Unlike other classical arguments for the existence of God, Pascal’s Wager provides a pragmatic rationale for theistic belief. Its most popular version says that it is rationally mandatory to choose a way of life that seeks to cultivate belief in God because this is the option of maximum expected utility. Despite its initial attractiveness, this long-standing argument has been subject to various criticisms by many philosophers. What is less discussed, however, is the rationality of this choice in situations where (...) the decision-makers are confronted with greater uncertainty. In this paper, I examine the imprecise version of Pascal’s Wager: those scenarios where an agent’s credence that God exists is imprecise or vague rather than precise. After introducing some technical background on imprecise probabilities, I apply five different principles for decision-making to two cases of state uncertainty. In the final part of the paper, I argue that it is not rationally permitted to include zero as the lower probability of God’s existence. Although the conditions for what makes an act uniquely optimal vary significantly across those principles, I also show how the option of wagering for God can defeat any mixed strategy under two distinct interpretations of salvation. (shrink)

In the domain of medical science, factual evidence is usually considered as the criterion on which to base decisions and construct hypotheses. Evidence-based medicine is the translation of this approach into the field of patient care, and it means providing only the type of care that is based on evidence that proves its effectiveness and appropriateness. However, while the literature has focused on the types and force of evidence used to establish the recommendation and treatment guidelines, the problem of how (...) evidence is used in doctor–patient interactions to motivate, or refuse, treatment or habit change has been almost completely neglected. In this specific context, characterized by the epistemic unbalance between the interlocutors and a specific conversational goal, the scientific categories of evidence are often irrelevant. The goal of this paper is to address this challenge by analyzing the role evidence plays in doctor–patient interactions in diabetes care. After introducing an analytical distinction between the epistemic and the pragmatic aspect of evidence, we will propose a classification of the types and functions of evidence in chronic care communication, and illustrate its possible uses through its application to our corpus of diabetes-care consultations. From our qualitative analyses, it is possible to observe how in this communicative context a crucial role is played by the conflicts of evidence, in which providers correct patients’ uses of evidence leading them to using less defeasible levels of evidence. (shrink)

In recent years, some epistemologists have argued that practical factors can make the difference between knowledge and mere true belief. While proponents of this pragmatic thesis have proposed necessary and sufficient conditions for knowledge, it is striking that they have failed to address Gettier cases. As a result, the proposed analyses of knowledge are either lacking explanatory power or susceptible to counterexamples. Gettier cases are also worth reflecting on because they raise foundational questions for the pragmatist. Underlying these challenges (...) is the fact that pragmatic epistemologies not only rely upon normative theories of rational choice but also require externalist standards to rule out epistemic luck. Unfortunately, we lack adequate externalist theories of rational choice. In response, I address these foundational challenges by offering the outlines of an externalist decision theory. While this task is an ambitious one that I cannot hope to complete, I survey the outlines of a decision-theoretic framework on which a richer pragmatic epistemology can be developed. My hope is that this framework opens up new avenues of exploration for the pragmatic epistemologist. (shrink)

Heterogeneous treatment effects represent a major issue for medicine as they undermine reliable inference and clinical decision-making. To overcome the issue, the current vision of precision and personalized medicine acknowledges the need to control individual variability in response to treatment. In this paper, we argue that gene-treatment-environment interactions (G × T × E) undermine inferences about individual treatment effects from the results of both genomics-based methodologies—such as genome-wide association studies (GWAS) and genome-wide interaction studies (GWIS)—and randomized controlled trials (...) (RCTs). Then, we argue that N-of-1 trials can be a solution to overcome difficulties in handling individual variability in treatment response. Although this type of trial has been suggested as a promising strategy to assess individual treatment effects, it nonetheless has limitations that limit its use in everyday clinical practice. We analyze the existing variability within the designs of N-of-1 trials in terms of a continuum where each design prioritizes epistemic and pragmatic considerations. We then support wider use of the designs located at the pragmatic end of the explanatory-pragmatic continuum. (shrink)

In this paper I argue that the search for explainable models and interpretable decisions in AI must be reformulated in terms of the broader project of offering a pragmatic and naturalistic account of understanding in AI. Intuitively, the purpose of providing an explanation of a model or a decision is to make it understandable to its stakeholders. But without a previous grasp of what it means to say that an agent understands a model or a decision, the (...) explanatory strategies will lack a well-defined goal. Aside from providing a clearer objective for XAI, focusing on understanding also allows us to relax the factivity condition on explanation, which is impossible to fulfill in many machine learning models, and to focus instead on the pragmatic conditions that determine the best fit between a model and the methods and devices deployed to understand it. After an examination of the different types of understanding discussed in the philosophical and psychological literature, I conclude that interpretative or approximation models not only provide the best way to achieve the objectual understanding of a machine learning model, but are also a necessary condition to achieve post hoc interpretability. This conclusion is partly based on the shortcomings of the purely functionalist approach to post hoc interpretability that seems to be predominant in most recent literature. (shrink)

