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)

Thesis --University of Stellenbosch, 2004 Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine, accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health care (...) professional. In addition to medical skills, the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. S Afr Med J 2008; 98: 284-286. (shrink)

Suppose that we think it important that people have the chance to enjoy autonomous lives. An obvious corollary of this thought is that people should, if they want it, have control over the time and manner of their deaths, either ending their own lives, or by securing the help of others in doing so. So, generally, and even if we overall think that the practice should not be legalized on other grounds, it looks like common sense to think that considerations (...) of autonomy tell at least somewhat in favour of legalizing at least some acts of suicide and voluntary euthanasia. In this paper, I argue that, in fact, when we scrutinize the reasons for most end of life decisions, it turns out that they are seriously problematic from the point of view of autonomy. Full autonomy requires that we are responsible for the consequences of our decisions, and responsibility is precluded by non-voluntariness, which is to say decisions made because there are no acceptable alternatives. Since most end of life decisions are made for precisely this reason, it looks as though most such decisions are non-voluntary, and therefore undermine our autonomy: a discomforting and paradoxical claim. I argue that we should respond by taking the paradox to illuminate the context required by an autonomy-respecting framework for legalizing assisted suicide and euthanasia. People should have a legal right to a reasonable choice about when and how to die. However, this must go hand in hand with institutions that ensure, as far as possible, that such choices are made against a background which ensures, as far as possible, that people choose death clear-sightedly and not because nothing else is acceptable. (shrink)

Disorders of consciousness include coma, the vegetative state and the minimally conscious state. Such patients are often regarded as unconscious. This has consequences for end of life decisions for these patients: it is much easier to justify withdrawing life support for unconscious than conscious patients. Recent brain imaging research has however suggested that some patients may in fact be conscious.

Patient autonomy has a critical role in making decisions in medical practice and it is accepted by international conventions on health care and various national medical codes. However, pertaining to terminally ill patients, this right becomes very problematic in regards to end of life decisions. Utilitarian ethicists motivated by materialistic worldview and individualism have made patient autonomy based arguments for the permissibility of active euthanasia. An appraisal of pro-euthanasia arguments that include the best interest, golden rule, and autonomy (...) is made in this paper. The best interest and golden rule arguments are based on subjective moral judgment thus failing the universalization test. The argument from autonomy is unconvincing because of the confounded autonomy of the terminally ill patients. (shrink)

The conditions of transport and slaughter at the end of their lives are a major challenge to the welfare of agricultural animals. • End-of-life experiences should be of a greater ethical concern than others of similar intensity and duration, due to their position in the animal’s life. • End-of-life welfare can have both internal importance to the animals and external ethical importance to human decision-makers. • We should pay extra care to ensure that the conditions during (...) transport and slaughter are as positive as possible. (shrink)

To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of concepts widely (...) disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (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)

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.

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple (...) reasonable models” problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (shrink)

In Almost Over: Aging, Dying, Dead, Frances Kamm seeks to make sense of people’s widely variant choices about which lives they would choose to continue living. She does this by defending the Prudential Prerogative, which, in analogy to the Moral Prerogative, holds that in a fairly wide range of conditions we are under no intrapersonal rational obligation to choose either to die or to live on. I argue against Kamm's case for the Prudential Prerogative in favor of Life Holism, (...) the view that you ought to live the life that would be best for you as an individual when each potential life is considered as a whole. I argue that the features of the Moral Prerogative that make it an attractive principle do not transfer to the Prudential Prerogative, and that Life Holism can better account for the perspectival and non-summative features of the normative phenomena Kamm wants to capture while retaining a tight connection between reasons and goodness. (shrink)

