Berger (forthcoming) states that moral intimacy is important in applying the best interests standard. But what he calls moral intimacy requires that someone has overcome epistemic burdens needed to represent the patient. We argue elsewhere that good surrogate decision-making is first and foremost a matter of overcoming epistemic burdens, or those obstacles that stand in the way of a surrogate decision-maker knowing what a patient wants and how to satisfy those preferences. Berger’s notion of moral intimacy depends on (...) epistemic intimacy: the fact that a surrogate's epistemic burdens with respect to the best interests of the incapacitated patient have been adequately surmounted, plus some other feature. Thus, where a particular patient-surrogate relationship fails to be morally intimate, what is lacking is either epistemic intimacy or this second feature. Furthermore, Berger uses the notion of moral intimacy as an explanans for the application of the best interests standard. We argue that the notions of epistemic intimacy and epistemic burdens not only help to explain the notion of moral intimacy, but also better explain the application of the best interests standard. Given the role of epistemic burdens and the epistemic intimacy that overcoming them enables, bioethicists and physicians should consider a surrogate’s epistemic standing relative to the patient’s best interests before pronouncing on the former’s ethical probity. (shrink)

We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will (...) either be neglected altogether or deeply discounted in the surrogate’s incentive structure. We establish this claim by arguing that the relation between epistemic burdens and incentives in decision-making is a general feature of surrogate decision-making. After establishing the claim, we draw out some of the implications for surrogate decision-making in medicine and offer philosophical and psychological explanations of the phenomenon. (shrink)

The Substituted Judgment Standard for surrogate decision-making dictates that a surrogate, when making medical decisions on behalf of an incapacitated patient, ought to make the decision that the patient would have made if the patient had decisional capacity. Despite its intuitive appeal, however, SJS has been the target of a variety of criticisms. Most objections to SJS appeal to epistemic difficulties involved in determining what a patient would have decided in a given case. In this article, I (...) offer an alternative standard for surrogate decision-making that avoids these difficulties. I then offer an account of its theoretical underpinnings which shows that it preserves the central moral justification for SJS, namely, respect for patient autonomy. (shrink)

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the explanation (...) of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (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)

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)

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)

Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients (...) by appealing to the values they had in the past, either the values expressed in an advance directive or the values recalled by a surrogate. There are two things I wish to add to the discussion. My first point is somewhat critical, for although I agree with his general conclusion about how, ideally, such decisions should be approached, I remain skeptical about whether his conclusion offers decisionmakers real practical help. The problem with these cases is that the evidence we have about the nature of the patient’s current interests is minimal or nonexistent. However—and this is important—Graham’s conclusion will be extremely relevant if in the future, our ability to communicate with such patients improves, as I hope it will. This leads to my second point. Graham’s conclusion illustrates a more general problem with our standard framework for decisionmaking for previously competent patients, a problem that has not been adequately recognized. So, in what follows, I explain the problem I see and offer some brief thoughts about solutions. (shrink)

Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection (...) were performed by two or more independent reviewers for each record. -/- Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. -/- Conclusions: Public views on the authority of the family in organ donation decision-making require further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation. (shrink)

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

Typical philosophical discussions of physician-assisted death have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad on terminally (...) ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad. (shrink)

Philosophers concerned with what would be good for a person sometimes consider a person’s past desires. Indeed, some theorists have argued by appeal to past desires that it is in the best interests of certain dementia patients to die. I reject this conclusion. I consider three different ways one might appeal to a person’s past desires in arguing for conclusions about the good of such patients, finding flaws with each. Of the views I reject, the most interesting one is the (...) view that prudential value is, at least partly, concerned with the shape of a life as a whole. (shrink)

Decisional capacity evaluations (DCEs) occur in clinical settings where it is unclear whether a consumer of medical services has the capacity to make an informed decision about the relevant medical options. DCEs are localized interventions, not the global loss of competence, that assign a surrogate decision maker to make the decision on behalf of the medical consumer. We maintain that one important necessary condition for a DCE to be morally justified, in cases of medical necessity, is that the health (...) care consumer under evaluation is incapable of expressing a preference for a certain outcome. (shrink)

Feminist bioethicists of a variety of persuasions discuss the 2013 case of Marlise Munoz, a pregnant woman whose medical care was in dispute after she became brain dead.

In this bioethical poem, the narrator reflects on the experience of their father's degenerative illness, and decisions that must be made about whether to continue life support technologies such as ventilation and nutrition/hydration. What is it that is owed to family and patient at the end of life? What must no one who loves anyone ever do to the one they love?

Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person’s donation wishes. Second, families (...) can authorize organ procurement in the absence of deceased’s preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world’s consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement. (shrink)

We apply the analysis that we have developed over the course of several publications on the significance of ignorance for decision-making, especially in surrogate (and, thus, in political) contexts, to political decision-making, such as it has been, during the COVID-19 pandemic (see Scheall 2019; Crutchfield and Scheall 2019; Scheall and Crutchfield 2020; Scheall 2020). Policy responses to the coronavirus constitute a case study of the problem of policymaker ignorance. We argue that political responses to the virus cannot be explained (...) by assuming that the interests of policymakers were at loggerheads with those of their constituents at the beginning of the crisis. In order to explain the responses of policymakers, it is necessary to recognize the effects of relevant ignorance on their incentives to pursue different policy objectives. We discuss the knowledge that policymakers required at the start of the pandemic in order to deliberately realize the goal of limiting overall human suffering and the spontaneous forces that could have facilitated the realization of this goal. The problem of policymaker ignorance implies that policymakers have not earnestly pursued the goal of limiting overall suffering due to the novel coronavirus, but have repeatedly resorted to the pursuit of relatively less epistemically burdensome goals. The problem of policymaker ignorance explains why policymakers have focused primarily on limiting one kind of suffering – physical suffering due to the virus – and have mostly ignored related kinds of suffering, i.e., the economic, sociological, psychological, and physical suffering caused by policies to limit physical suffering from the virus. The problem of policymaker ignorance also helps to explain why policymakers relied on the relatively blunt instrument of economic lockdown rather than more focused protection policies, and why they continue to resort to lockdowns, despite the emerging scientific evidence of their ineffectiveness at mitigating physical suffering due to the virus. (shrink)

In biomedical measurement, biomarkers are used to achieve reliable prediction of, and useful causal information about patient outcomes while minimizing complexity of measurement, resources, and invasiveness. A biomarker is an assayable metric that discloses the status of a biological process of interest, be it normative, pathophysiological, or in response to intervention. The greatest utility from biomarkers comes from their ability to help clinicians (and researchers) make and evaluate clinical decisions. In this paper we discuss a specific methodological use of (...) clinical biomarkers in pharmacological measurement: Some biomarkers, called ‘surrogate markers’, are used to substitute for a clinically meaningful endpoint corresponding to events and their penultimate risk factors. We confront the reliability of clinical biomarkers that are used to gather information about clinically meaningful endpoints. Our aim is to present a systematic methodology for assessing the reliability of multiple surrogate markers (and biomarkers in general). To do this we draw upon the robustness analysis literature in the philosophy of science and the empirical use of clinical biomarkers. After introducing robustness analysis we present two problems with biomarkers in relation to reliability. Next, we propose an intervention-based robustness methodology for organizing the reliability of biomarkers in general. We propose three relevant conditions for a robust methodology for biomarkers: (R1) Intervention-based demonstration of partial independence of modes: In biomarkers partial independence can be demonstrated through exogenous interventions that modify a process some number of “steps” removed from each of the markers. (R2) Comparison of diverging and converging results across biomarkers: By systematically comparing partially-independent biomarkers we can track under what conditions markers fail to converge in results, and under which conditions they successfully converge. (R3) Information within the context of theory: Through a systematic cross-comparison of the markers we can make causal conclusions as well as eliminate competing theories. We apply our robust methodology to currently developing Alzheimer’s research to show its usefulness for making causal conclusions. (shrink)

In modern hospitals in developed countries, deaths are determined usually after a prearranged schedule of resuscitative efforts. By default, death is diagnosed and determined after “full code” or after the failure of intensive resuscitation. In end-of-life contexts, however, various degrees of less-than-full resuscitation and sometimes no resuscitation are allowed after the consent and shared decision-making of the patient and/or surrogates. The determination of brain death is a unique exception in these contexts because such an end-of-life care plan is usually not (...) offered until after brain death is declared. This essay analyzes and critiques three arguments for denying the family and/or surrogate a chance to consent to or forego the diagnostic protocol of brain death and choose an alternative end-of-life plan. First, opponents of consent for the determination of brain death argue that presenting it as a selectable end-of-life plan undermines the integrity of death determination. The second argument is that it is inconsistent to allow foregoing the determination of brain death when the determination of circulatory death is non-negotiable. The third argument is that allowing the patient/surrogate to forego the determination of brain death would jeopardize the fair and appropriate utilization of intensive care resources and potentially reduce organ donor pools. After closer conceptual examinations of these three arguments, this essay concludes that these arguments are conceptually and morally problematic. It defends an alternative patient-centered end-of-life care plan based on consent and shared decision-making. (shrink)