The Holy Scriptures can be considered a specific kind of normative texts, whose use to assess practical moral cases requires interpretation. In the field of ethics, this interpretative problem results in the necessity of bridging the gap between the normative source – moral precepts – and the specific cases. In the history of the Church, this problem was the core of the so-called casuistry, namely the decision-making practice consisting in applying the Commandments and other principles of the Holy (...) Scriptures to specific cases or moral problems. By taking into account the sin of lying, this paper argues that casuistic texts reveal an extremely sophisticated interpretative method, grounded on “pragmatic” contextual and communicative considerations and argumentative structures that resemble the ones used in legal interpretation. These works show how the underspecified biblical text expressing an abstract norm was enriched pragmatically by completing it and modulating its meaning so that it could be used to draw a conclusion in a specific context on a specific case. The mutual interdependence between biblical interpretation, pragmatics, and argumentation sheds light on a much broader phenomenon, namely the pragmatic nature of argumentation. (shrink)

This paper has three interdependent aims. The first is to make Reichenbach’s views on induction and probabilities clearer, especially as they pertain to his pragmatic justification of induction. The second aim is to show how his view of pragmatic justification arises out of his commitment to extensional empiricism and moots the possibility of a non-pragmatic justification of induction. Finally, and most importantly, a formal decision-theoretic account of Reichenbach’s pragmatic justification is offered in terms both of (...) the minimax principle and the dominance principle. (shrink)

Drawing on unpublished and published sources from 1926-1932, this chapter builds on John Dewey’s naturalistic pragmatic pluralism in ethical theory. A primary focus is “Three Independent Factors in Morals,” which analyzes good, duty, and virtue as distinct categories that in many cases express different experiential origins. The chapter suggests that a vital role for contemporary theorizing is to lay bare and analyze the sorts of conflicts that constantly underlie moral and political action. Instead of reinforcing moral fundamentalism via an (...) outdated quest for the central and basic source of normative justification, we should foster theories with a range of idioms and emphases which, while accommodating monistic insights, better inform decision-making by opening communication across diverse elements of moral and political life, placing these elements in a wider context in which norms gain practical traction in non-ideal conditions, and expanding prospects for social inquiry and convergence on policy and action. (shrink)

This paper turns to pragmatism for strategies to assist with the timely implementation of conservation efforts, as it provides tools to unfreeze policy decision making so that stakeholders, from farmers to wildlife organizations, can readily address impacts associated with climate induced non-human migration. The first section of this essay introduces readers to the topic of climate induced migration and provides an overview of how agriculture could either inhibit or help facilitate migrating species. The second section then applies Thompson’s (...) analysis of water policy, specifically his triangular structure of libertarianism, utilitarianism, and egalitarianism, to the problem of non-human climate refugees to identify positions that could be taken, as producers, policy makers, and other stakeholders determine if they should adopt strategies to assist migrating species. This analysis ends with the argument that the field of applied ethics, while useful for identifying key policy positions, can provide little insight to stakeholders facing issues associated with climate induced migration. The final section of the paper turns to pragmatism for strategies that could help guide wildlife conservation decisions on the ground. It is the author’s hope that a wide range of readers will find this paper useful, as it brings together work in environmental ethics, wildlife conservation literature, and public policy. (shrink)

[[[ (Here only the chapters 3 – 8, see *** ) First I argue that the prohibition of linguistic self-reference as a solution to the antinomy problem contains a pragmatic contradiction and is thus not only too restrictive, but just inconsistent (chap.1). Furthermore, the possibilities of non-restrictive strategies for antinomy avoidance are discussed, whereby the explicit inclusion of the – pragmatically presuposed – consistency requirement proves to be the optimal strategy (chap.2). ]]] The central question here is that about (...) the actual reason for antinomic structures. It turns out to be a form of negative self-conditioning (chap.3). This makes it necessary to clarify the status of negative concepts (chap.4). The generalization of these considerations (chap.5) leads to the actual analysis of the antinomic basic structure (chap.6): Decisively for the pragmatics of the concept is that it positively owns a meaning, so that positivity is always constituted by the concept qua concept. Thus a negative concept is characterized by a fundamental ambivalence: From a semantic point of view it has negative character, in its pragmatic status as a concept, however, it has positive character. If the meaning is especially that of a negative self-reference, the ambivalence leads to the antinomic constellation of a negative self-condition – that is the crux of the matter here! The concept thus possesses the property defined by it exactly when it does not possess it and vice versa. A closer analysis shows that the function of reflective structures for the occurrence of antinomies has to be judged much more differentiated than previous opinions suggest. Not only are four forms of reflectivity to be distinguished in this context – ontic, semantic, pragmatic reflectivity, and especially the form of negative self-condition; but it is also apparent that these are intertwined with each other in a way that is difficult to be understood. The astonishing variety of relationships associated with this makes the irritation that has always emanated from the antinomy problem appear more comprehensible. In the developed pragmatic perspective furtheron parallels to the structure of self-consciousness become visible (chap.7). I conclude with considerations about the significance of the antinomic structure for the problem of dialectics, especially for the synthesis formation of mutually exclusive terms (chap.8). (shrink)