What question are decision theorists trying to answer, and why is it worth trying to answer it? A lot of philosophers talk as if the aim of decision theory is to describe how we should make decisions, and the reason to do this is to help us make better decisions. I disagree on both fronts. The aim of the decision theory is to describe how a certain kind of idealised decider does in fact decide. And the reason (...) to do this is that this idealisation, like many other idealisations, helps generate explanations of real-world behaviour. We shouldn't do what these ideal deciders do, or try to be more like them, because a lot of what they do only makes sense because of the differences between us and them. Still, sometimes those differences are small enough that they can be ignored in explanations, and that's when decision theory is useful. (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)

In Humanity’s End: Why We Should Reject Radical Enhancement, Nicholas Agar presents a novel argument against the prospect of radical life-extension. Agar’s argument hinges on the claim that extended lifespans will result in people’s lives being dominated by the fear of death. Here we examine this claim and the surrounding issues in Agar’s discussion. We argue, firstly, that Agar’s view rests on empirically dubious assumptions about human rationality and attitudes to risk, and secondly, that even if those assumptions are (...) granted, the fears that Agar adverts to are unlikely to dominate people’s lives if and when radical life-extension is made possible. Further, we claim that the structure of the decision-making process around life-extension is unlikely to be the way that it would have to be in order for Agar’s claims about fear of death to make sense. Finally, we argue that Agar is implicitly committed to a narrow conception of human value. In response, we suggest that the pursuit of life-extension can itself be seen as an expression of certain important aspects of our distinctively human nature. (shrink)

End-of-life care has a number of characteristics that make economic evaluation particularly challenging. These include proximity to death, the improbability of survival gain, individuals’ changing priorities, declining cognition and effects on close persons. In view of these particularities of end-of-life care, some researchers have determined that current ‘extra-welfarist’ approaches to defining do not adequately reflect well-being. As a result, suggestions are being made that would see the QALY approach either replaced or subject to significant redefinition. The purported goal (...) of adopting alternative evaluation approaches is to extend the evaluative space ‘beyond’. The purpose of this chapter is to guide the definition of what should be included in the evaluative space in end-of-life care. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments and (...) biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

The article addresses the problem of making life decisions by people during the period of late adolescence; describes the specifics of the influence of various factors, in particular, the sense of life orientations, life position, impulsivity; the questions of the influence of fear on the process of making life decisions by young people; and the influence of various types of fears on this process. -/- The results of the research show that the influence of (...) fears on the process of making life decisions during the late adolescence is largely determined by characteristics of this age period, such as the formation of identity and the affirmation of one’s own self in the society. Thus, the most influential types of fears during this period are sociophobia, which consists of fear of social opinions and fear of social interactions; and fortunophobia (fear of fate). Sociophobia has such a powerful influence because young people go through the process of separation from their parents and joining society as separate individuals, and therefore the society’s opinion about them as an identity becomes very important to them. Fortunophobia is essentially the fear of the unknown and unavoidable fate, which is an inseparable part of making any life decision, especially in such a young age when people are only making their first crucial life decisions. According to the conducted research, meaningfulness of life has a reverse effect on the impact of fears on making life decisions, which means that with a greater meaningfulness of the individual’s life, the impact of fears is reduced. At the same time, impulsiveness has a direct effect, i.e. the more impulsive an individual is, the more influence fear has on their making life decisions. Life position of “Me + World –” is the least influenced by fears during the process of making life decisions. Also, the influence of fears appears to be more of a motivating factor rather than constraining, which forces young people to act and change their lives. (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)

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?

Is the sense of smell a source of aesthetic perception? Traditional philosophical aesthetics has centered on vision and audition but eliminated smell for its subjective and inherently affective character. This article dismantles the myth that olfaction is an unsophisticated sense. It makes a case for olfactory aesthetics by integrating recent insights in neuroscience with traditional expertise about flavor and fragrance assessment in perfumery and wine tasting. My analysis concerns the importance of observational refinement in aesthetic experience. I argue that the (...) active engagement with stimulus features in perceptual processing shapes the phenomenological content, so much so that the perceptual structure of trained smelling varies significantly from naive smelling. In a second step, I interpret the processes that determine such perceptual refinement in the context of neural decision-making processes, and I end with a positive outlook on how research in neuroscience can be used to benefit philosophical aesthetics. (shrink)

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)

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)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles (...) help to understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (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)

Some economists, notably Gary Becker, claim that economic analysis is applicable to any decision, ethical or otherwise. Ethical principles within Objectivist Ethics are based on long-range success— life being the measure of success. This paper examines these different approaches to decision-making. Decision theory and Rand's Benevolent Universe Premise form the basis for the analysis.

