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)

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)

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)

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.

Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) (...) something like the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus. (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)

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)

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)

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)

Objectives—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 effectDesign, subjects and setting–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”.Results–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.Conclusions—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)

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?

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.

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.

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)

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)

It is more than a platitude to admit that we are always dying. It is a recognition of the fundamental finitude that marks our existence as human persons. It says something essential about the human condition. We are all born. We all die. And the very living of life is, leaving aside for the moment religious considerations, oriented toward death. Phenomenologists make much of this observation, perhaps none more so than Martin Heidegger who argues that our being-toward-death permits the (...) ontological grasping of Da-sein as a whole. Indeed for him, the“existential and ontological concept of death” is “the own most nonrelational, certain, and, as such, indefinite and not to be bypassed possibility of Da-sein.” However, if one spends much time around those who are very close to death it can begin to sound disingenuous to talk about death as one’s own most possibility. It is easy to think these patients are dying—not me. Still, the phenomenologist might claim that, vis-à-vis our being-toward-death, the difference between me and the terminally ill patient is a matter of degree and not kind. But, is this so? One may be excused for thinking not. There appears to be an important difference in the kinds of possible experiences open to us. I may experience healing if I become ill; on the other hand, the very condition of the patient with a terminal illness is defined by the impossibility of her experiencing healing. The primary aim of this paper is to argue that the terminally ill patient can, in fact, experience healing at the end of her life and in the face of impending death. I will not argue that the possibility of experiencing healing at the end of life means leaving room for divine intervention, though neither do I intend to preclude such a possibility. Rather, I will argue that healing is something that we experience quite apart from what happens to our biological make-up. While healing is often correlated with a change in the state of our bodies, it need not be. (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)

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)

With the rise and public accessibility of AI-enabled decision-support systems, individuals outsource increasingly more of their decisions, even those that carry ethical dimensions. Considering this trend, scholars have highlighted that uncritical deference to these systems would be problematic and consequently called for investigations of the impact of pertinent technology on humans’ ethical decision-making. To this end, this article conducts a systematic review of existing scholarship and derives an integrated framework that demonstrates how intelligent decision-support systems (IDSSs) (...) shape humans’ ethical decision-making. In particular, we identify resulting consequences on an individual level (i.e., deliberation enhancement, motivation enhancement, autonomy enhancement and action enhancement) and on a societal level (i.e., moral deskilling, restricted moral progress and moral responsibility gaps). We carve out two distinct methods/operation types (i.e., processoriented and outcome-oriented navigation) that decision-support systems can deploy and postulate that these determine to what extent the previously stated consequences materialize. Overall, this study holds important theoretical and practical implications by establishing clarity in the conceptions, underlying mechanisms and (directions of) influences that can be expected when using particular IDSSs for ethical decisions. (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)

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 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)

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)

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)

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)

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

The Netherlands was the first country to legalize euthanasia and physician-assisted suicide. This paper offers a first legal perspective on the prospects of using AI in the Dutch practice of euthanasia and physician-assisted suicide. It responds to the Regional Euthanasia Review Committees’ interest in exploring technological solutions to improve current procedures. The specific characteristics of AI – the capability to process enormous amounts of data in a short amount of time and generate new insights in individual cases – may for (...) example alleviate the increased workload of review committees due to the continuous increase of euthanasia cases. The paper considers three broad categories for the use of AI in the Dutch euthanasia practice: (1) the physician’s assessment of euthanasia requests, (2) the actual execution of euthanasia, and (3) the retrospective reviews of cases by the Regional Euthanasia Review Committees. Exploring the legal considerations around each avenue, both in the EU AI Act and the Dutch legal framework, this paper aims to facilitate the societal discussion on the role of technology in such deeply human decisions. This debate is equally relevant to other countries that legalized euthanasia (e.g. Belgium and Canada) or physician-assisted suicide (e.g. Switzerland and numerous states in the US). (shrink)

