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)

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)

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)

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the (...) ethical imperative of respecting patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy. (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)

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, (...) calculations, and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient. (shrink)

In response to the Royal Society report’s claim that “the acceptability of geo­engineering will be determined as much by social, legal, and political issues as by scientific and technical factors” (Geoengineering the Climate: Science, Governance and Uncertainty [London: Royal Society, 2009], ix), a number of authors have suggested the key to this challenge is to engage the public in geoengineering decision-making. In effect, some have argued that inclusion of the public in geoengineering decision-making is necessary for (...) any geoengineering project to be morally permissible. Yet, while public engagement on geoengineering comes in various forms, the discussion in geoengineering governance and the ethics of geoengineering have too often conceptualized it exclusively in terms of public participation in decision-making, and supported it by various liberal democratic values. However, if the predominant understanding of public engagement on—or, the role of the public in—geoengineering decision-making is indeed only grounded on liberal democratic values, then its normative relevance could be challenged by and in other ethical-political traditions that do not share those values. In this paper, I shall explore these questions from a Confucian perspective. I argue that the liberal democratic values invoked in support of the normative importance of public participation are, at least, foreign to Confucian political philosophy. This presents a prima facie challenge to view public participation in geoengineering decision-making as a universal moral requirement, and invites us to reconsider the normative significance of this form of public engagement in Confucian societies. Yet, I contend that the role of the public remains normatively significant in geoengineering governance and the ethics of geoengineering from a Confucian perspective. Drawing from recent work on Confucian political philosophy, I illustrate the potential normative foundation for public engagement on geoengineering decision-making. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

It is argued that the design of decisions is a process that in many ways is shaped by social factors such as identities, values, and influences. To be able to understand how these factors impact organizational decisions, the focus must be set on the management level. It is the management that shoulders the chief responsibility for designing collective actions, such as decisions. Our propositions indicate that the following measures must be taken in order to improve the quality of organizational decisions: (...) 1. The identity of the people, involved in organizational decision making, affects the quality of decisions and should be taken into account in the design of decisions. 2. The decision maker or designer of decisions should engage the members of an organization to create a shared vision. 3. Getting the members of an organization to express and share common values should improve the decision making process. 4. Being able to socially influence the members of an organization, or other stakeholders involved, as well as letting them participate in the process, should improve the quality of decisions. (shrink)

The process of decision making is predictable and irrational according to Daniel Ariely and other economic behaviorists, historians, and philosophers such as Daniel Kahneman or Yuval Noah Harari. Decisions made anteriorly can be, but don’t have to be, present in the actions of a person. Stories and shared belief in myths, especially those that arise from a system of human norms and values and are based on a belief in a “supernatural” order (religion) are important. Because of (...) this, mass cooperation amongst strangers is possible. (shrink)

In a context of imperfect risk protection, households may protect against the impact of a health shock by employing various financial and non-financial coping mechanisms, such as foregoing or reducing needed medical care, labor substitution, consumption reduction, borrowing money, dissaving, and selling assets. However, leveraging certain coping mechanisms may reduce future productivity, potentially trapping households in chronic or persistent poverty. Resources and risk are not necessarily shared equitably within a household; the ability and willingness of the household to leverage (...) coping mechanisms, or the choice of coping mechanism may depend on the social protection policy context, household socioeconomic status, and type of intrahousehold risk sharing. Vietnam has been making policy changes aimed towards achieving Universal Health Coverage for the past several decades, culminating in a 2015 change mandating universal insurance coverage. This can potentially influence both providers in making decisions around service delivery and households around financing care. This research aims to contribute to the literature exploring the relationships among direct and indirect health care costs, potentially maladaptive coping mechanisms, and household living standards, within the particular health financing and social protection environment in Vietnam. (shrink)