This article explores the use of model organisms in studying the cognitive phenomenon of decision-making. Drawing on the framework of biological control to develop a skeletal conception of decision-making, we show that two core features of decision-making mechanisms can be identified by studying model organisms, such as E. coli, jellyfish, C. elegans, lamprey, and so on. First, decision mechanisms are distributed and heterarchically structured. Second, they depend heavily on chemical information processing, such as (...) that involving neuromodulators. We end by discussing the implications for studying distinctively human decision-making. (shrink)

An emotional deficit in individuals with psychopathy has been regarded as a potential factor in the disinhibition of selfish behaviors, which can be an impediment to a successful life in human society. However, recent studies in the field of economics have made clear that emotional function is associated with irrational decision-making. In the present study, to test whether psychopathy may have a positive aspect in a social setting, we examined the decision-making of college students with (...) high and low tendencies for psychopathy in the ultimatum game, which illustrates conflict between fairness and economic utility. We also investigated electrodermal responses to fair and unfair offers for each group. Compared to low psychopathic controls, individuals with a high tendency toward psychopathy more often choose economic utility by accepting unfair offers. Whereas controls more often exhibited an electrodermal response to unfair offers compared to fair offers, high psychopathic individuals did not show a similar difference between the types of offer. The results suggest that the affective deficit of psychopathy might be associated with insensitivity to unfairness and may contribute to a rational decision to accept unfair offers. Hence, psychopathy can be rational in some social situations. (shrink)

Forms of Artificial Intelligence (AI) are already being deployed into clinical settings and research into its future healthcare uses is accelerating. Despite this trajectory, more research is needed regarding the impacts on patients of increasing AI decision making. In particular, the impersonal nature of AI means that its deployment in highly sensitive contexts-of-use, such as in healthcare, raises issues associated with patients’ perceptions of (un) dignified treatment. We explore this issue through an experimental vignette study comparing individuals’ perceptions (...) of being treated in a dignified and respectful way in various healthcare decision contexts. Participants were subject to a 2 (human or AI decision maker) x 2 (positive or negative decision outcome) x 2 (diagnostic or resource allocation healthcare scenario) factorial design. We found evidence of a “human bias” (i.e., a preference for human over AI decision makers) and an “outcome bias” (i.e., a preference for positive over negative outcomes). However, we found that for perceptions of respectful and dignified interpersonal treatment, it matters more who makes the decisions in diagnostic cases and it matters more what the outcomes are for resource allocation cases. We also found that humans were consistently viewed as appropriate decision makers and AI was viewed as dehumanizing, and that participants perceived they were treated better when subject to diagnostic as opposed to resource allocation decisions. Thematic coding of open-ended text responses supported these results. We also outline the theoretical and practical implications of these findings. (shrink)

When many people think of bioethics, they think of gripping issues in clinical medicine such as end-of-life decision-making, controversies in biomedical research such as that over work with stem cells, or issues in allocating scarce health-care resources such as organs or money. The term “bioethics” may evoke images of moral controversies being discussed on news programs and talk shows. But this “controversy of the day” focus often treats ethical issues in medicine superficially, for it addresses them as (...) if they could be examined and discussed in isolation from the context in which they are situated. Such a focus on the latest controversies fails to take into account that medicine is a social institution and that the controversies in bioethics often reflect deeper social and moral issues that transcend the boundaries of medicine and ethics. If one moves beyond the issue-of-the-day approach to bioethics, one can see that the field must address these deeper issues. (shrink)