Folklore has a critical role as a cultural transmitter, all the while being a socially accepted medium for the expressions of culturally contradicting wishes and conducts. In this study of Vietnamese folktales, through the use of Bayesian multilevel modeling and the Markov chain Monte Carlo technique, we offer empirical evidence for how the interplay between religious teachings (Confucianism, Buddhism, and Taoism) and deviant behaviors (lying and violence) could affect a folktale’s outcome. The findings indicate that characters who lie and/or commit (...) violent acts tend to have bad endings, as intuition would dictate, but when they are associated with any of the above Three Teachings, the final endings may vary. Positive outcomes are seen in cases where characters associated with Confucianism lie and characters associated with Buddhism act violently. The results supplement the worldwide literature on discrepancies between folklore and real-life conduct, as well as on the contradictory human behaviors vis-à-vis religious teachings. Overall, the study highlights the complexity of human decision-making, especially beyond the folklore realm. (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)

Can interests survive dementia, permanent unconsciousness--even death? If not, what kills them off? Perhaps lack of attention (one could almost say "lack of interest"), if having the interest requires believing that you have it, caring about its object, and in some sense investing in that object. Thus, once you no longer care about the object, the investment--and the interest--is gone. If an interest disappears when you stop caring about its object, will it disappear when you are mentally incompetent and unable (...) to care about it? If so, then it seems such interests cannot survive the onset of incompetence (let alone death). -/- This issue arises with living wills and other ways to decide the medical care you will receive when you become mentally incapacitated and unable to decide for yourself. Such decisions are made to protect certain kinds of interest. For example, you may want to avoid expensive end-of-life care in order to protect your family's inheritance, thereby protecting your interest in your family's welfare. Or you might have a religious commitment to the sanctity of life, and therefore an interest in keeping your biological life going as long as possible, even when you are permanently unconscious. We use living wills and similar forms of advance medical decision making to protect our such interests when we anticipate being unable to protect those interests by acting autonomously at the time of treatment. If, however, those interests do not survive incompetence, then the moral authority of living wills is severely undermined, for the interests they are meant to protect do not exist. It will be argued that some interests can survive a permanent loss of mental capacity, for sometimes, as strange as it sounds, you can be disposed to care about a thing even when you will never be conscious again. (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)

In this paper, we report on the development of The Sustainable Port video game, which aims to simulate the complex dynamics and decisions occurring in the present and future development of a port area considering environmental aspects (CO2 emissions) and profit. To evaluate if this game fulfills its purpose, we asked 75 students and 34 employees at the Port of Rotterdam (PoR) to play The Sustainable Port. Our results show that PoR employees score higher than students suggesting a transfer between (...) real-life experience of being an employee in the port and performance in the game. Furthermore, port participants reported that The Sustainable Port can be successfully used to start discussions about the future of the Port of Rotterdam and to raise awareness about the complexity characterizing the decision-making processes occurring in a port environment. Our results, taken together, provide evidence of the effectiveness of The Sustainable Port in simulating dynamics occurring in port development and give us optimism about future applications. (shrink)

Financial literacy is becoming a pivotal skill in navigating the marketplaces within the predominant rising digital branches of trading domains; however, there remains a concerning gap in the purchasing behavior of adolescents, who are its primary users. With this in mind, the main objective of our research is to determine whether there is a relationship between a student's level of financial literacy and their online purchase decision-making. The researchers employed an explanatory mixed approach and purposive sampling to identify (...) respondents from Immaculate Conception College of Balayan, Inc. A 5-point Likert scale survey was utilized to collect data from 66 respondents, followed by semi-structured interviews with 10 selected participants. The results showed a moderately positive correlation between a student's financial literacy and online purchase decisions, as determined by the Pearson correlation coefficient. Thus, the thematic analysis revealed that respondents generally have good financial literacy, emphasizing factors like pricing, online reviews, and product ratings when making digital marketplace decisions. However, there are notable gaps in their understanding of basic financial concepts and their ability to apply them in real-life situations. To effectively enhance students’ financial literacy and online purchasing decisions, a holistic approach is necessary, including targeted interventions, practical applications, and continuous adaptation to evolving consumer behaviors. Educational institutions, policymakers, and stakeholders should work together to create comprehensive programs that provide students with the knowledge, skills, and attitudes needed to negotiate real-world financial situations and make sound judgments in the digital commerce ecosystem. By emphasizing practical learning, key financial concepts, and trustbuilding approaches, educators may empower students to become responsible consumers capable of managing their resources successfully and ethically. (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)

