accepting these criteria, I examine how, in practice, it is difficult to identify when these conditions have been adequately met. I investigate the limitations of Norton’s proceduralist approach through a case study in community-based forest management in a New York State urban old-growth park. I argue that Norton’s procedural priorities are too rigid given the contextual constraints of local decision-making. While they are useful for guiding an ideal, high standards sense of the decision-making process, less rigid Deweyan considerations of social learning and community engagement often provide sufficient guidelines for evaluating success. (shrink)

The purpose of cause-related marketing is to capitalise on a firm’s social engagement initiatives to achieve a positive return on a firm’s social investment. This article discusses two strategic perspectives of cause-related marketing and their impact on a firm’s decision-making regarding campaign development. The instrumental dominant logic of cause-related marketing focuses on attracting customers’ attention in order to generate sales. The relational dominant logic of cause-related marketing focuses on building relationships with the target stakeholders through the enhancement of (...) a firm’s legitimacy. The combination of these two types of logic gives rise to four types of cause-related marketing: altruistic, commercial, social and integrative. This paper uses the qualitative method to explore a firm’s marketing decision choices regarding campaign-related decision dimensions—campaign duration, geographical scope, cause selection, and implementation strategy—for each type of cause-related marketing. The finding provides theoretical, managerial and public policy implications. (shrink)

We evaluate the consistency of different constructs affecting risk attitude in individuals’ decisions across different levels of risk. Specifically, we contrast views suggesting that risk attitude is a single primitive construct with those suggesting it consists of multiple latent components. Additionally, we evaluate such constructs as sensitivity to losses, diminishing sensitivity to increases in payoff, sensitivity to variance, and risk acceptance (the willingness to accept probable outcomes over certainty). In search of trait-like constructs, the paper reviews experimental results focusing on (...) the consistency of these constructs in different tasks as well as their temporal consistency. Overall, the findings show that the most consistent factor is risk acceptance, and they also demonstrate its potential boundaries. These results are modeled with a simple quantitative index of subjective risk. A survey of decisions under risk further reveals that participants exhibit almost no consistency across different tasks in this setting, highlighting the advantage of experiential tasks for studying individual differences. (shrink)

Decision-making adhering to the “principle of autonomy" takes place within the wider context of decision-making processes in modern society. Within the medical area, as regards the decision through informed consent, the patient's intention assumes vital importance. The principle of autonomy is derived from the modern thought that the essence of human being is the reason. It becomes difficult, however, to rely on decision-making based on the principle of autonomy when a person’s intention is (...) not clear and the opinions of those who are involved differ from each other. Here, I think that the principle of consensus, which seeks the agreement of those who are concerned, becomes as important as the principle of autonomy. This paper examines the problems of certainty, reliability, andcreativity of medical action through the consideration of the principle of consensus. (shrink)

Research is ongoing concerning the medical risks and benefits of routine neonatal male circumcision. Interpretation of the data, however, is controversial. Circumcision presents a number of challenges in obtaining informed consent because of a variety of interesting issues. It is a nonemergent, elective procedure that allows for evaluation and discussion over time. In this respect, observation of the informed consent process for circumcision is relevant to other medical decisions, such as advance directives, discussed between primary care providers and patients. Obtaining (...) informed consent for circumcision has its constraints. The process generally occurs over a brief hospital stay. There have been recent changes in the official position regarding the procedure by professional medical societies, and it raises considerable psychologic issues for the provider and may Impact the way in which Information is provided. (shrink)

As web analytics become increasingly common in newsrooms worldwide, it is imperative to understand how they are employed to meet news organizations’ journalistic and business goals. This study examines the evolution and applications of web analytics in newsrooms through a comprehensive analysis of relevant literature. It situates the rise of web analytics in the larger historical, social, and financial context. It explores the strategies news organizations adopt to integrate web analytics in news production. After discussing the impact of analytics on (...) news production, the project juxtaposes the pessimistic ethical concerns—primarily the prediction of market logic uprooting journalistic logic—surrounding the use of web analytics in newsrooms with ground realities. Finally, in view of the analysis, we reflect on the ethical concerns against analytics, the state of editorial autonomy in newsrooms, the implications of newly empowered audience for news ecosystem, and conclude with a practical view of analytics in newsrooms. (shrink)

