In this essay, I draw on Haidt’s and Baron’s respective insights in the service of a bit of philosophical psychoanalysis. I will argue that deontological judgments tend to be driven by emotional responses, and that deontological philosophy, rather than being grounded in moral reasoning, is to a large extent3 an exercise in moral rationalization. This is in contrast to consequentialism, which, I will argue, arises from rather different psychological processes, ones that are more “cognitive,” and more likely to involve genuine (...) moral reasoning. These claims are strictly empirical, and I will defend them on the basis of the available evidence. Needless to say, my argument will be speculative and will not be conclusive. Beyond this, I will argue that if these empirical claims are true, they may have normative implications, casting doubt on deontology as a school of normative moral thought. (shrink)

Background One of the biggest challenges of practicing medicine in the age of informational technology is how to conciliate the overwhelming amount of medical-scientific information with the multiple patients’ values of modern pluralistic societies. To organize and optimize the the Decision-Making Process of seriously ill patient care, we present a framework to be used by Healthcare Providers. The objective is to align Bioethics, Evidence-based Practice and Person-centered Care. Main body The framework divides the DMP into four steps, each with a (...) different but complementary focus, goal and ethical principle. Step 1 focuses exclusively on the disease, having accuracy is its ethical principle. It aims at an accurate and probabilistic estimation of prognosis, absolute risk reduction, relative risk reduction and treatments’ burdens. Step 2 focuses on the person, using empathic communication to learn about patient values and what suffering means for the patient. Emphasis is given to learning and active listening, not taking action. Thus, instead beneficence, we trust comprehension and understanding with the suffering of others and respect for others as autonomous moral agents as the ethical principles of Step 2. Step 3 focuses on the healthcare team, having the ethics of situational awareness guiding this step. The goal is, through effective teamwork, to contextualize and link rates and probabilities related to the disease to the learned patient’s values, presenting a summary of which treatments the team considers as acceptable, recommended, potentially inappropriate and futile. Finally, Step 4 focuses on provider-patient relationship, seeking shared Goals of Care, for the best and worst scenario. Through an ethics of deliberation, it aims for a consensus that could ensure that the patient’s values will be respected as well as a scientifically acceptable medical practice will be provided. In summary: accuracy, comprehension, understanding, situational awareness and deliberation would be the ethical principles guiding each step. Conclusion Hopefully, by highlighting and naming the different perspectives of knowledge needed in clinical practice, this framework will be valuable as a practical and educational tool, guiding modern medical professionals through the many challenges of providing high quality person-centered care that is both ethical and evidence based. (shrink)

In the international bestseller, Thinking, Fast and Slow, Daniel Kahneman, the renowned psychologist and winner of the Nobel Prize in Economics, takes us on a groundbreaking tour of the mind and explains the two systems that drive the way we think. System 1 is fast, intuitive, and emotional; System 2 is slower, more deliberative, and more logical. The impact of overconfidence on corporate strategies, the difficulties of predicting what will make us happy in the future, the profound effect of cognitive (...) biases on everything from playing the stock market to planning our next vacation—each of these can be understood only by knowing how the two systems shape our judgments and decisions. -/- Engaging the reader in a lively conversation about how we think, Kahneman reveals where we can and cannot trust our intuitions and how we can tap into the benefits of slow thinking. He offers practical and enlightening insights into how choices are made in both our business and our personal lives—and how we can use different techniques to guard against the mental glitches that often get us into trouble. Winner of the National Academy of Sciences Best Book Award and the Los Angeles Times Book Prize and selected by The New York Times Book Review as one of the ten best books of 2011, Thinking, Fast and Slow is destined to be a classic. (shrink)

Patients with advanced dementia suffer from severe cognitive and functional impairment, including eating disorders. The focus of our research is on the issue of life-sustaining treatment, specifically on the social and ethical implications of tube feeding. The treatment decision, based on values of life and dignity, involves sustaining lives that many people consider not worth living. We explore the moral approach to caring for these patients and review the history of the debate on artificial nutrition and hydration showing the impact (...) of the varying perceptions of the value of these patients' lives on changing norms. We argue that in light of the value of solidarity, decisions about life-sustaining treatment for patients with advanced dementia should be made on a case by case basis, as with any other patient, in consideration of the medical implications of the intervention which might best serve the goals of care for the individual patient. (shrink)

For millennia, philosophers have speculated about the origins of ethics. Recent research in evolutionary psychology and the neurosciences has shed light on that question. But this research also has normative significance. A standard way of arguing against a normative ethical theory is to show that in some circumstances the theory leads to judgments that are contrary to our common moral intuitions. If, however, these moral intuitions are the biological residue of our evolutionary history, it is not clear why we should (...) regard them as having any normative force. Research in the neurosciences should therefore lead us to reconsider the role of intuitions in normative ethics. (shrink)