This paper accomplishes two tasks. First, I examine in detail Edmund Husserl’s earliest philosophy of surrogates, as it is found in his 1890 “On the Logic of Signs ”. I analyze his psychological and logical investigations of surrogates, where the former is concerned with explaining how these signs function and the latter with how they do so reliably. His differentiation of surrogates on the basis of their genetic origins and degrees of necessity is discussed. Second, the historical importance of this (...) text is disclosed by showing how Semiotic serves as both the inspiration for, and the foil to, Husserl’s 1901 First Logical Investigation. Husserl not only adopts the idea that linguistic signs can function via association, but also maintains that such signs can motivate me to execute one of two experiences. The key difference between the texts is that Husserl abandons his theory of surrogates in 1901, instead holding that I can experience absent objects by means of empty intentions. The reasons why Husserl found it necessary to transform this tenet of his philosophy are discussed at length. (shrink)

Decision theory has at its core a set of mathematical theorems that connect rational preferences to functions with certain structural properties. The components of these theorems, as well as their bearing on questions surrounding rationality, can be interpreted in a variety of ways. Philosophy’s current interest in decision theory represents a convergence of two very different lines of thought, one concerned with the question of how one ought to act, and the other concerned with the question of what action consists (...) in and what it reveals about the actor’s mental states. As a result, the theory has come to have two different uses in philosophy, which we might call the normative use and the interpretive use. It also has a related use that is largely within the domain of psychology, the descriptive use. This essay examines the historical development of decision theory and its uses; the relationship between the norm of decision theory and the notion of rationality; and the interdependence of the uses of decision theory. (shrink)

This article challenges a widespread assumption, arguing that Wittgenstein and the Austrian composer Arnold Schoenberg had little in common beyond their shared cultural heritage, overlapping social circles in fin-de-ciecle Vienna. The article explores Wittgenstein's aesthetic inclinations and the intellectual and philosophical influences that may have reinforced them. The article culminates in an attempt to form a Wittgensteinian response to Schoenberg's dodecaphonic language and to answer the question as to why Wittgenstein and Schoenberg arrived at very different ideas about contemporary music (...) and the music of the future. (shrink)

The classic formulation of causal decision theory (CDT) appeals to counterfactuals. It says that you should aim to choose an option that would have a good outcome, were you to choose it. However, this version of CDT faces trouble if the laws of nature are deterministic. After all, the standard theory of counterfactuals says that, if the laws are deterministic, then if anything—including the choice you make—were different in the present, either the laws would be violated or the distant past (...) would be changed. And as several authors have shown, it's easy to transform this upshot of the standard theory of counterfactuals into full-blown counterexamples to CDT. In response to these counterexamples, I argue here that the problem lies, not so much with CDT's guiding idea—that it's the expected causal consequences of your actions that matter for rational decision-making—but with the fact that the classic formulation of CDT doesn't pay sufficient attention to the context-sensitivity of counterfactuals. I develop a contextualist version of CDT which better accounts for this context-sensitivity. And I show that my theory avoids the problems faced by the classic formulation of CDT in determinstic worlds. (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)

The dispute in philosophical decision theory between causalists and evidentialists remains unsettled. Many are attracted to the causal view’s endorsement of a species of dominance reasoning, and to the intuitive verdicts it gets on a range of cases with the structure of the infamous Newcomb’s Problem. But it also faces a rising wave of purported counterexamples and theoretical challenges. In this paper I will describe a novel decision theory which saves what is appealing about the causal view while avoiding its (...) most worrying objections, and which promises to generalize to solve a set of related problems in other normative domains. (shrink)

What does it mean to act politically? This paper contributes an answer to this question by looking at the role that necessity plays in the political theory of Carl Schmitt. It argues that necessity, whether in the form of existential danger or absolute values, does not affect the sovereign decision, which must be free from normative determinations if it is to be a decision in Schmitt’s sense at all. The paper then provides a reading of Schmitt in line with Weber’s (...) ethics of responsibility, according to which the political actor decides not arbitrarily and irresponsibly, but actively assumes responsibility for the decisions he takes. (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)

