Nonrational processes in ethical decision making

Most current ethical decision-making models provide a logical and reasoned process for making ethical judgments, but these models are empirically unproven and rely upon assumptions of rational, conscious, and quasilegal reasoning. Such models predominate despite the fact that many nonrational factors influence ethical thought and behavior, including context, perceptions, relationships, emotions, and heuristics. For example, a large body of behavioral research has demonstrated the importance of automatic intuitive and affective processes in decision making and judgment. These processes profoundly affect human behavior and lead to systematic biases and departures from normative theories of rationality. Their influence represents an important but largely unrecognized component of ethical decision making. We selectively review this work; provide various illustrations; and make recommendations for scientists, trainers, and practitioners to aid them in integrating the understanding of nonrational processes with ethical decision making.     

Toward a hermeneutic model of ethical decision making in clinical practice

Documented ethical violations and empirical research have demonstrated that, despite professional standards and formal training in ethical principles, some psychotherapists engage in unethical behaviors that compromise the welfare of clients. It appears that competing values and interests that emerge in the therapeutic endeavor can interfere with therapists' considerations of ethical standards and their willingness to act ethically. Expanding current models of ethical decision making, this article offers a hermeneutic model that recognizes that in addition to moral reasoning, the context of the therapeutic relationship and the therapist's subjective responses are fundamental considerations in the interpretation and application of ethical interventions. Implications for understanding and training of ethics in psychotherapy in this broader context are explored.     

Complexity of ethical decision making in psychiatry

Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.     

Sequential decision making: An aggregate scheduling methodology

Recent studies of sequential decision making performance have utilized optimal dynamic programming solutions as the criteria for evaluating the quality of human decisions. The difficulties incumbent in increasing the dimensionality of dynamic programming formulations effectively prohibit their extension beyond the case of a single decision variable. In the following article an alternative optimization formulation for a two-decision-variable case is presented, followed by the development of a corresponding one-decision-variable problem. In addition, related methodological problems limiting the comparability of results among previous studies are presented. It is suggested that the proposed problem formulation and its accompanying interpretation for the decision maker largely eliminate these previous methodological problems. Furthermore, the problem formulation permits quantification of the relative weights that should optimally be placed on future decision periods in the multiple-stage decision problem.     

Juvenile psychopathy and judicial decision making: an empirical analysis of an ethical dilemma

In the burgeoning juvenile psychopathy literature, there is a debate on whether it is appropriate to apply this construct to youths. Some have suggested that labeling children/adolescents as psychopathic might result in negative consequences, such as being recommended for more restrictive placements. However, the scant evidence is equivocal. This study provides additional insights on this issue by assessing judicial perceptions and recommendations to a hypothetical case. Results indicate that psychopathy influenced perceptions of amenability (eta = .12) and dangerousness (eta = .25), and recommendations for placement (eta = .11). More specifically, youth who were both labeled as psychopathic and ascribed psychopathic traits were viewed as less amenable to treatment and more dangerous and were more likely to be recommended for a restrictive placement than youth who were neither labeled nor described as such. The effect of psychopathy on placement recommendations, however, was not significant after controlling for perceptions of dangerous. This suggests that the influence of psychopathy on judicial restrictiveness may operate through the perceived dangerousness of the youth.     

A study of the foundations of ethical decision making of clinical medical ethicists

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values.     

An exploration of values in ethical consumer decision making

Consumer concern for ethical issues has been well documented across much of the developed world. Research on values is also prominent in the literature. Neglected in consumer behaviour is an understanding of the pertinence of particular values in ethical decision making contexts. This paper outlines the results of qualitative research, which explores those values pertinent to ethical consumers in decision making and the nature of their influence in grocery consumption contexts. A questionnaire was used to ascertain the dominance and nature of values influencing consumer decision making in this context.     

The findings of the Dartmouth Atlas Project: a challenge to clinical and ethical excellence in end-of-life care

The Dartmouth Institute for Health Policy and Clinical Practice Atlas Project found "staggering variations" in the quality and quantity of end-of-life care provided to Medicare patients with severe chronic illness across the United States. Particularly concerning is the finding that more care is provided to patients who live in "high-supply" areas, irrespective of the effectiveness of care, and that more care often equaled inappropriate care that increased patients' suffering at the end of life. Patients in "lower supply" areas typically received better, more appropriate levels of care and reported higher levels of satisfaction with the care they received.     