There is wide consensus among bioethicists about the importance of autonomy when determining whether or not a patient has the right to refuse life-saving treatment (LST). In this context, autonomy has typically been understood in terms of the patient’s ability to make an informed decision. According to the traditional view, decision-making capacity (DMC) is seen as both necessary and sufficient for the right to refuse LST. Recently, this view has been challenged by those who think that considerations (...) of authenticity and putative counterexamples should lead us to revise the traditional account. In this paper, we respond to these revisionist arguments, and we defend the traditional view according to which we have autonomy-based reasons to respect a patient’s decision to refuse LST if and only if she has DMC. (shrink)

Decision-making Capacity matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; (...) and concern for sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy. (shrink)

Many collective decision making problems have a combinatorial structure: the agents involved must decide on multiple issues and their preferences over one issue may depend on the choices adopted for some of the others. Voting is an attractive method for making collective decisions, but conducting a multi-issue election is challenging. On the one hand, requiring agents to vote by expressing their preferences over all combinations of issues is computationally infeasible; on the other, decomposing the problem into several (...) elections on smaller sets of issues can lead to paradoxical outcomes. Any pragmatic method for running a multi-issue election will have to balance these two concerns. We identify and analyse the problem of generating an agenda for a given election, specifying which issues to vote on together in local elections and in which order to schedule those local elections. (shrink)

In § 6 of his General Psychopathology (1st edition 1913) Jaspers distinguished between drives, wants and volitions as three different and irreducible kinds of motivational phenomena which are involved in human decision making and which may lead to successful actions. He has characterized the qualitative differences between volitions in comparison with basic vital drives and emotional wants such as being (a.) intentional, (b.) content-specific and (b.) directed towards concrete objects and actions as goals. Furthermore, Jaspers has presented and (...) discussed three kinds of pathological problems about motivation and willing. (1.) The first kind is impulsive action or impulsive behaviour, as e.g. in psychoses or personality disorders, which he compares with instinctive action which are both without any previous hesitation, deliberation and reflection of any presumable consequences, but still very different with respect to their motivational content. (2.) The second kind of pathological problems about motivation and willing are the inhibitions of the will and Jaspers is discussing two major kinds of them: (a.) the energetic or motivational inhibition of the will which is an inability of willing due to the mere lack of any drives and motives, as in the case of any severe and pathological depression; (b.) the cognitive inhibition of the will which is due to the pathological inability to be aware of and understand properly the complexity and difficulty of real life situations in order to solve some given tasks by appropriate decision making, as e.g. in some cases of schizophrenia. (3.) The third kind is a pathological weakness of the will which is extraordinary and not familiar to normal human adults. This pathological kind of weakness of the will consist in the complete causal ineffectiveness of the subjectively felt impulse of willing which is not leading to any inward and outward observable action, such as e.g. as a movement of the limbs or some verbal utterance. This pathological weakness of the will is a complete ineffectiveness of the volitional impulse and therefore different from what philosophers discuss under the heading of weakness of the will which presuppose some evaluation of the intended resp. realized action as ethically, morally or religiously right or wrong. Finally, there are three kinds of normal or non-pathological weakness of the will, as discussed by philosophers: (A.) ethical weakness of the will as in Aristotle’s disagreement about akrasia with the Platonic Socrates; (B) moral weakness of the will as in Kant’s analysis of the absence or failure of any specific moral reasoning by pure practical reason as opposed to mere strategic and pragmatic reason or as the occurrence of a self-deceptive “dialectics of the exception“; (C.) religious weakness of the will as in Pauls personal insight about the incoherence between his high spiritual aspirations and his factual ethical achievements. (shrink)

Moral fundamentalism is the habit of acting as though one has access to the exclusively right way to diagnose problems, along with the single approvable practical solution to any particular problem. This approach causes us to oversimplify situations, neglect broader context, take refuge in dogmatic absolutes, ignore possibilities for finding common ground, assume privileged access to the right way to proceed, and shut off honest inquiry. In this way, moral fundamentalism-exacerbated by social media silos-also makes the worst of native impulses (...) toward social bonding and antagonism. This makes it impossible to debate and achieve superordinate social goals, such as public health, justice, security, sustainability, peace, and democracy. Drawing from John Dewey's pluralistic and pragmatic approach to philosophical questions, Steven Fesmire develops an alternative to both the oversimplification of moral fundamentalism and the arbitrariness of relativism. His pragmatic pluralism is set up as a response to particular conditions and consequences, so it gains practical leverage with complex ethical, political, educational, and policy problems without flattening variability among values or presuming that abstract theories can determine what we ought to do. He argues that the reductive monistic premise that logically underlies moral fundamentalism is both unwarranted and constrictive, and there is little to be said in favor of the grand philosophical quest for a unifying principle that cannot be accommodated within a wider pluralistic approach. In a concrete and engaging style, Fesmire clarifies and illustrates the promises and challenges of democratic decision-making in societies struggling to grow beyond moral fundamentalism. (shrink)