The authors developed this textbook in response to an increasing interest in ethics, and a growing number of courses on this topic that are now being offered in educational leadership programs. It is designed to fill a gap in instructional materials for teaching the ethics component of the knowledge base that has been established for the profession. The text has several purposes: First, it demonstrates the application of different ethical paradigms (the ethics of justice, care, critique, and the profession) through (...) discussion and analysis of real-life moral dilemmas that educational leaders face in their schools and communities. Second, it addresses some of the practical, pedagogical, and curricular issues related to the teaching of ethics for educational leaders. Third, it emphasizes the importance of ethics instruction from a variety of theoretical approaches. Finally, it provides a process that instructors might follow to develop their own ethics unit or course. * Part I provides an overview of why ethics is so important, especially for today's educational leaders, and describes a multiparadigm approach essential to practitioners as they grapple with ethical dilemmas. * Part II deals with the dilemmas themselves. Ethical dilemmas written by the authors' graduate students bring readers face-to-face with the kinds of dilemmas faced by practicing administrators in urban, suburban, and rural settings in an era full of complexities and contradictions. * Part III focuses on pedagogy and provides teaching notes for the instructor. The authors discuss the importance of self-reflection on the part of both instructors and students, and model how they thought through their own personal and professional ethical codes as well as reflected upon the critical incidents in their lives that shaped their teaching and frequently determined what they privileged in class. (shrink)

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

Entry on "Authenticity" for the fourth edition of the Encyclopedia of Bioethics, edited by Bruce Jennings. Discusses the concept in the context of end-of-life decision-making, human enhancement, and the treatment of mental disorder.

Bipolar neutrosophic sets are the extension of neutrosophic sets and are based on the idea of positive and negative preferences of information. Projection measure is a useful apparatus for modelling real life decision making problems. In the paper, we define projection, bidirectional projection and hybrid projection measures between bipolar neutrosophic sets. Three new methods based on the proposed projection measures are developed for solving multi-attribute decision making problems. In the solution process, the ratings of performance (...) values of the alternatives with respect to the attributes are expressed in terms of bipolar neutrosophic values. We calculate projection, bidirectional projection, and hybrid projection measures between each alternative and ideal alternative with bipolar neutrosophic information. All the alternatives are ranked to identify the best alternative. Finally, a numerical example is provided to demonstrate the applicability and effectiveness of the developed methods. Comparison analysis with the existing methods in the literature in bipolar neutrosophic environment is also performed. (shrink)

When it comes to online fashion, this research focused on the interaction between three factors: preferences for online fashion goods, consumer buying choices for online fashion products, and brand image. A descriptive correlational approach was used. A total of 184 sampled active online purchasers of fashion items from a population of 350 online buyers in Thailand participated in the research. The study was carried out with the use of tools that had been adopted. Descriptive data showed that respondents had a (...) high preference for online marketing, a positive attitude towards online fashion goods, a high degree of consumer buying choices towards online fashion products, and a high preference for favorable brand image in the research. There were significant variations in respondents' preferences for online shopping as well as attitudes toward fashion items and consumer purchase decisions based on age, civil status, education, monthly income, and profession, according to the results of a test of difference. A further connection test revealed that respondents' liking for online marketing tends to improve their attitude toward online fashion items and consumer buying choices. In the end, the results of multiple regression analysis revealed that age, civil status and education level, online marketing approach, attitude towards online fashion goods, and brand image and attitude are all predictors of buying choices. The study's practical consequences for an internet business are addressed. The study's practical consequences for an internet business are addressed. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (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)

In this peer commentary on L. Syd M. Johnson’s “Inference and Inductive Risk in Disorders of Consciousness,” I argue for the necessity of disability education as an integral component of decision-making processes concerning patients with DOC and, mutatis mutandis, all patients with disabilities. The sole qualification Johnson places on such decision-making is that stakeholders are educated about and “understand the uncertainties of diagnosis and prognosis.” Drawing upon research in philosophy of disability, social epistemology, and health psychology, (...) I argue that this educational qualification is insufficient to address systemic ableism and other forms of epistemic bias in quality of life judgments. (shrink)