One relatively straightforward way in which academics could have more impact on global poverty is by doing more to help people make wise decisions about issues relevant to such poverty. Academics could do this by conducting appropriate kinds of research on those issues and sharing what they have learned with the relevant decision makers in accessible ways. But aren’t academics already doing this? In the case of many of those issues, I think the appropriate answer would be that they (...) could do so much better. As an illustration, I examine the academic input into one decision about an issue concerning global poverty in some detail in this paper. I argue that that input has been seriously deficient, and suggest some ways in which it might be improved. Building on this discussion, I then formulate two questions that can be applied to any such decision, answers to which would indicate the quality of the input academics are currently providing. In cases where that input is deficient, and the decision in question an important one, I suggest that academics consider organising themselves in ways that will improve that input. I finish by briefly discussing how Academics Stand Against Poverty might help them do so. (shrink)

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. Most (...) physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

In this essay we collect and put together a number of ideas relevant to the under- standing of the phenomenon of creativity, confining our considerations mostly to the domain of cognitive psychology while we will, on a few occasions, hint at neuropsy- chological underpinnings as well. In this, we will mostly focus on creativity in science, since creativity in other domains of human endeavor have common links with scientific creativity while differing in numerous other specific respects. We begin by briefly (...) introducing a few basic notions relating to cognition, among which the notion of ‘concepts’ is of basic relevance. The myriads of concepts lodged in our mind constitute a ‘conceptual space’ of an enormously complex structure, where con- cepts are correlated by beliefs that are themselves made up of concepts and are as- sociated with emotions. The conceptual space, moreover, is perpetually in a state of dynamic evolution that is once again of a complex nature. A major component of the dynamic evolution is made up of incessant acts of inference, where an inference occurs essentially by means of a succession of correlations among concepts set up with beliefs and heuristics, the latter being beliefs of a special kind, namely, ones relatively free of emotional associations and possessed of a relatively greater degree of justification. Beliefs, along with heuristics, have been described as the ‘mind’s software’, and con- stitute important cognitive components of the self-linked psychological resources of an individual. The self is the psychological engine driving all our mental and physical activity, and is in a state of ceaseless dynamics resulting from one’s most intimate ex- periences of the world accumulating in the course of one’s journey through life. Many of our psychological resources are of a dual character, having both a self-linked and a shared character, the latter being held in common with larger groups of people and imbibed from cultural inputs. We focus on the privately held self-linked beliefs of an individual, since these are presumably of central relevance in making possible inductive inferences – ones in which there arises a fundamental need of adopting a choice or making a decision. Beliefs, decisions, and inferences, all have the common link to the self of an individual and, in this, are fundamentally analogous to free will, where all of these have an aspect of non-determinism inherent in them. Creativity involves a major restructuring of the conceptual space where a sustained inferential process eventually links remote conceptual domains, thereby opening up the possibility of a large number of new correlations between remote concepts by a cascading process. Since the process of inductive inference depends crucially on de- cisions at critical junctures of the inferential chain, it becomes necessary to examine the basic mechanism underlying the making of decisions. In the framework that we attempt to build up for the understanding of scientific creativity, this role of decision making in the inferential process assumes central relevance. With this background in place, we briefly sketch the affect theory of decisions. Affect is an innate system of response to perceptual inputs received either from the exter- nal world or from the internal physiological and psychological environment whereby a positive or negative valence gets associated with a perceptual input. Almost every sit- uation faced by an individual, even one experienced tacitly, i.e., without overt aware-ness, elicits an affective response from him, carrying a positive or negative valence that underlies all sorts of decision making, including ones carried out unconsciously in inferential processes. Referring to the process of inferential exploration of the conceptual space that gener- ates the possibility of correlations being established between remote conceptual do- mains, such exploration is guided and steered at every stage by the affect system, analogous to the way a complex computer program proceeds through junctures where the program ascertains whether specified conditions are met with by way of generating appropriate numerical values – for instance, the program takes different routes, depending on whether some particular numerical value turns out to be positive or negative. The valence generated by the affect system in the process of adoption of a choice plays a similar role which therefore is of crucial relevance in inferential processes, especially in the exploration of the conceptual space where remote domains need to be linked up – the affect system produces a response along a single value dimension, resembling a number with a sign and a magnitude. While the affect system plays a guiding role in the exploration of the conceptual space, the process of exploration itself consists of the establishment of correlations between concepts by means of beliefs and heuristics, the self-linked ones among the latter having a special role in making possible the inferential journey along alternative routes whenever the shared rules of inference become inadequate. A successful access to a remote conceptual domain, necessary for the creative solution of a standing problem or anomaly – one that could not be solved within the limited domain hitherto accessed – requires a phase of relatively slow cumulative search and then, at some stage, a rapid cascading process when a solution is in sight. Representing the conceptual space in the form of a complex network, the overall process can be likened to one of self-organized criticality commonly observed in the dynamical evolution of complex systems. In order that inferential access to remote domains may actually be possible, it is necessary that restrictions on the exploration process – necessary for setting the context in ordinary instances of inductive inference – be relaxed and a relatively free exploration in a larger conceptual terrain be made possible. This is achieved by the mind going into the default mode, where external constraints – ones imposed by shared beliefs and modes of exploration – are made inoperative. While explaining all these various aspects of the creative process, we underline the supremely important role that analogy plays in it. Broadly speaking, analogy is in the nature of a heuristic, establishing correlations between concepts. However, analo- gies are very special in that these are particularly effective in establishing correlations among remote concepts, since analogy works without regard to the contiguity of the concepts in the conceptual space. In establishing links between concepts, analogies have the power to light up entire terrains in the conceptual space when a rapid cas- cading of fresh correlations becomes possible. The creative process occurs within the mind of a single individual or of a few closely collaborating individuals, but is then continued by an entire epistemic community, eventually resulting in a conceptual revolution. Such conceptual revolutions make pos- sible the radical revision of scientific theories whereby the scope of an extant theory is broadened and a new theoretical framework makes its appearance. The emerging theory is characterized by a certain degree of incommensurability when compared with the earlier one – a feature that may appear strange at first sight. But incommen- surability does not mean incompatibility and the apparently contrary features of the relation between the successive theories may be traced to the multi-layered structureof the conceptual space where concepts are correlated not by means of single links but by multiple ones, thereby generating multiple layers of correlation, among which some are retained and some created afresh in a conceptual restructuring. We conclude with the observation that creativity occurs on all scales. Analogous to correlations being set up across domains in the conceptual space and new domains being generated, processes with similar features can occur within the confines of a domain where a new layer of inferential links may be generated, connecting up sub- domains. In this context, insight can be looked upon as an instance of creativity within the confines of a domain of a relatively limited extent. (shrink)