In this study, we propose a new approach based on fuzzy TODIM (Portuguese acronym for interactive and multicriteria decision-making) for decision-making problems in uncertain environments. Our method incorporates group utility and individual regret, which are often ignored in traditional multicriteria decision-making (MCDM) methods. To enhance the analysis and application of fuzzy sets in decision-making processes, we introduce novel entropy and distance measures for q-rung picture fuzzy sets. These measures include an entropy measure (...) based on the sine function and a distance measure derived from the Jensen-Shannon divergence. In our methodology, incorporating the sine function into the entropy measure stands out as a distinctive decision, grounded in a profound understanding of the inherent characteristics of fuzzy sets. Utilizing the sine function proves especially advantageous when handling fuzzy sets that exhibit cyclical variations or fluctuations in their membership degrees. We effectively weight the criteria for an improved evaluation by using this new entropy measure. The introduced distance measure finds application in the TODIM approach, allowing the execution of TODIM method steps within a fuzzy environment until the determination of one alternative’s dominance over another—an advancement beyond traditional approaches. We apply our enhanced fuzzy TODIM method to a real-life construction project management problem from the literature and compare the results with those in the literature and obtained from other MCDM methods. Our proposed measures are robust, as demonstrated by the sensitivity analysis that varied the weights of group utility and individual regret, with the results visualized in a 3D sensitivity plot. The findings demonstrate the superiority of our method in providing a more comprehensive evaluation of alternatives, making it a useful tool for decision-makers facing complex and uncertain decision-making problems. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct (...) verdicts about who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

Recent trends in psychiatry involve a transition from categorical to dimensional frameworks, in which the boundary between health and pathology is understood as a difference in degree rather than as a difference in kind. A major tenet of dimensional approaches is that no qualitative distinction can be made between health and pathology. As a consequence, these approaches tend to characterize such a threshold as pragmatic or conventional in nature. However, dimensional approaches to psychopathology raise several epistemological and ontological issues. (...) First, we review major sources of evidence usually recruited in support of the dimensional trend (focusing on clinical observation and biological data), and we show that these are connected to different conceptualizations of how dimensional traits extend across health and pathology. Second, we criticize two unquestioned assumptions that stand at the core of the dimensional trend: a) that there is continuity from health to pathology at the symptomatic level; b) that such continuity reflects an underlying continuity in the genetic liability for pathological conditions. Third, we argue against the idea of a conventional threshold by showing that such a view implies a linear relationship between the genotype and the phenotype. Fourth, drawing on epigenetics and developmental biology, we offer a characterization of mental disorders as stable and dynamic constellations of multi-level variables that differ qualitatively from ‘healthy states’. We conclude by showing that our account has several theoretical advantages over both categorical and dimensional approaches. Notably, it provides crucial insights into psychological development over time and individual differences, with major implications in terms of intervention and clinical decision-making. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence (...) in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

Across two studies the hypotheses were tested that stressful situations affect both leadership ethical acting and leaders' recognition of ethical dilemmas. In the studies, decision makers recruited from 3 sites of a Swedish multinational civil engineering company provided personal data on stressful situations, made ethical decisions, and answered to stress-outcome questions. Stressful situations were observed to have a greater impact on ethical acting than on the recognition of ethical dilemmas. This was particularly true for situations involving punishment and lack (...) of rewards. The results are important for the Corporate Social Responsibility (CSR) of an organization, especially with regard to the analysis of the Stressors influencing managerial work and its implications for ethical behavior. (shrink)

Because “evidence” is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical attention toward EBM’s rigid hierarchy of evidence as the culprit (...) of its objectionable epistemic practices. It reframes the EBM discourse in light of a distinction between objectivist and pragmatic epistemology, which allows for a more nuanced analysis of EBM than previously offered: one that is not either/or in its evaluation of the decision-making technology as either iconoclastic or creedal. -/- . (shrink)

Decisions are made under uncertainty when there are distinct outcomes of a given action, and one is uncertain to which the act will lead. Decisions are made under indeterminacy when there are distinct outcomes of a given action, and it is indeterminate to which the act will lead. This paper develops a theory of (synchronic and diachronic) decision-making under indeterminacy that portrays the rational response to such situations as inconstant. Rational agents have to capriciously and randomly choose how (...) to resolve the indeterminacy relevant to a given choice-situation, but such capricious choices once made constrain how they will choose in the future. The account is illustrated by the case of self-interested action in situations where it is indeterminate whether you yourself will survive to benefit or suffer the consequences. The conclusion emphasizes some distinctive anti-hedging predictions of the account. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We report (...) on the difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

