A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...) decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

In many situations, people are unsure in their moral judgements. In much recent philosophical literature, this kind of moral doubt has been analysed in terms of uncertainty in one’s moral beliefs. Non-cognitivists, however, argue that moral judgements express a kind of conative attitude, more akin to a desire than a belief. This paper presents a scientifically informed reconciliation of non-cognitivism and moral doubt. The central claim is that attitudinal ambivalence—the degree to which one holds conflicting attitudes towards the same object—can (...) play the role of moral doubt for non-cognitivists. I will demonstrate that ambivalence has all of the features that we would expect it to have in order to play the role of moral doubt. It is gradable, can vary through time, covaries with strength of motivation, and is suitably distinct from the other features of our moral judgements. As well as providing a defence of non-cognitivism, this insight poses a new challenge for the view: deciding how to act under moral ambivalence. (shrink)

The aim of this paper is to provide a detailed characterisation of some ways in which our preferences reflect our reasons. I will argue that practical reasons can be characterised along two dimensions that influence our preferences: their balance and their weight. This is analogous to a similar characterisation of the way in which probabilities reflect the balance and weight of evidence in epistemology. In this paper, I will illustrate the distinction between the balance and weight of reasons, and show (...) how this is crucial for an adequate account of preference and choice. The upshot is a more complete picture of a particular kind of decision, labelled by Isaac Levi and, more recently, Ruth Chang as ‘hard choices’. These are choices in which one option is better than another in some ways, the other is better than the first in some ways, but neither seems better overall. The distinction between the balance and weight of reasons presents a new way of understanding how hard choices vary by degree and what it is that makes them so hard. (shrink)

An AI-based “patient preference predictor” (PPP) is a proposed method for guiding healthcare decisions for patients who lack decision-making capacity. The proposal is to use correlations between sociodemographic data and known healthcare preferences to construct a model that predicts the unknown preferences of a particular patient. In this paper, I highlight a distinction that has been largely overlooked so far in debates about the PPP–that between algorithmic prediction and decision-making–and argue that much of the recent philosophical disagreement stems from this (...) oversight. I show how three prominent objections to the PPP only challenge its use as the sole determinant of a choice, and actually support its use as a source of evidence about patient preferences to inform human decision-making. The upshot is that we should adopt the evidential conception of the PPP and shift our evaluation of this technology towards the ethics of algorithmic prediction, rather than decision-making. (shrink)

This paper presents a unifying diagnosis of a number of important problems facing existing models of rational choice under moral uncertainty and proposes a remedy. I argue that the problems of (i) severely limited scope, (ii) intertheoretic comparisons, and (iii) 'swamping’ all stem from the way in which values are assigned to options in decision rules such as Maximisation of Expected Choiceworthiness. By assigning values to options under a given moral theory by asking something like ‘how much do I desire (...) this option, supposing this theory is true?’ rather than ‘how much value does this theory assign to this option?’ these problems can be avoided, while the appealing features of these accounts can be preserved. This amendment provides a role for the preferences, desires, or goals of rational agents that is curiously absent from the existing discussion of what individuals rationally ought to do when they are uncertain about what they morally ought to do. (shrink)