Philosophers have predominantly regarded morality and aesthetics judgments as fundamentally different. However, whether this claim is empirically founded has remained unclear. In a novel task, we measured brain activity of participants judging the aesthetic beauty of artwork or the moral goodness of actions depicted. To control for the content of judgments, participants assessed the age of the artworks and the speed of depicted actions. Univariate analyses revealed whole-brain corrected, content-controlled common activation for aesthetics and morality judgments in frontopolar, dorsomedial and (...) ventrolateral prefrontal cortex. Temporoparietal cortex showed activation specific for morality judgments, occipital cortex for aesthetics judgments. Multivariate analyses revealed both common and distinct whole-brain corrected representations for morality and aesthetics judgments in temporoparietal and prefrontal regions. Overall, neural commonalities are more pronounced than predominant philosophical views would predict. They are compatible with minority accounts that stress commonalities between aesthetics and morality judgments, such as sentimentalism and a valuation framework. (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment (...) choices are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

This paper proposes a philosophically informed decision-making methodology, inspired by Aristotle, that encourages constructive discussions amongst employers and employees; is directed towards shared higher-level goals; is consistent with planning frameworks already in place in many businesses; can be amended over time without disruptive disputes; and accounts for the particularities of each industry, enterprise, workplace, and job. It seeks to establish a more fundamental basis for discussions about remote vs. in-person office work: specifically, the purpose and nature of (...) the work of those affected. If these matters can be decided, then subsequent discussions might be focused more upon the shared outcomes to which stakeholders are committed and less upon individual preferences and ‘hunches.’. (shrink)