Emerging evidence suggests that the long-established distinction between habit-based and goal-directed decision-making mechanisms can also be sustained in humans. Although the habit-based system has been extensively studied in humans, the goal-directed system is less well characterized. This review brings to that task the distinction between conceptual and nonconceptual representational mechanisms. Conceptual representations are structured out of semantic consituents - the use of which requires an ability to perform some language-like syntactic processing. Decision making - as investigated (...) by neuroscience and psychology - is normally studied in isolation from questions about concepts as studied in philosophy and cognitive psychology. We ask what role concepts play in the "goal-directed" decision-making systems. We argue that one fruitful way of studying this system in humans is to investigate the extent to which it deploys conceptual representations. (shrink)

Decision-making under uncertainty is sometimes investigated as a homogeneous problem, independently of the type of decision-maker and the level and nature of the decision itself. However, when the decision-maker is a public authority, there immediately arise problems additional to those that concern any other (private) decision-maker. This is not always clearly recognised in orthodox discussions on decisions under conditions of uncertainty. This article investigates the methodological, strategic and procedural challenges of taking public decisions in (...) such conditions. It focuses mainly on decisions involving urban contexts, such as planning decisions regarding land use and building transformations, by trying to develop some pioneering research studies in this field. (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.

The objective of this article is to identify and analyze the changes made to IFRS 3, 9, 10 and 16 since the beginning of COVID-19, and how these affect the presentation of financial statements, influencing decision-making. With the use of the deductive method and applying a qualitative approach, collecting information through the database of the Superintendency of Companies of Ecuador, an evaluative analysis of each company was carried out and how they applied the modifications offered by the IFRS, (...) reviewing the financial statements of 60 companies in the Commercial, Real Estate and Financial sectors where it was obtained that 15% of these companies presented changes in their financial statements, of this percentage 8.3% belong to companies in the commercial sector, 5. 1% comes from entities in the real estate sector and 1.6% are from companies in the financial sector. It is concluded that there is no significant change in the presentation of financial information since COVID-19. (shrink)

Research shows that the physician’s personal attributes and social characteristics have a strong association with their end-of-life decision making. Despite efforts to increase patient, family and surrogate input into EOL decision making, research shows the physician’s input to be dominant. Our research finds that physician’s social values, independent of religiosity, have a significant association with physician’s tendency to withhold or withdraw life sustaining, EOL treatments. It is suggested that physicians employ personal social values in their EOL (...) medical coping, because they have to cope with existential dilemmas posed by the mystery of death, and left unresolved by medical decision making mechanisms such as advanced directives and hospital ethics committees. (shrink)

We focus on a class of multicriteria methods that are commonly used in environmental decision making--those that employ the weighted linear average algorithm (and this includes the popular analytic hierarchy process (AHP)). While we do not doubt the potential benefits of using formal decision methods of this type, we draw attention to the consequences of not using them well. In particular, we highlight a property of these methods that should not be overlooked when they are applied in (...) environmental and wider decision-making contexts: the final decision or ranking of options is dependent on the choice of performance scoring scales for the criteria when the criteria weights are held constant. We compare this "sensitivity" to a well-known criticism of the AHP, and we go on to describe the more general lesson when it comes to using weighted linear average methods--a lesson concerning the relationship between criteria weights and performance scoring scales. (shrink)

This paper contributes to the contemporary business ethics narrative by proposing an approach to corporate ethical decision making (EDM) which serves as an alternative to the imposition of codes and standards to address the ethical consequences of grand challenges, like COVID-19, which are impacting today’s society. Our alternative approach to EDM embraces the concept of reflexive thinking and ethical consciousness among the individual agents who collectively are the corporation and who make ethical decisions, often in isolation, removed from (...) the collocated corporate setting. We draw on the teachings of the Canadian philosopher and theologian, Fr. Bernard Lonergan, to conceptualize an approach to EDM which focuses on the ethics of the corporate agent by nurturing the universal and invariant structure that is operational in all human beings. Embracing Lonergan’s dynamic cognitive structure of human knowing, and the structure of the human good, we advance a paradigm of EDM in business which emboldens authentic ethical thought, decision making, and action commensurate with virtuous living and germane to human flourishing. Lonergan’s philosophy guides us away from the imposition of over-arching corporate codes of ethics and inspires us, as individual agents, to attend to the data of our own consciousness in our ethical decision making. Such cognitional endowment leads us out of the ethics of the ‘timeless present’ (Islam and Greenwood in Journal of Business Ethics 170: 1–4, 2021) towards ethical authenticity in business, leaving us better placed to reflect upon and address the ethical issues emanating from grand challenges like COVID-19. (shrink)