The paper aims to clarify the role of the meaning of life in Anselm Müller’s philosophy. Müller says that the ethically good life is the life of acting well, and acting well requires at least a rough conception of the meaning of life, or a conception of what makes a life go well. But why is such a conception required and what does it mean to have such a conception? I argue that such a conception (...) cannot provide us with ultimate ends in our practical deliberations. Nor can its role be merely to provide a standard against which practical reasoning can be assessed. Rather, our conception of the meaning of life is, in the first instance, that which allows us, in our practical reasoning, to see certain considerations as good reasons for certain actions and to weigh reasons for and against different options. One upshot of my interpretation is that Müller should be more optimistic about philosophy’s ability to answer the question of the meaning of life than he allows himself to be. (shrink)

Artificial intelligence has arrived. In the online world it is already a part of everyday life, sitting invisibly behind a wide range of search engines and online commerce sites. It offers huge potential to enable more efficient and effective business and government but the use of artificial intelligence brings with it important questions about governance, accountability and ethics. Realising the full potential of artificial intelligence and avoiding possible adverse consequences requires societies to find satisfactory answers to these questions. This (...) report sets out some possible approaches, and describes some of the ways government is already engaging with these issues. (shrink)

Presupposing that our consideration of ethical issues can be enriched by examining literary works, this paper focuses on Marsha Norman's play ‘night, Mother. The play describes the last hour and a half in the life of Jessie, a young woman who decides to die by suicide. Before ending her life, Jessie explains to her mother her reasons for her suicide. In the context of the play, these are presented as quite weighty and as, perhaps, justifying her decision. (...) Scholarly research on the play has also treated Jessie's suicide favorably. In this paper I argue that Jessie, and people in similar conditions, are wrong to die by suicide. Among other points, I criticize Jessie's arguments from the impossibility to improve life; the assured termination of suffering; the badness of the world; and the right for suicide. I also criticize arguments in the scholarly literature that view Jessie's suicide favorably, such as the arguments from independence, heroism, authenticity, and emotional closeness. (shrink)

Towards the end of A System of Logic, John Stuart Mill makes some intriguing, suggestive, and neglected claims about what he calls “The Art of Life”. Despite the comparatively little attention that the Art of Life has received in the extensive scholarly literature on Mill, it turns out to be extremely important to understanding his moral philosophy and his practical philosophy more generally. It reveals Mill to be a considerably more subtle philosopher than it would otherwise seem. It (...) also insulates him from many unwarranted criticisms. In this entry I proceed by picking out some elements of Mill's discussion of the Art of Life, explaining them and then examining their significance. These include the metaethical distinction between sciences and arts, the relation between the art of life and morality, and the significance of his art of life in understanding normative ethical views, such as those defended in Utilitarianism. (shrink)