Algorithm Decision Making (ADM) systems designed to augment or automate human decision-making have the potential to produce better decisions while also freeing up human time and attention for other pursuits. For this potential to be realised, however, algorithmic decisions must be sufficiently aligned with human goals and interests. We take a Principal-Agent (P-A) approach to the questions of ADM alignment and trust. In a broad sense, ADM is beneficial if and only if human principals can trust (...) algorithmic agents to act faithfully on their behalf. This mirrors the challenge of facilitating P-A relationships among humans, but the peculiar nature of human-machine interaction also raises unique issues. The problem of asymmetric information is omnipresent but takes a different form in the context of ADM. Although the decision-making machinery of an algorithmic agent can in principle be laid bare for all to see, the sheer complexity of ADM systems based on deep learning models prevents straightforward monitoring. We draw on literature from economics and political science to argue that the problem of trust in ADM systems should be addressed at the level of institutions. Although the dyadic relationship between human principals and algorithmic agents is our ultimate concern, cooperation at this level must rest against an institutional environment which allows humans to effectively evaluate and choose among algorithmic alternatives. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that (...) supported decision-making would be better understood as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit all other, lower-quality (...) research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)

This paper argues that the plethora of experiments with decentralized social technologies (DSTs)—clusters of which are sometimes called “the Web 3.0 ecosystem” or “the Fediverse”—have brought us to a constitutional moment. These technologies enable radical innovations in social, economic, and political institutions and practices, with the potential to support transformative approaches to political economy. They demand governance innovation. The paper develops a framework of prudent vigilance for making ethical choices in this space that help to both grasp positive opportunities (...) for transformation and avoid the potentially problematic consequences. Most of our specific examples and concerns come from the blockchain/Web3 universe, as this has received the greatest investment, attention, and adoption to date. However, we aim to offer a framework for governance decision-making in conditions of uncertainty that applies more broadly to other DSTs. Specifically, under the framework of prudent vigilance, we propose a pragmatic, democratic, and pluralist approach to navigating bold experimentation with social practices and political economy enabled by these technologies. Our overarching goal is to provide a framework open to transformative improvement and constrained by guardrails and guiding values supportive of democracy, freedom, and pluralism. We take a relatively strong position, rather than simply laying out ethical issues and potential approaches. We seek to be provocative in order to spur further work and hope this paper will serve as a first bridge between academic philosophy and the DST community, which have hardly interacted to date. (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)

Prima facie, we make successful decisions as we act on and intervene in the world day-to-day. Epistemologists are often concerned with whether rationality is involved in such decision-making practices, and, if so, to what degree. Some, particularly in the post-structuralist tradition, argue that successful decision-making occurs via an existential leap into the unknown rather than via any determinant or criterion such as rationality. I call this view radical voluntarism (RV). Proponents of RV include those who subscribe (...) to a view they call Critical Complexity (CC). In this paper, I argue that CC presents a false dichotomy when it conceives of rationality in Cartesian – i.e. ideal and transcendental – terms, and then concludes that RV is the proper alternative. I then outline a pragmatist rationality informed by recent work in psychology on bounded rationality, ecological rationality, and specifically embodied rationality. Such a pragmatist rationality seems to be compatible with the tenets of post-structuralism, and can therefore replace RV in CC. (shrink)

Management decision-making is a daily task that managers of various levels solve in every organization. Degree of difficulty of this process depends on the scope of authority, responsibility level, manager’s position in organizational hierarchy; on the changes in the environment, unpredictability of which causes emergence of significant amounts of alternatives. For this reason, managers do not rely only on intuition or personal experience (which limited with selective perception, cognitive ability, ability to withstand stress and/or the presence of bias), (...) but use tools (methods) that have stood the test of time and practice; are based at the analysis of a significant amount of primary and secondary information; involve team-building to find the optimal option or to generate ideas. A significant amount of research papers are devoted to such methods, however, the author forms a synergetic approach which contains a detailed analysis of their correlation with the key factors of the competitiveness of enterprise, such as organizational culture and leadership. Existing decision-making practices, problems and style of management at the tourism enterprises are revealed from conducted survey (the first half of 2014) in tourism firms of Dnepropetrovsk and Zaporizhzhia regions of Ukraine, in which 729 tourism managers took part. The most popular decision-making practices in tourism branch were specified, among them are modeling and monitoring of previous results. The study proved the hypothesis of the author concerning strong connection of decision-making management and type of organizational culture. Moreover, 63% of managers were dissatisfied with low attention to organizational culture at their companies. The basis for future research and the synergetic matrix for decision-making management were worked out in the article which give preconditions for further studies and improvements in tourism management of Ukrainian enterprises. (shrink)

