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)

The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and (...) professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted—a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option. (shrink)

There is a growing need to increase our understanding of ethical decision making in U.S. based organizations. The authors examine the complexity of creating uniform ethical standards even when the meaning of ethical behavior is being debated. The nature of these controversies are considered, and three important dimensions for ethical decision making are discussed: leaders with integrity and a strong sense of social responsibility, organization cultures that foster dialogue and dissent, and organizations that are willing to (...) reflect on and learn from their actions. Leaders with integrity demonstrate consistency between vision and action that promotes trust, regularly concern themselves with developing moral standards, and are proactive agents of change in an increasingly complex world. Organizational cultures that support dialogue suspend judgments and increase their capacity to think together towards new levels of understanding. Ethical concepts evolve in these organizational cultures, and actions are informed and responsible. Organizations that reflect on their actions engage in double loop learning so that the time taken to reflect on the past and present leads to a more judicious and ethical future. In essence, the authors point to organizational guidelines for ethical decision making that lead to an increase in members' capacity to think and act ethically. (shrink)

Autonomous decisions are decisions that reflect the self who makes them. Since patients in need of surrogate decision making can no longer enjoy the dignity of being free to express who they are through choice and action, surrogates should strive to, at least, make sure that decisions on behalf of the patient reflects that patient's self. Concepts of the self, then, underlie views about the role autonomy should play in surrogate decision making. Alzheimer's disease (AD) complicates (...) the situation because it is a disease which effects the self and theorists disagree about which aspect of the AD self the decision should reflect. This disagreement has led to a seemingly irresolvable split between those who favor the then self and those who favor the now self. The debate has stalled because while both of these views are attractive, neither seems adequate. That is, neither view is complete because each focuses only on one aspect of a whole self. In this paper, I argue that a good mode of surrogate decision making is one that focuses on the whole self and I offer practical advice concerning how we can begin to think about how such a decision might be made. (shrink)

We would like to thank the commentators for their generous comments, valuable insights and helpful suggestions. We begin this response by discussing the selfishness axiom and the importance of the preferences, beliefs, and constraints framework as a way of modeling some of the proximate influences on human behavior. Next, we broaden the discussion to ultimate-level (that is evolutionary) explanations, where we review and clarify gene-culture coevolutionary theory, and then tackle the possibility that evolutionary approaches that exclude culture might be sufficient (...) to explain the data. Finally, we consider various methodological and epistemological concerns expressed by our commentators. (shrink)

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

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)

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 study used structural equation modeling to verify the performance of the ethical decision-making models developed by Jones and by Kelley and Elm. A comparison showed that the Kelley and Elm decision model yielded the optimal degree of fit. The investigations conducted in this study indicated that moral intensities are not an objective, existing concept but rather the product of subjective perception influenced by organizational factors. In addition to directly influencing ethical decisions, organizational factors indirectly influence ethical (...) decisions through moral intensities. (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)

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)

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)

Shift work is a fixture of our 24-hour economy, with approximately 18 per cent of workers in the USA engaging in shift work, many overnight. Since shift work has been linked to an increased risk for an array of serious maladies, including cardiometabolic disorders and cancer, and is done disproportionately by the poor and by minorities, shift work is a highly prevalent economic and occupational health disparity. Here we draw primarily on the state of science around shift work and breast (...) cancer to argue that shift work represents a public health threat serious enough to warrant a precautionary stance. We use the precautionary principle to advance our case and view it as a moral compass for shift work research, empowering public health to cast shift work within the domain of health disparities deserving action despite scientific uncertainty. With the precautionary principle, we call for a deliberative decision-making process and formation of a broad shift work research collaboration to protect the health of many millions who work at night. (shrink)

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

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)

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)

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

(2011). Life and Death Choices in Neonatal Care: Applying Shared Decision-Making Focused on Parental Values. The American Journal of Bioethics: Vol. 11, No. 2, pp. 35-36.

The American Journal of Bioethics, Volume 12, Issue 10, Page 51, October 2012.

The aim of the Committee’s discussions is to contribute to giving the conceptual instruments to those in governments and to society, in a broad sense, so as to understand the complex, dynamic, changeable ethical issues and their importance and urgency, envisaging the possible scenarios and lines of action in social policies to be undertaken at public level. These lines of action should attempt, through the search for an ethical balance, to reconcile the needs of science and technology to progress with (...) the protection of human beings, health, environment, and future generations. In this way, ethics committees play a key role in developing and implementing institutional ethics. (shrink)