Local participation is always beneficial for sustainable action and environmental problems resulting from urban implementation due to the failure of social and institutional change necessary for a successful transformation of rural life to urban life ahead of the rapid movement of the population. Despite good legal practice and comprehensive guidelines, evidence suggests that Environmental Impact Assessment (EIA) or more broadly Environmental, Social and Health Impact Assessment (ESHIA) have not yet been found satisfactory in Nigeria, as the current system (...) amounts to duplication of efforts and cost. However, ESHIA has been developed and integrated to help manage project activities, facilities, and operations sustainably, so that both economic and ecological profits are accrued (sustainable development) or ensure that any development project does not result in excessive deterioration of and/or the irreversible adverse effect on any component of the environment – a recite for sustainable development. A literature review was done by using a variety of search engines including Research Gate, Google Scholar, Academia, Mendeley, SSRN search strategy to retrieve research publications, “grey literature” and expert working group reports. The thrust of this study is to evaluate the potential benefits of ESHIA as a tool for sustainable environmental development. The evaluation and implementation of EIA are one of the strengths of these tools. Indeed, EIA is the first and foremost management tool employed to help mitigate adverse, potential, and associated impacts of proposed major developments in our environment. EIA is a regulatory requirement that is efficiently used to improve performance, project design, enhancing decision-making, and facilitating policy programs in a sustainable environment. An evaluation of the EIA systems reveals several weaknesses of the EIA system. These include the inadequate capacity of EIA approval authorities, deficiencies in screening and scoping, poor EIA quality, insufficient public participation, and weak monitoring, and erratic government policies. Overall, most EIA study rarely meets the objectives of being a project planning tool to contribute to achieving sustainable development and mitigate the impact of the development project. The study recommends some directions for the future to ensure that entire content of the EIA are religiously implemented, review the existing EIA act, increase the expertise of EIA consultants, create a liaison office with an international organisation and with sister agency, ESHIA must enjoy Improved budgetary provision, time latitude, spatial contexts and methodological improvements for outcome measures to achieve results that are relevant to sustainable development by improving project design, enhancing decision making and facilitating policy programs. (shrink)

Most properties have comparatives, which are relations. For instance, the property of width has the comparative relation denoted by `_ is wider than _'. Let us say a property is reducible to its comparative if any statement that refers to the property has the same meaning as another statement that refers to the comparative instead. Width is not reducible to its comparative. To be sure, many statements that refer to width are reducible: for instance, `The Mississippi is wide' means the (...) same as `The Mississippi is wider than most rivers'. But some statements that refer to width are not reducible: for instance, `Electrons have zero width' is not. A property is not reducible to its comparative if it has absolute degrees, and specifically an absolute zero. A property's comparative relation places things in an order from those that have the property least to those that have it most. If there is an absolute zero point somewhere in this ordering, the property is not reducible to its comparative. For width, there is an absolute zero at one end of the ordering, so width is not reducible. The property of goodness is reducible to its comparative, betterness. In particular, there is no absolute zero of goodness. Things are ordered by betterness – some things are better than others – but nothing is absolutely good or absolutely bad. This is an exaggeration. In certain applications, goodness does have absolute degrees of a sort, and an absolute zero. For instance, it makes sense to say an event is good, and another event bad. These are absolute degrees of a sort, but they are themselves reducible to betterness. To say an event is good simply means the event is better than what would otherwise have happened. The goodness of lives has a different sort of absolute zero. Lives are ordered by betterness; some lives are better than others. We can make sense of the question `Where in this ordering is the division between lives that are good and those that are bad?' The division between good and bad lives is again reducible to betterness. To say a person's life is good means it is better that the person should continue living, rather than that she should die. Or it may mean it is better that her life should be lived rather than that it should never have been lived at all. As it is often put: a good life is a life worth living. Derek Parfit appears to attach a different sense to the idea of a good life. He appears to mean a life that contains a preponderance of good things (such as pleasure) over bad things (such as pain). If a life contains no good things and no bad things, it has zero goodness in this sense. In this sense, absolute goodness and the absolute zero of goodness are not reducible to betterness. However, this is a naturalistic sense of goodness, and it is subject to the open-question objection. If a life contains no good things and no bad things, it is an open question whether it has zero goodness. It might, for instance, be a bad thing that this life should be lived. In discussing the evil of death, some philosophers seem to have been searching for an absolute goodness that is not reducible to betterness. Thomas Nagel speaks of an asymmetry between what is good about life and what is bad about death. But if a person's life is good, that only means it would be better that she should continue living than that she should die. And if a person's death would be bad, that only means it would be worse that she should die than that she should continue living. So there can be no asymmetry. (shrink)