Influence of consultation on ethical decision making: an analogue study

Participants (62 students from 6 doctoral programs in professional psychology) were given 3 ethical dilemmas, asked to generate their own solutions, and asked to make judgments about a number of provided alternatives. Students were asked either to make decisions after seeking consultation or to make decisions independently of consultation. There were few significant between-group differences along a number of dimensions including participants' ratings of acceptability of provided alternatives and levels of certainty, justification, and satisfaction with personally generated solutions. For one of the vignettes, individuals using consultation, when compared with the control group, were significantly more likely to prefer their own solution to that of provided alternatives. The study was viewed as a needed first step in investigating a cherished assumption in clinical practice.     

Toward a methodology for moral decision making in medicine

The failure of medical codes to provide adequate guidance for physicians' moral dilemmas points to the fact that some rules of analysis, informed by moral theory, are needed to assist in resolving perplexing ethical problems occurring with increasing frequency as medical technology advances. Initially, deontological and teleological theories appear more helpful, but critcisms can be lodged against both, and neither proves to be sufficient in itself. This paper suggests that to elude the limitations of previous approaches, a method of moral decision making must be developed incorporating both coherence methodology and some independently supported theoretical foundations. Wide Reflective Equilibrium is offered, and its process described along with a theory of the person which is used to animate the process. Steps are outlined to be used in the process, leading to the application of the method to an actual case.     

Moral disengagement in ethical decision making: a study of antecedents and outcomes

This article advances understanding of the antecedents and outcomes of moral disengagement by testing hypotheses with 3 waves of survey data from 307 business and education undergraduate students. The authors theorize that 6 individual differences will either increase or decrease moral disengagement, defined as a set of cognitive mechanisms that deactivate moral self-regulatory processes and thereby help to explain why individuals often make unethical decisions without apparent guilt or self-censure (Bandura, 1986). Results support 4 individual difference hypotheses, specifically, that empathy and moral identity are negatively related to moral disengagement, while trait cynicism and chance locus of control orientation are positively related to moral disengagement. Two additional locus of control orientations are not significantly related to moral disengagement. The authors also hypothesize and find that moral disengagement is positively related to unethical decision making. Finally, the authors hypothesize that moral disengagement plays a mediating role between the individual differences they studied and unethical decisions. Their results offer partial support for these mediating hypotheses. The authors discuss the implications of these findings for future research and for practice.     

Ego depletion and its paradoxical effects on ethical decision making

Whereas previous research has shown that ego depletion can lead to an increase in unethical behavior, we suggest that this effect hinges on the social consensus of the unethical behavior. Drawing from theories on social consensus and dual-process decision-making, we hypothesize and confirm that ego depletion is associated with increased unethical behavior of comparatively low social consensus. We then find that, as hypothesized, ego depletion is associated with decreased unethical behavior of high social consensus (Studies 1 and 2). Results further suggest that, controlling for state self-control resources, depleted participants are less likely to engage in unethical behavior of high social consensus as a result of increased subjective fatigue (Study 3). Taken together, our findings challenge a widely-held assumption about the negative effects of ego depletion on ethical decision making.     

Teaching ethical analysis in environmental management decisions: A process-oriented approach

The general public and environmental policy makers often perceive management actions of environmental managers as “science,” when such actions are, in fact, value judgments about when to intervene in natural processes. The choice of action requires ethical as well as scientific analysis because managers must choose a normative outcome to direct their intervention. I examine a management case study involving prescribed burning of sagebrush (Artemisia tridentata) communities in south-central Montana (USA) to illustrate how to teach students to ethically evaluate a management action by precisely identifying: 1) the proposed management action, 2) the deficiency of the system to be remedied by the action, 3) the stakeholders affected by the action, and 4) the category and type of values affirmed in the management action. Through such analysis, students are taught to recognize implicit and explicit value judgments associated with management actions, identify stakeholders to whom managers have legitimate ethical obligations, and practice a general method of ethical analysis applicable to many forms of environmental management. An earlier version of this paper was presented at the Fourteenth Annual Meeting, Association for Practical and Professional Ethics, February 24–27, 2005.