How do we prepare engineering students to make ethical and responsible decisions in their professional work? This paper presents an approach that enhances engineering students’ engagement with ethical reasoning by simulating decision-making in a complex scenario. The approach has two principal inspirations. The first is Anthony Weston’s scenario-based teaching. Weston’s concept of a scenario is a situation that changes in response to choices made by participants, according to an inner logic. Scenarios can dynamically explore open-ended complex problems without (...) imposing predetermined results, allowing students to apply their ethical reasoning in a more realistic fashion. The second inspiration is Thi Nguyen’s theory of games. According to Nguyen, games are the “art of agency,” meaning that they provide a structure under which some result is agreed to be valuable, along with prescribed ways of achieving that result, in a relatively low-stakes and temporary social arrangement. By playing many games, Nguyen argues, we can develop a “library of agency,” that is to say, a set of values and means to achieving them that can inform how we make high-stakes decisions in real life. Engaging with carefully designed game scenarios, then, can enable students to practice making ethical decisions within a structured framework, which unfolds in response to their choices, while their decisions are driven by some defined goal. This roleplaying game–based approach thus allows students to build their own ethical libraries of agency, in preparation for professional decision-making. The approach is illustrated using a specific example recently deployed in a seminar on engineered living materials (building materials that incorporate living tissues). The scenario uses techniques from tabletop roleplaying games (e.g. Dungeons & Dragons) for outcome resolution, adventure design, and character creation. Through the game, students practice making difficult decisions in a humanitarian context. (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)

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human (...) beings generally. While hypocrisy is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (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)

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)

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)

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 thesis examines the key moral principles that should govern decision-making by police and military when using lethal force. To this end, it provides an ethical analysis of the following question: Under what circumstances, if any, is it morally justified for the agents of state-sanctioned security institutions to use lethal force, in particular the police and the military? Recent literature in this area suggests that modern conflicts involve new and unique features that render conventional ways of thinking about (...) the ethics of armed conflict, and the use of lethal force, as inadequate or redundant. In particular, there is an increased concern with the moral difficulties created by “non-standard” cases. This is where the police or military are obliged to operate outside their conventional contexts. In such non-standard cases, on what moral basis can (or should) state actors – especially the police and military – use lethal force? One approach argues that there is nothing morally exceptional about the use of lethal force by police or military. This says the only available moral justification for using lethal force is killing in self-defence or defence of others. In contrast, I use an institutional approach to develop a moral framework for the state’s morally exceptional use of lethal force. The institutional approach is concerned with the ends (telos) or purpose of a social institution. It says that the moral purpose of a social institution alters the moral responsibilities of its agents; what is referred to as role morality. My analysis demonstrates that there is an important moral distinction between justified killing in self-defence and state-sanctioned uses of lethal force. My claim is that police and military uses of lethal force are not morally justified in the same way as the average person’s use of lethal force (i.e. self-defence or defence of others). Instead, I argue that the state-sanctioned institutional role of police and military give these state actors special moral duties, and therefore exceptional moral justification, for using lethal force. I argue that the institutional end of the police is the preservation of public safety. This includes using lethal force where it is necessary to protect life and prevent serious injury to jurisdictional inhabitants. In contrast, a morally responsible state uses military force to defend the “common good.” That is, when it is necessary to defend the peaceful functioning of a state from armed threats or other forms of political violence. I then conclude that non-standard cases require the addition of jus ad vim (or the just use of military force short-of-war) as a hybrid element to the moral framework for the state-sanctioned use of lethal force. This provides a better way of applying ethics to the use of military force when defending the common good against serious threats in non-standard cases. This is because jus ad vim complements the conventional military paradigm by permitting the use of military capabilities to defend the common good. But, at the same time, it inhibits the move towards the more destructive levels of violence characteristic of conventional warfighting. (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)

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)

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)