While there is an extensive literature on how the precautionary principle should be interpreted and when precautions should be taken, relatively little discussion exists about the fair distribution of costs of taking precautions. We address this issue by proposing a general framework for deciding how costs of precautions should be shared, which consists of a series of default principles that are triggered according to desert, rights, and ability to pay. The framework is developed with close attention to the pragmatics of (...) how distributions will affect actual behaviours. It is intended to help decision-makers think more systematically about distributional consequences of taking precautionary measures, thereby to improve decision-making. Two case studies—one about a ban on turtle fishing in Costa Rica, and one about a deep-sea mining project in Papua New Guinea—are given to show how the framework can be applied. (shrink)

This text provides an introduction to the topic of rational decision making as well as a brief overview of the most common biases in judgment and decision making. "Decision Making" is relatively short (300 pages) and richly illustrated with approximately 100 figures. It is suitable for both self-study and as the basis for an upper-division undergraduate course in judgment and decision making. The book is written to be accessible to anybody with minimum (...) knowledge of mathematics (high-school level algebra and some elementary notions of set theory and probability, which are reviewed in the book). At the end of each chapter there is a collection of exercises that are grouped according to that chapter’s sections. Complete and detailed answers for each exercise are given in the last section of each chapter. The book contains a total of 121 fully solved exercises. (shrink)

The study aimed to identify the reality of decision-making in the local NGOs in Gaza Strip. In order to achieve the objectives of the study and to test its hypotheses, the analytical descriptive method was used, relying on the questionnaire as a main tool for data collection. The study society was one of the decision makers in the local NGOs in Gaza Strip. The study population reached 78 local NGOs in Gaza Strip. A Census Method of the (...) possible study community was adopted, and the use of the Statistical Package for Social Sciences (SPSS) was mainly based on the analysis and analysis of the data obtained through the survey tool. The study reached a set of results, the most important of which are: NGOs follow a decision-making mechanism. NGOs examine the problems and causes of the organization. Organizations are less concerned with stakeholder participation. Make decision. The main recommendations of the study are: To promote systematic methods of decision-making in NGOs in Gaza Strip: Local NGOs in Gaza Strip should continue to develop their competencies in order to make sound and correct decisions and encourage them to follow the scientific methodologies in the mechanism of taking Decisions. (shrink)

The Millennium Development Goals (MDG) set time-bound targets that are powerful shapers of how and for whom health is pursued. In this paper we examine some ramifications of both the temporal limitation, and maternal-child health targeting of MDG 4 and 5. The 2015 end date may encourage increasing the number of mass campaigns to meet the specific MDG objectives, potentially to the detriment of a more comprehensive approach to health. We discuss some ethical, political, and pragmatic ramifications of this (...) tendency, and show that these are not unique to the MDGs but rather have a long history in health policy debates. We also examine attempts to counter a narrow focus on vertical interventions in campaigns through integrated health system delivery platforms. We argue that the way forward is not to assume that evidence is value free, but rather to make explicit the political and ethical decisions in the design of metrics and evaluation research. We propose an index of five factors that should be included in research designed to inform decision making about providing interventions as part of routine services or periodic campaigns, toward serving more members of the population, and long-term strengthening of the health system via integrated health interventions. (shrink)

Sustainable Values, Sustainable Change is a culminating work written for a general audience of environmental professionals. In keeping with what he has long urged for environmental philosophers, Norton focuses on ameliorative processes for resolving disagreements, on making decisions, while sidestepping the monistic quest for the right general principles to think about and govern human relationships with nature. Norton presupposes his “convergence hypothesis” familiar to readers of this journal: multi-scalar anthropocentric arguments, he holds, usually justify the same policies as ecocentric (...) arguments; hence, it is not essential to convince doubters that parts of nature have intrinsic value. Norton’s principal aim in this new work is to spell out his “heuristic proceduralism” while showing that Adaptive Ecosystem Management’s pluralistic model of sustainability works better for real decision making than the narrow focus on economic welfare in mainstream environmental economics. Environmental philosophers will also rightly read the book as, in part, Norton’s seasoned response to a familiar accusation: that pragmatic pluralism is too mushy to guide action, hence ethicists must fall back on defense of antecedent principles. (shrink)