Evidential decision theory (EDT) says that the choiceworthiness of an option depends on its evidential connections to possible outcomes. Causal decision theory (CDT) holds that it depends on your beliefs about its causal connections. While Newcomb cases support CDT, Arif Ahmed has described examples that support EDT. A new account is needed to get all cases right. I argue that an option A's choiceworthiness is determined by the probability that a good outcome ensues at possible A‐worlds that match actuality in (...) the facts causally unaffected by your decision (the “unaffected facts”). Moreover, you should evaluate A on the assumption that A is compossible with the unaffected facts. This view entails that you should use EDT when evaluating A on the assumption that the unaffected facts determine your action, but use CDT when assessing A on the opposite assumption. A's choiceworthiness equals a weighted average of these conditional assessments. The weights are determined by your beliefs about whether the unaffected fact determine your action. This account gets both Newcomb and Ahmed cases right. According to an influential view, whether you take the unaffected facts to determine your action can make a difference to whether you can regard yourself as free and the action as being under your control. While my account is neutral on this issue, it entails that whether you take the unaffected facts to determine your action is important in a different way: it matters to whether you should follow EDT or CDT. (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)

Orthodox decision theory gives no advice to agents who hold two goods to be incommensurate in value because such agents will have incomplete preferences. According to standard treatments, rationality requires complete preferences, so such agents are irrational. Experience shows, however, that incomplete preferences are ubiquitous in ordinary life. In this paper, we aim to do two things: (1) show that there is a good case for revising decision theory so as to allow it to apply non-vacuously to agents with incomplete (...) preferences, and (2) to identify one substantive criterion that any such non-standard decision theory must obey. Our criterion, Competitiveness, is a weaker version of a dominance principle. Despite its modesty, Competitiveness is incompatible with prospectism, a recently developed decision theory for agents with incomplete preferences. We spend the final part of the paper showing why Competitiveness should be retained, and prospectism rejected. (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)

I defend counterfactual decision theory, which says that you should evaluate an action in terms of which outcomes would likely obtain were you to perform it. Counterfactual decision theory has traditionally been subsumed under causal decision theory as a particular formulation of the latter. This is a mistake. Counterfactual decision theory is importantly different from, and superior to, causal decision theory, properly so called. Causation and counterfactuals come apart in three kinds of cases. In cases of overdetermination, an action can (...) cause a good outcome without the latter counterfactually depending on the former. In cases of constitution, an action can constitute a good outcome rather than causing it. And in cases of determinism, either the laws or the past counterfactually depend on your action, even though your action cannot cause the laws or the past to be different. In each of these cases, it is counterfactual decision theory which gives the right verdict, and for the right reasons. (shrink)

The problem of the man who met death in Damascus appeared in the infancy of the theory of rational choice known as causal decision theory. A straightforward, unadorned version of causal decision theory is presented here and applied, along with Brian Skyrms’ deliberation dynamics, to Death in Damascus and similar problems. Decision instability is a fascinating topic, but not a source of difficulty for causal decision theory. Andy Egan’s purported counterexample to causal decision theory, Murder Lesion, is considered; a simple (...) response shows how Murder Lesion and similar examples fail to be counterexamples, and clarifies the use of the unadorned theory in problems of decision instability. I compare unadorned causal decision theory to previous treatments by Frank Arntzenius and by Jim Joyce, and recommend a well-founded heuristic that all three accounts can endorse. Whatever course deliberation takes, causal decision theory is consistently a good guide to rational action. (shrink)

This article shows how the MISS account of models—as isolations and surrogate systems—accommodates and elaborates Sugden’s account of models as credible worlds and Hausman’s account of models as explorations. Theoretical models typically isolate by means of idealization, and they are representatives of some target system, which prompts issues of resemblance between the two to arise. Models as representations are constrained both ontologically (by their targets) and pragmatically (by the purposes and audiences of the modeller), and these relations are coordinated (...) by a model commentary. Surrogate models are often about single mechanisms. They are distinguishable from substitute models, which are examined without any concern about their connections with the target. Models as credible worlds are surrogate models that are believed to provide access to their targets on account of their credibility (of which a few senses are distinguished). (shrink)