It has been argued by disability advocates that supported decision-making must replace surrogate, or substituted, decision-making for people with cognitive disabilities. From a moral perspective surrogate decision-making it is said to be an indefensible form of paternalism. At the heart of this argument against surrogate decision-making is the belief that such paternalistic action expresses something fundamentally disrespectful about those upon whom it is imposed: that they are inferior, deficient or child-like in some (...) way. Contrary to this widespread belief, I will argue that surrogate decision-making sometimes expresses more respect for people with life-long, ‘severe’ or ‘profound’ cognitive disabilities than does the adoption of supported decision-making.. Specifically, I argue that in some cases supported decision-making can arguably express that people with severe or profound cognitive disabilities lack equal moral value. I also argue that supported decision-making for people with profound cognitive disabilities can arguably express that they lack complex and rich inner lives. If our aim is to ensure our behaviour and practices express respect for people with life-long ‘severe’ or ‘profound’ cognitive disabilities, then sometimes surrogate rather than supportive decision-making will be a better option. (shrink)

This article is about the information relevant to decision-making capacity in refusal of life-prolonging medical treatment cases. We examine the degree to which the phenomenology of the options available to the agent—what the relevant states of affairs will feel like for them—forms part of the capacity-relevant information in the law of England and Wales, and how this informational basis varies across adolescent and adult medical treatment cases. We identify an important doctrinal phenomenon. In the leading authorities, the courts (...) appear to count the first-personal phenomenology of the available options among the information that adolescents seeking to refuse life-prolonging treatment must understand and appreciate in order to possess capacity; adults are not held to this (higher) standard. We evaluate this differential treatment in light of philosophical work on transformative choice—decisions involving options whose sensory character, and effect on our values and preferences, are grasped only through experience itself. (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)

This book is concerned with helping you improve your approach to decision-making. The author examines judgement in a selection of managerial contexts and provides important understanding that can help you make better leadership decisions. The book also pinpoints the in-house politics of organisational decision-making. Drawing on the very latest research, it introduces practical techniques that show you how to analyse and develop your own decision-making style. It will help you to deliver sharp and insightful (...) analyses of your business and develop effective solutions. In addition, it presents simple checklists that will give you vital insights throughout the decision-making process. Students and practitioners of leadership, management, and allied fields will find this book useful in order to understand and implement useful methods. (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)

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)

Automated decision making for sentencing is the use of a software algorithm to analyse a convicted offender’s case and deliver a sentence. This chapter reviews the moral arguments for and against employing automated decision making for sentencing and finds that its use is in principle morally permissible. Specifically, it argues that well-designed automated decision making for sentencing will better approximate the just sentence than human sentencers. Moreover, it dismisses common concerns about transparency, privacy and (...) bias as unpersuasive or inapplicable. The chapter also notes that moral disagreement about theories of just sentencing are plausibly resolved by applying the principle of maximising expected moral choiceworthiness, and that automated decision making is better suited to the resulting ensemble model. Finally, the chapter considers the challenge posed by penal populism. The dispiriting conclusion is that although it is in theory morally desirable to use automated decision-making for criminal sentencing, it may well be the case that we ought not to try. (shrink)

Sometimes citizens disagree about political matters, but a decision must be made. We have two theoretical frameworks for resolving political disagreement. The first is the framework of social choice. In it, our goal is to treat parties to the dispute fairly, and there is no sense in which some are right and the others wrong. The second framework is that of collective decision-making. Here, we do believe that preferences are truth apt, and our moral consideration is owed (...) not to those who disagree but to the community that stands to benefit or suffer from the decision. In this chapter, I describe and explore these two frameworks. I conclude two things. First, analysis of real-world disagreement suggests that collective decision-making is the right way to model politics. In most, possibly even all, political disagreement, all parties believe (if implicitly) that there is an objective standard of correctness. Second, this matter is connected to the concept of pluralism. If pluralism is true, then collective decision-making cannot be applied to some political disagreements. More surprisingly, pluralism may rule out the applicability of social choice theory as well. (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)

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)

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)

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)