In this article I explain why cognitive science (including some neuroscience) matters for normative ethics. First, I describe the dual-process theory of moral judgment and briefly summarize the evidence supporting it. Next I describe related experimental research examining influences on intuitive moral judgment. I then describe two ways in which research along these lines can have implications for ethics. I argue that a deeper understanding of moral psychology favors certain forms of consequentialism over other classes of normative moral theory. I (...) close with some brief remarks concerning the bright future of ethics as an interdisciplinary enterprise. (shrink)

Although deductive reasoning is a closed system, one's beliefs about the world can influence validity judgements. To understand the associated functional neuroanatomy of this belief-bias we studied 14 volunteers using event-related fMRI, as they performed reasoning tasks under neutral, facilitatory and inhibitory belief conditions. We found evidence for the engagement of a left temporal lobe system during belief-based reasoning and a bilateral parietal lobe system during belief-neutral reasoning. Activation of right lateral prefrontal cortex was evident when subjects inhibited a prepotent (...) response associated with belief-bias and correctly completed a logical task, a finding consistent with its putative role in cognitive monitoring. By contrast, when logical reasoning was overcome by belief-bias, there was engagement of ventral medial prefrontal cortex, a region implicated in affective processing. This latter involvement suggests that belief-bias effects in reasoning may be mediated through an influence of emotional processes on reasoning. (shrink)

In philosophy, a debate can live forever. Nowhere is this more evident than in ethics, a field that is fueled by apparently intractable dilemmas. To promote the wellbeing of many, may we sacrifice the rights of a few? If our actions are predetermined, can we be held responsible for them? Should people be judged on their intentions alone, or also by the consequences of their behavior? Is failing to prevent someone’s death as blameworthy as actively causing it? For generations, questions (...) like these have provoked passionate arguments and counterarguments, but few clear answers. Here, we offer a psychological account of why philosophical dilemmas arise, why they resist resolution, and why scientists should pay attention to them. Building on a family of recent proposals (Cushman & Young, 2009; Greene, 2008; Sinnott- Armstrong, 2008), we argue that dilemmas result from conflict between dissociable psychological processes. When two such processes yield different answers to the same question, that question becomes a “dilemma”. No matter which answer you choose, part of you walks away dissatisfied. This explanation of philosophical dilemmas has an important payoff for psychological research, and we discuss two specific cases in which it has yielded promising results. In each case, social neuroscience has played an important role in distinguishing the psychological processes responsible for producing a dilemma. This, we suggest, is no accident; cognitive neuroscientific methods are particularly well-suited to dissociating independent psychological processes (Henson, 2006). Consequently, philosophers’ dilemmas provide a reliable guide toward productive cognitive neuroscience by identifying the contours of distinct psychological process. The research we review below focuses particularly on moral dilemmas, which is our own area of expertise. The psychological processes that contribute to moral judgment are of interest in their own right, and play a central role in social cognition.. (shrink)

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact (...) that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions. (shrink)

Professional control in the selection of treatment options for patients is changing. In light of social and legal developments emphasising patient choice and autonomy, and restricting medical paternalism and judicial deference, this article examines how far patients and families can demand NHS treatment in England and Wales. It considers situations where the patient is an adult with capacity, an adult lacking capacity and a child. In all three cases, there is judicial support for professional autonomy, but there are also inconsistencies (...) that have potential to elevate the importance of patient and family preferences. In combination, they may be perceived by healthcare professionals as an obligation to follow patient preferences, even where doing so conflicts with other professional obligations. It is argued that a more nuanced approach to shared decision-making could help clarify the boundaries of decision-making responsibility. (shrink)

Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: “If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity of the person” (p. 80). He (...) urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory.In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice‐based science. (shrink)

Most contemporary philosophers accept Kant's view1 that the central question of morality is what ought I to do. This gives choice a pivotal role, for choice is what one faces when the question has to be answered. Since what is chosen is an action, this view of morality—I shall call it the current view —is action-orientated. And since actions are directed towards people, the current view stresses altruism and universalizability. Morality is thus supposed to be activist and social. It is (...) a sensible, public-spirited enterprise in which responsible members of society will participate because they realize that reason requires it. Kantians, Utilitarians, Contractarians, and Marxists disagree, of course, about the nature of the relation between reason and morality. But they agree that choice intending to lead to action contributing to the welfare of others is the central concern of morality. (shrink)