A de minimis risk is defined as a risk that is so small that it may be legitimately ignored when making a decision. While ignoring small risks is common in our day-to-day decision making, attempts to introduce the notion of a de minimis risk into the framework of decision theory have run up against a series of well-known difficulties. In this paper, I will develop an enriched decision theoretic framework that is capable of overcoming two major obstacles to the modelling (...) of de minimis risk. The key move is to introduce, into decision theory, a non-probabilistic conception of risk known as normic risk. (shrink)

My topic is how to make decisions when you possess foreknowledge of the consequences of your choice. Many have thought that these kinds of decisions pose a distinctive and novel problem for causal decision theory (CDT). My thesis is that foreknowledge poses no new problems for CDT. Some of the purported problems are not problems. Others are problems, but they are not problems for CDT. Rather, they are problems for our theories of subjunctive supposition. Others are problems, but (...) they are not new problems. They are old problems transposed into a new key. Nonetheless, decisions made with foreknowledge illustrate important lessons about the instrumental value of our choices. Once we've appreciated these lessons, we are left with a version of CDT which faces no novel threats from foreknowledge. (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)

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)

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 role of causation and counterfactuals in causal decision theory is vexed and disputed. Recently, Brian Hedden (2023) argues that we should abandon causal decision theory in favour of an alternative: counterfactual decision theory. I argue that, pace Hedden, counterfactual decision theory is not a competitor to, but rather a version of, causal decision theory – the most popular version by far. I provide textual evidence that the founding fathers of causal decision theory (Stalnaker, Gibbard, Harper, Lewis, Skyrms, Sobel, and (...) Joyce) all endorse counterfactual decision theories. I additionally discuss why these theories came to be called ‘causal’, rather than ‘counterfactual’. And I argue that, properly understood, causal decision theory escapes Hedden's objections. (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)

Epistemic decision theory (EDT) employs the mathematical tools of rational choice theory to justify epistemic norms, including probabilism, conditionalization, and the Principal Principle, among others. Practitioners of EDT endorse two theses: (1) epistemic value is distinct from subjective preference, and (2) belief and epistemic value can be numerically quantified. We argue the first thesis, which we call epistemic puritanism, undermines the second.

This paper is about two requirements on wish reports whose interaction motivates a novel semantics for these ascriptions. The first requirement concerns the ambiguities that arise when determiner phrases, such as definite descriptions, interact with ‘wish’. More specifically, several theorists have recently argued that attitude ascriptions featuring counterfactual attitude verbs license interpretations on which the determiner phrase is interpreted relative to the subject’s beliefs. The second requirement involves the fact that desire reports in general require decision-theoretic notions for their analysis. (...) The current study is motivated by the fact that no existing account captures both of these aspects of wishing. I develop a semantics for wish reports that makes available belief-relative readings but also allows decision-theoretic notions to play a role in shaping the truth conditions of these ascriptions. The general idea is that we can analyze wishing in terms of a two-dimensional notion of expected utility. (shrink)

The essay presents a novel counterexample to Causal Decision Theory (CDT). Its interest is that it generates a case in which CDT violates the very principles that motivated it in the first place. The essay argues that the objection applies to all extant formulations of CDT and that the only way out for that theory is a modification of it that entails incompatibilism. The essay invites the reader to find this consequence of CDT a reason to reject it.

Innovative research on decision making under ‘deep uncertainty’ is underway in applied fields such as engineering and operational research, largely outside the view of normative theorists grounded in decision theory. Applied methods and tools for decision support under deep uncertainty go beyond standard decision theory in the attention that they give to the structuring of decisions. Decision structuring is an important part of a broader philosophy of managing uncertainty in decision making, and normative decision theorists can both learn from, (...) and contribute to, the growing deep uncertainty decision support literature. (shrink)

I consider Glimcher's claim to have given an account of mental functioning that is at once neurological and decision-theoretical. I am skeptical, but remark on some good ideas of Glimcher's.

It is often argued that future-directed decisions are effective at shaping our future conduct because they give rise, at the time of action, to a decisive reason to act as originally decided. In this paper, I argue that standard accounts of decision-based reasons are unsatisfactory. For they focus either on tie-breaking scenarios or cases of self-directed distal manipulation. I argue that future-directed decisions are better understood as tools for the non-manipulative, intrapersonal division of deliberative labor over time. A (...) future-directed decision to ϕ gives rise to a defeasible exclusionary reason to ϕ. This reason is grounded on the default authority that is normally granted to one’s prior self as an “expert” deliberator. I argue that this kind of exclusionary reason is the only one that can account for the effectiveness of future-directed decisions at shaping our diachronic agency without violating our autonomy over time. (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)