What process ought to guide decision making for pediatric patients? The prevailing view is that decision making should be informed and guided by the best interest of the child. A widely discussed structural model proposed by Buchanan and Brock focuses on parents as surrogate decision makers and examines best interests as guiding and/or intervention principles. Working from two recent articles by Ross on “constrained parental autonomy” in pediatric decision making (which is grounded in (...) the Buchanan and Brock model), I discuss (supportively) features of Ross’s effort visa-vis the best interest standard. I argue that any pediatric decision-making model that brackets or formally limits an engagement with the child patient assumes too much. Further, any model that under appreciates the place of parents and their autonomy, and the dynamic parent-child relationship, misses an opportunity to broaden the clinical encounter by considering questions of justice for the child (Rawls) and within a family (Ross). In this context, I focus on the child’s emerging and ongoing emotional and intellectual development and autonomy—their capabilities and identifying primary goods. (shrink)

This volume presents research that integrates decision making and creativity within the social contexts in which these processes occur. The volume is an essential addition to and expansion of recent approaches to decision making. Such approaches attempt to incorporate more of the psychological and socio-cultural context in which human decision making takes place. The authors come from different disciplines and also belong to a broad spectrum of research traditions. They present innovative chapters dealing with (...) both theoretical and empirical aspects of decision making in different personal and organizational contexts. All chapters are written from the perspective that human decision making is inherently social and more or less creative. The volume addresses fundamental questions about the nature of human decision making as it occurs in different social contexts. Thereby, it becomes essential reading for researchers in decision making and for advanced students in psychology, management science, informatics, and related disciplines. (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)

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)

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)

Kahneman's theory of two systems assumes that human decision making in Economy is based on two cognitive systems, one that is automatic, intuitive and mostly unconscious, and one that is reflexive, rational and fully conscious. The authors consider Kahneman’s approach incomplete and limited in accounting for the creativity of embodied agents grasping the opportunities afforded by physical and social environments. This limitation leads us to argue for the existence of a third system in decision making in (...) Economy, the creative intuition based on direct perception of affordances, addressing not only the dispositions and goals of agents but also the social and environmental responsibility of corporations and governments. The authors argue that the third decision-making system the authors propose implies a concept of intuition that is different from the type of association process discussed by Morewedge and Kahneman [2] and gives an example of the third system operation, the Bolsa Família in Brazil, and finding new options for the funding of similar programs. (shrink)

The application of artificial intelligence (AI) to judicial decision-making has already begun in many jurisdictions around the world. While AI seems to promise greater fairness, access to justice, and legal certainty, issues of discrimination and transparency have emerged and put liberal democratic principles under pressure, most notably in the context of bail decisions. Despite this, there has been no systematic analysis of the risks to liberal democratic values from implementing AI into judicial decision-making. This article sets (...) out to fill this void by identifying and engaging with challenges arising from artificial judicial decision-making, focusing on three pillars of liberal democracy, namely equal treatment of citizens, transparency, and judicial independence. Methodologically, the work takes a comparative perspective between human and artificial decision-making, using the former as a normative benchmark to evaluate the latter. -/- The chapter first argues that AI that would improve on equal treatment of citizens has already been developed, but not yet adopted. Second, while the lack of transparency in AI decision-making poses severe risks which ought to be addressed, AI can also increase the transparency of options and trade-offs that policy makers face when considering the consequences of artificial judicial decision-making. Such transparency of options offers tremendous benefits from a democratic perspective. Third, the overall shift of power from human intuition to advanced AI may threaten judicial independence, and with it the separation of powers. While improvements regarding discrimination and transparency are available or on the horizon, it remains unclear how judicial independence can be protected, especially with the potential development of advanced artificial judicial intelligence (AAJI). Working out the political and legal infrastructure to reap the fruits of artificial judicial intelligence in a safe and stable manner should become a priority of future research in this area. (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)

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.

In this chapter, it is argued that some animal shelters fulfill the conditions that make triage protocols necessary, namely, the operation with limited financial budgets, space, medical resources, and staff. It is suggested that requirements presented for triage in humans can be fruitfully applied to the context of animal shelters. The focus lies on the criteria of maximizing benefit, justice, medical criteria, life-span considerations, fair decision-making, patient will, re-evaluation of triage decisions and changes in the therapeutic goal, and (...) burden of triage and staff support. The establishment of triage protocols for shelters will make the decision-making process less arbitrary, fairer, and more transparent. Furthermore, it is argued that, in situations where disagreement persist among shelter staff, an external Ethics Board could be called in to help analyze and potentially resolve some of the remaining ethical issues. (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.