In order to strengthen RI in the private sector, it is imperative to understand how companies organise this process, where it takes place, and what considerations and motivations are central in the innovation process. In this chapter, the questions of whether and where normative considerations play a role in the innovation process, and whether dimensions of RI are present in the innovation process, are addressed. In order answer these research questions, a theoretical framework is developed based on Jones’s theory of (...) ethical decision making and Cooper’s stagegate model of innovation management. In order to answer the research questions, a specific case of innovations that contribute to public health is explored, namely, that of food companies that participate in a Front-of-Pack logo for healthier food. As the use of healthy food logos does not necessarily have a positive impact on sales and profits, it is expected that in the decision-making process, as part of their innovation process, companies make several trade-offs between economic, technical and moral factors. As the social-ethical values at stake in corporate innovation processes have remained to a large extent unexplored in research on innovation management, the aim of this chapter is to identify the motivations and barriers for companies embracing and continuing a FoP logo for healthier food, and to assess whether ethical considerations play a role in this innovation process. From the findings in this research, it will become clear that although the studied companies participated in a programme for healthy food and thus are responsive to the needs of society, and although the companies feel responsible for public health, ethical considerations do not play a central role in the operational innovation process. Instead, technical and economic considerations seem to prevail in the operational innovation process. Furthermore, none of the procedural dimensions of RI seems to be present at this level in the innovation trajectory. It is argued that this may be an indication that the ethical decision-making process for RI is not located at the level of the operational innovation process itself, but is something that might be located on a higher strategic level in the company. It is at this level that the moral decision is taken to adopt the FoP logo and to engage in the RI process. The findings cast a new light on the discourse on RI in general, and in the private sector in particular. (shrink)

The stakes associated with an algorithmic decision are often said to play a role in determining whether the decision engenders a right to an explanation. More specifically, “high stakes” decisions are often said to engender such a right to explanation whereas “low stakes” or “non-high” stakes decisions do not. While the overall gist of these ideas is clear enough, the details are lacking. In this paper, we aim to provide these details through a detailed investigation of what we (...) will call the “Simple Stakes Thesis”. The Simple Stakes Thesis, as it will turn out, is too simple. For even if the stakes associated with a specific one-off decision are low—and hence does not engender a right to an explanation—such decisions may nevertheless form part of a high stakes pattern or aggregate of decisions. In such cases, we argue, even a low stakes decision may engender a right to explanation. Not only does this show that the right to explanation is more demanding than so far recognized. It also shows that the stakes thesis is significantly harder to apply in practice. (shrink)

In this paper, we define correlation coefficient measure between any two rough neutrosophic sets. We also prove some of its basic properties.. We develop a new multiple attribute group decision making method based on the proposed correlation coefficient measure. An illustrative example of medical diagnosis is solved to demonstrate the applicability and effecriveness of the proposed method.

This paper examines the relationship of ethical decision-making by individuals to corporate business ethics and organizational performance of three groups: SMEs, Outstanding SMEs and Large Enterprises, in order to provide a reference for Taiwanese entrepreneurs to practice better business ethics. The survey method involved random sampling of 132 enterprises within three groups. Some 524 out of 1320 questionnaires were valid. The survey results demonstrated that ethical decision-making by individuals, corporate business ethics and organizational performance are highly (...) related. In summary, then, high levels of organizational performance were directly attributable to high levels of applied corporate and individual ethics. Furthermore, there is a demonstrable tendency for Outstanding SMEs to reject ethically unsound practices such as padded expense accounts, tax evasion and misleading advertising. The measurement criteria used to assess organizational performance, however, did not include an objective evaluation of financial performance. (shrink)

Stephanie Collins’ Group Duties offers interesting new arguments and brings together numerous interconnected issues that have hitherto been treated separately. My critical commentary focuses on two particularly original and central claims of the book: (1) Only groups that are united under a group-level decision-making procedure can bear duties. (2) Attributions of duties to other groups should be understood as attributions of “coordination duties” to each member of the group, duties to take steps responsive to the others with a (...) view to the group’s φ-ing or express willingness to do so. In support of the first claim, Collins argues that only groups that can make decisions can bear duties, and that the ability to make decisions requires the relevant sort of decision-making procedure. I suggest that both parts of this argument remain in need of further support. I furthermore argue that Collins’ account of coordination duties gets certain kinds of cases wrong, and suggest that attributions of duties to groups without decision-making procedures are more plausibly understood as attributing shared duties. (shrink)

Employing the framework of conflicting goals in democracy promotion as departure point, the paper addresses the issue of arms exports to non-democratic countries as an important research topic which points to a reconsideration of certain fundamental conceptual and normative commitments underpinning democracy promotion. Empirically, we remind of the lingering hypocrisy of Western arms exporters, knowing that exports to non-democratic countries often hinder or block democratisation. This is not easily circumvented, because of the many conflicting objectives both internal and external to (...) democracy promotion itself. Yet democracy and human rights promotion remain, ethically and pragmatically, important policy goals. Noting that the self-evident character of the state-based liberal democratic model is being increasingly questioned in the literature, we then critically explore a radical if surprisingly natural alternative vision: Namely that if the commitment to democracy and human rights is to be genuine, only global democracy remains a viable way of resolving the many dilemmas, as it aspires to deal both with regulating arms exports and building of accountable decision-making structures. Although we ultimately reject the globalist solution and lean towards a less radical constructivist approach, we endorse the underlying rationale, namely that democracy promotion needs to sincerely embrace normative democratic theory. (shrink)