Aim: To improve clinical and ethical understanding of patient preferences for information and involvement in decision making.Objectives: To develop and evaluate a clinical tool to elicit these preferences and to consider the ethical issues raised.Design: A before and after study.Setting: Three UK hospices.Participants: Patients with advanced life-threatening illnesses and their doctors.Intervention: Questionnaire on information and decision-making preferences.Main outcome measures: Patient-based outcome measures were satisfaction with the amount of information given, with the way information was given, with (...) family or carer information, and confidence about future decision making. Doctor-based outcome measures were confidence in matching information to patient preference, matching family or carer communication to patient preference, knowing patient preferences and matching future decision making with patient preference.Results: Of 336 admissions, 101 patients completed the study . Patient satisfaction with the way information was given and family communication improved after introduction of the tool. Doctor confidence improved across all outcome measures .Conclusions: Patient satisfaction and doctor confidence were improved by administering the questionnaire, but complex ethical issues were raised by implementing and applying this research. The balance of ethical considerations were changed by advanced life-threatening illness, because there is increased risk of harm through delivery of information discordant with the patient’s own preferences. The importance of truly understanding patient preferences towards the end of life is highlighted by this study. (shrink)

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

Volume 24, Issue 8, August 2024, Page 124-126.

In this article the theoretic evolution and the empirical-experimental efforts that have led to the affirmation of the bounded/procedural rationality paradigm are discussed. Moreover, the debate on supporters of the "optimization" approach and supporters of the "bounded/procedural rationality" approach is traced, highlighting the irreconcilability of these two approaches and, in retort, a solid defense against a merely "reductionist" attempt of the innovative context of the Simonian theory. Critically going over the debate on decision dynamics, it becomes clear how, due (...) to the uncertain nature of rational processes, it is impossible to establish the decision-making best way. The imperfect character of individual choice is explained by how the decider identifies a solution that appears satisfying in that moment due to cognitive and temporal limits. (shrink)

Introduction As deep brain stimulation (DBS) has shifted to being used earlier during Parkinson’s disease (PD), data is lacking regarding patient specific attitudes, preferences, and factors which may influence the timing of and decision to proceed with DBS in the United States. This study aims to identify and compare attitudes and preferences regarding the earlier use of DBS in Parkinson’s patients who have and have not undergone DBS. Methods We developed an online survey concerning attitudes about DBS and its (...) timing in PD. The survey was distributed nationally in the United States via the Michael J. Fox Foundation Trial Finder, the American Parkinson Disease Association flyers, and as a link on the Parkinson Alliance website. Differences in responses between PD DBS and non-DBS patients were assessed. Results A total of 445 patients with PD met eligibility criteria for the survey of which 160 self-identified as having undergone DBS. Fifty-five percent (n = 124) of non-DBS patients believed that DBS for PD should only be considered after all medication options have been tried. Patients favoring early DBS had fewer concerns regarding the surgery than those favoring later DBS. Conclusion Our findings highlight a variety of important considerations and concerns patients have regarding DBS and its timing. These viewpoints are important aspects of shared decision-making, as they help to identify patients’ preferences, values, and goals, which should enable providers to better navigate, with their patients, the decision path for therapeutic options to consider. (shrink)

Background: Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold...

Incapacitated and surrogateless patients are an ever-growing trend in the world of health care. Although the extent of the issue is unknown, 1 out 20 deaths in the intensive care unit (ICU) occurre...

The values of individuals who have never had the capacity to express their preferences are often overlooked or even ignored in the decision-making process. The case of “Michael,” a non-verbal young adult with a genetic condition and intellectual disability, is presented to challenge the traditional approach of relying solely on clinical indicators and the “best interest” standard narrowly construed in healthcare decision-making. Michael's interaction with his environment, gleaned through his family's input, illustrates that values and quality (...) of life can be discerned through observed behaviors and preferences, even in the absence of communicative ability. We argue for a broader definition of “values” that encompasses any aspect of life that brings meaning or enjoyment to the individual. This model not only personalizes care for never-capacitated individuals but may also be applied to other incapacitated populations, such as those with dementia, suggesting that past directives may not always align with their evolving values and interests. Underlying this expanded understanding of values in healthcare is a patient-centered approach that accounts for personal elements that contribute to an individual's sense of purpose and satisfaction. (shrink)