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)

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)

Psychopathy, which is characterized by a constellation of antisocial behavioral traits, may be subdivided on the basis of etiology: “primary” (low-anxious) psychopathy is viewed as a direct consequence of some core intrinsic deficit, whereas “secondary” (high-anxious) psychopathy is viewed as an indirect consequence of environmental factors or other psychopathology. Theories on the neurobiology of psychopathy have targeted dysfunction within ventromedial prefrontal cortex (vmPFC) as a putative mechanism, yet the relationship between vmPFC function and psychopathy subtype has not been fully explored. (...) In this study, we administered two laboratory decision-making tasks (the Ultimatum Game and the Dictator Game) to a group of prisoners (n=47) to determine whether the different subtypes of psychopathy (primary vs. secondary) are associated with characteristic patterns of economic decision-making, and furthermore, whether either subtype exhibits similar performance to patients with vmPFC lesions. Comparing primary psychopaths (n=6) to secondary psychopaths (n=6) and non-psychopaths (n=22), we found that primary psychopathy was associated with significantly lower acceptance rates of unfair Ultimatum offers and lower offer amounts in the Dictator Game. Moreover, primary psychopaths were quantitatively similar to vmPFC lesion patients in their response patterns. These results support the purported connection between psychopathy and vmPFC dysfunction, bolster the distinction between primary and secondary psychopathy, and demonstrate the utility of laboratory economic decision-making tests in differentiating clinical subgroups. (shrink)

This paper explores the defects in fuzzy (hyper) graphs (as complex (hyper) networks) and extends the fuzzy (hyper) graphs to fuzzy (quasi) superhypergraphs as a new concept.We have modeled the fuzzy superhypergraphs as complex superhypernetworks in order to make a relation between labeled objects in the form of details and generalities. Indeed, the structure of fuzzy (quasi) superhypergraphs collects groups of labeled objects and analyzes them in the form of the part to part of objects, the part of objects to (...) the whole group of objects, and the whole to the whole group of objects at the same time. We have investigated the properties of fuzzy (quasi) superhypergraphs based on any positive real number as valued fuzzy (quasi) superhypergraphs, considering the complement of valued fuzzy (quasi) superhypergraphs, the notation of isomorphism of valued fuzzy (quasi) superhypergraphs based on the permutations, and we have presented the isomorphic conditions of (self complemented) valued fuzzy (quasi) superhypergraphs. The concept of impact membership value of fuzzy (quasi) superhypergraphs is introduced in this study and it is applied in designing the real problem in the real world. Finally, the problem of business superhypernetworks is presented as an application of fuzzy valued quasi superhypergraphs in the real world. (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)

Research on human decision making is at the present time undergoing rapid changes. From previously being much focused on models and approaches with an origin in economy, much of the present day research finds its inspiration from disciplinary approaches concerned with incorporating more of the context that the decision making takes place in. This context includes psychological aspects of the decision maker and social-cultural aspects of the situation he or she acts in. All human (...) class='Hi'>decision making occurs in dynamically changing contexts. One factor contributing to this is that human beings or groups in many situations act as entrepreneurs trying to improve the situation for themselves or their organization. Given that this is the case, it is of increasing interest for both researchers and practitioners interested in the social aspects of decision making to consider the relation between creativity and decision making. (shrink)

What does it mean to respect autonomy and encourage meaningful consent to treatment in the case of patients who have dementia or are otherwise incompetent? This question has been thrown into sharp relief by the Law Lords' decision in R.v Bournewood Community and Mental Health NHS Trust, ex parte L.

In this paper, multi attribute decision making problem based on grey relational analysis in neutrosophic cubic set environment is investigated. In the decision making situation, the attribute weights are considered as single valued neutrosophic sets. The neutrosophic weights are converted into crisp weights. Both positve and negative GRA coefficients, and weighted GRA coefficients are determined. Hamming distances for weighted GRA coefficients and standard (ideal) GRA coefficients are determined. The relative closeness coefficients are derived in order to (...) rank the alternatives. The relative closeness coefficients are designed in ascending order. Finally, a numerical example is solved to demonstrate the applicability of the proposed approach. (shrink)