Life can be awful. For this to be the stuff of tragedy and not farce, we require a capacity to be more than we presently are. Tony Webster, the narrator of Julian Barnes’s The Sense of an Ending, poses a challenge to this commitment of ethics in his commentary on the instability of memory. But Barnes leads us past this difficulty by showing us that Tony’s real problem is his inability to make sense of himself—a failure of self-knowledge. Tony’s (...) past is tangled up with others he can scarcely see as people. Let us hope we can do better. (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)

Tricycles are one of the most popular, most accessible, and least expensive forms of public transit in the Philippines. In addition to being common modes of transportation, motorcycles, and tricycles also contribute significantly to the livelihoods of millions of Filipinos who rely on them for a living. Hence, this study explores the lived experiences and challenges faced by female tricycle drivers. Employing the Interpretative Phenomenological Analysis, the findings of this study were: The participants strive to assist their husbands in providing (...) for their families. Their motivation comes primarily from their families. They each make every effort to provide a better life for their children. Thus, have faced challenges related to their ability to make ends meet, find time to balance job and family obligations, and encounter discrimination and stereotypes in others, and day-to-day life. Moreover, they evade and disregard the problem and discrimination as a coping mechanism. They feel that if they ignore their problem and focus on achieving their goal of providing for their family, it would eventually disappear. (shrink)

Artificial intelligence and robotics is pervasive in daily life and set to expand to new levels potentially replacing human decision-making and action. Self-driving cars, home and healthcare robots, and autonomous weapons are some examples. A distinction appears to be emerging between potentially benevolent civilian uses of the technology (eg unmanned aerial vehicles delivering medicines), and potentially malevolent military uses (eg lethal autonomous weapons killing human com- batants). Machine-mediated human interaction challenges the philosophical basis of human existence and (...) ethical conduct. Aside from technical challenges of ensuring ethical conduct in artificial intelligence and robotics, there are moral questions about the desirability of replacing human functions and the human mind with such technology. How will artificial intelligence and robotics engage in moral reasoning in order to act ethically? Is there a need for a new set of moral rules? What happens to human interaction when it is mediated by technology? Should such technology be used to end human life? Who bears responsibility for wrongdoing or harmful conduct by artificial intelligence and robotics? -/- Whilst Kant may be familiar to international lawyers for setting restraints on the use of force and rules for perpetual peace, his foundational work on ethics provides an inclusive moral philosophy for assessing ethical conduct of individuals and states and, thus, is relevant to discussions on the use and development of artificial intelligence and robotics. His philosophy is inclusive because it incorporates justifications for morals and legitimate responses to immoral conduct, and applies to all human agents irrespective of whether they are wrongdoers, unlawful combatants, or unjust enemies. Humans are at the centre of rational thinking, action, and norm-creation so that the rationale for restraints on methods and means of warfare, for example, is based on preserving human dignity as well as ensuring conditions for perpetual peace among states. Unlike utilitarian arguments which favour use of autonomous weapons on the basis of cost-benefit reasoning or the potential to save lives, Kantian ethics establish non-consequentialist and deontological rules which are good in themselves to follow and not dependent on expediency or achieving a greater public good. -/- Kantian ethics make two distinct contributions to the debate. First, they provide a human-centric ethical framework whereby human exist- ence and capacity are at the centre of a norm-creating moral philosophy guiding our understanding of moral conduct. Second, the ultimate aim of Kantian ethics is practical philosophy that is relevant and applicable to achieving moral conduct. -/- I will seek to address the moral questions outlined above by exploring how core elements of Kantian ethics relate to use of artificial intelli- gence and robotics in the civilian and military spheres. Section 2 sets out and examines core elements of Kantian ethics: the categorical imperative; autonomy of the will; rational beings and rational thinking capacity; and human dignity and humanity as an end in itself. Sections 3-7 consider how these core elements apply to artificial intelligence and robotics with discussion of fully autonomous and human-machine rule-generating approaches; types of moral reasoning; the difference be- tween ‘human will’ and ‘machine will’; and respecting human dignity. (shrink)