Using artificial intelligence (AI) to make decisions in human resource management (HRM) raises questions of how fair employees perceive these decisions to be and whether they experience respectful treatment (i.e., interactional justice). In this experimental survey study with open-ended qualitative questions, we examine decision making in six HRM functions and manipulate the decision maker (AI or human) and decision valence (positive or negative) to determine their impact on individuals’ experiences of interactional justice, trust, dehumanization, and perceptions (...) of decision-maker role appropriate- ness. In terms of decision makers, the use of human decision makers over AIs generally resulted in better perceptions of respectful treatment. In terms of decision valence, people experiencing positive over negative decisions generally resulted in better perceptions of respectful treatment. In instances where these cases conflict, on some indicators people preferred positive AI decisions over negative human decisions. Qualitative responses show how people identify justice concerns with both AI and human decision making. We outline implications for theory, practice, and future research. (shrink)

Abstract: This paper defends a constraint that any satisfactory decision theory must satisfy. I show how this constraint is violated by all of the decision theories that have been endorsed in the literature that are designed to deal with cases in which opinions or values are represented by a set of functions rather than a single one. Such a decision theory is necessary to account for the existence of what Ruth Chang has called “parity” (as well as (...) for cases in which agents have incomplete preferences or imprecise credences). The problem with the all of the decision theories that have been defended to account for parity is that they are committed to a claim I call unanimity: when all of the functions in the set agree that an agent ought to do A, then an agent ought to do A. A decision theory committed to unanimity violates the constraint I defend in this paper. Thus, if parity exists, a new approach to decision theory is necessary. (shrink)

This paper inaugurates a discussion about the phenomenology of union decision-making. Phenomenology provides a new lens that may enable us to gain penetrating insights into how unions function in the fractious world of human resources management. The present paper is preliminary to any fieldwork that may be undertaken. Its main purposes are to identify theory that could be the foundation of further practical work, relate recent work in the phenomenology of management to union practices and to propose directions (...) of enquiry. The relevant theory is that of Edmund Husserl who provides us with a practical method of enquiry into the real world of human resource practice. Husserl’s work has already been applied in relation to local government functioning and some of the findings there appear relevant to the present enquiry. In particular, the nature and role of plebiscites. (shrink)

Albert Jonsen and Stephen Toulmin have argued that the best way to resolve complex “moral” issues in clinical settings is to focus on the details of specific cases. This approach to medical decision-making, labeled ‘casuistry’, has met with much criticism in recent years. In response to this criticism, Carson Strong has attempted to salvage much of Jonsen’s and Toulmin’s version of casuistry. He concludes that much of their analysis, including Jonsen’s further elaboration about the casuistic methodology, is on (...) the mark. In this essay, the details of Jonsen’s and Toulmin’s version of casuistry and the major criticisms against their approach to clinical decision-making are explicated. Furthermore, it is argued that Strong’s salvage efforts fail to deflect these criticisms. The upshot of this analysis, which includes a few additional criticisms, is that Jonsen’s and Toulmin’s version of casuistry is not an appropriate framework from which to resolve complex “moral” issues in clinical settings. (shrink)

The Comprehensive Human Decision-Making Equation presents a robust model for understanding Holistic Free Will (HFW), conceptualizing decision-making as an autonomous, non-deterministic process within a complex network of influences. This model addresses the Infinite Regress issue by portraying free will as an emergent property of interacting layers, including internal beliefs, external contexts, emotional responses, cognitive biases, and habitual tendencies. Departing from traditional linear models, the equation adopts a systemic framework where each choice reflects a cumulative utility, integrating (...) multiple components such as personal, ethical, social, and temporal utilities. This holistic approach emphasizes the probabilistic nature of free will, challenging deterministic interpretations and highlighting the ethical and relational dimensions of autonomy. By situating free will within a structured yet adaptive process, the model supports the notion that true autonomy is ethically aligned, relational, and embedded in a flexible reality, thereby promoting communal and ethical development. (shrink)

This essay investigates, via the concepts of the philosophy of orientation, Annie Duke’s decision-making theory in "Thinking in Bets" and scrutinizes as to what extent one can universalize the 'orientation skill' of decision-making with regard to our everyday and professional life.

Jennifer Hawkins (2024) offers two cases that challenge traditional accounts of decision-making capacity, according to which respect for a medical decision turns on an individual’s cognitive capacities at the time the decision is made (Hawkins 2024; Appelbaum and Grisso 1988). In each of her described cases (involving anorexia nervosa and grief, respectively), a patient makes a decision that—although instrumentally rational at the time—does not reflect the patient’s longer-term values due to being in a particular psychological (...) state. Importantly, this state does not impair the patient’s cognition, but rather predisposes them to make a decision that conflicts with their own broader values, beliefs, or desires. (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, (...) and Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

According to many of its proponents, shared decision making ("SDM") is the right way to interpret the clinician-patient relationship because it respects patient autonomy in decision-making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, (...) this paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy. (shrink)