There is considerable correspondence between theories and models used in biology and the social sciences. One type of model that is in use in both biology and the social sciences is the fitness landscape model. The properties of the fitness landscape model have been applied rather freely in the social domain. This is partly due to the versatility of the model, but it is also due to the difficulties of transferring a model to another domain. We will demonstrate that in (...) order to transfer the biological fitness landscape model to the social science it needs to be substantially modified. We argue that the syntactic structure of the model can remain unaltered, whilst the semantic dimension requires considerable modification in order to fit the specific phenomena in the social sciences. We will first discuss the origin as well as the basic properties of the model. Subsequently, we will demonstrate the considerations and modifications pertaining to such a transfer by showing how and why we altered the model to analyse collective decision-making processes. We will demonstrate that the properties of the target domain allow for a transfer of the syntactic structure but don’t tolerate the semantic transfer. (shrink)

The development of neonatology and the establishment of neonatal intensive care units has led to a vast array of new medical ethical problems and dilemmas centered around discontinuing treatment or nontreatment decisions. Neonatology has become one of the fields that has made clear that medical success is only rarely nonproblematic. The new technology can be a blessing for some, but it may also become a sad experience to others, with life-long repercussions.The ethical problems of neonatology transcend national boundaries. Nevertheless, there (...) are differences in approach among various countries. In The Netherlands, the ethical deliberations have been a matter of public debate, but most of the decision making is left to the medical profession; these decisions are considered too harsh for the general public. Recently, two developments have emerged. The Royal Dutch Medical Association and the Dutch Pediatrics Society have published reports with guidelines and ethical reflections. Over the same period of time, cases have been brought to court for legal analysis and the development of case precedence. (shrink)

Corporate social responsibility, sustainability and acting ethically are all accepted business aims, but their meaning and implementation in a global context is far less clear-cut. Global Business Ethics cuts through the confusion to provide a coherent basis for ethical decision-making within the complications of the international business landscape. Underpinned by theory and including worked-through examples of ethical dilemmas and their solutions, this textbook will guide the reader beyond theory to real-world business decisions. Practical tools such as decision (...) trees and suggested principles to apply in dilemma situations give readers the skills and confidence to tackle the ethical challenges they face. A unique working code of ethics is provided as a model with guidance to readers for adaptation and implementation. Case studies include: Walmart, Hershey's, Citibank, Ford, Nike, Johnson & Johnson, Harley- Davidson, The Body Shop and Procter and Gamble. A chapter on the legal aspects of ethics provides clear guidance on the complex relationship between law and ethics in international business. The final part takes an in-depth look at the practical application of ethics in business life. Covering all the major theories of ethics, including an examination of the role of quantification of ethics, Global Business Ethics demonstrates how their principles can be applied to inform better business decisions. (shrink)

Volume 24, Issue 8, August 2024, Page 53-55.

University psychology and sociology researchers rated the likelihood they would engage in misconduct as described in 9 research scenarios, while also making moral judgments and rating the likelihood of discovery and sanctions. Multiple regression revealed significant effects across various scenarios for moral judgment as well as shame and embarrassment on reducing misconduct. The effects on misconduct of the perceived probability of sanctions were conditioned on moral judgments in some scenarios. The results have implications for how universities address the prevention, (...) detection, and sanctioning of research misconduct. (shrink)

Previous studies have explored the impact of the cost ratio of individual solutions versus collective solutions on people’s cooperation tendency in the presence of individual solutions. This study further explored the impact of team credibility on people’s propensity to cooperate in the presence of individual solutions. Study 1 investigated the influence of different level of altruistic tendencies or the self-interest tendencies of teammates on participants’ decision-making. Study 2 explored the influence of the distribution of altruistic tendencies or self-interest (...) tendencies on participants’ decision-making. The results of Study 1 showed that the proportion of participants who chose the collective solution increased with an increase in the altruistic tendencies of the team. When the altruistic tendencies of the teammates reached a certain value, the proportion of participants taking the collective solution showed a trend to stabilize. Furthermore, the proportion of participants who chose the individual solution increased with the increase in the self-interest tendencies of the team. When the self-interest tendencies of the teammates reached a certain value, the individual solution was stably adopted. The results of Study 2 showed that with the total altruistic tendency remaining unchanged, the more altruistic group members that altruistic tendencies were allocated to, the higher a participant’s level of trust in the team would be, which showed the decentralized effect of altruistic tendencies. In the case that the total self-interest tendency was unchanged, the fewer self-interest group members the self-interest tendencies were allocated to, the higher a participant’s level of trust in the team would be, which showed the convergent effect of self-interest tendencies. (shrink)

Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics (...) support tool to assist care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care. Results Care providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions. Discussion Developing an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support. (shrink)