Negotiating the moral order: paradoxes of ethics consultation

Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society.     

Principled moral sentiment and the flexibility of moral judgment and decision making

Three studies test eight hypotheses about (1) how judgment differs between people who ascribe greater vs. less moral relevance to choices, (2) how moral judgment is subject to task constraints that shift evaluative focus (to moral rules vs. to consequences), and (3) how differences in the propensity to rely on intuitive reactions affect judgment. In Study 1, judgments were affected by rated agreement with moral rules proscribing harm, whether the dilemma under consideration made moral rules versus consequences of choice salient, and by thinking styles (intuitive vs. deliberative). In Studies 2 and 3, participants evaluated policy decisions to knowingly do harm to a resource to mitigate greater harm or to merely allow the greater harm to happen. When evaluated in isolation, approval for decisions to harm was affected by endorsement of moral rules and by thinking style. When both choices were evaluated simultaneously, total harm -- but not the do/allow distinction -- influenced rated approval. These studies suggest that moral rules play an important, but context-sensitive role in moral cognition, and offer an account of when emotional reactions to perceived moral violations receive less weight than consideration of costs and benefits in moral judgment and decision making.     

Gender bias and moral decision making: The moral orientations of justice and care

This study investigated gender related moral reasoning in student essays containing arguments on moral issues. Undergraduate students in a medical ethics course viewed two films on morally controversial issues. The students wrote brief essays about the films which were transcribed and numerically coded to conceal the author's gender from the evaluator. Using a coding scheme originated by Lyons, the evaluator classified each essay as a justice/right essay or a care/response essay or an equal response essay. Subsequently, calculations were made to determine the percentage of male authored essays that were justice/rights essays or care/response essays and the percentage of female authored essays that were justice/rights or care/response essays. The males (87.7%) tended to exhibit the justice/rights moral orientation, and the females (69.4%) exhibited the care/response moral orientation. Several different calculations were made to determine various degrees of gender related orientations also. The difference in orientation was highly statistically significant (p≤0.001). These data contribute to understanding moral orientation and development. Interpretations are given to explain some differences between the genders and help explain the traditional roles in society that males and females have played historically.     

The effects of physical contact and decision type on moral decision making: A study of harm to save moral behavior

This study examined the relationship between physical contact and decision type in predicting “harm to save” behavior. Participants were assigned to making either a judgment or a choice involving moral dilemmas. All participants were presented with dilemmas that either required or did not require having physical contact with potential victims. Participants were asked to decide whether to sacrifice fewer people to save more (utilitarian responses) or not to do so and thus more people would die (deontological responses). The study sample included 345 participants who completed a set of self‐report measures. Results indicated an interaction between physical contact and decision type. In the choice condition only, participants reported significantly less utilitarian responses to the dilemmas that required having physical contact with the person to be harmed than to dilemmas that did not require physical contact. This difference was not found in the judgment condition. These results contribute to a greater understanding of the nature and potential malleability of human morality.     

Multi-attribute decision support and complexity: An evaluation and process analysis of aided versus unaided decision making

The present study addresses the effectiveness of a computerized decision aid (DECAID, Pitz 1987) based on the Multi-Attribute Utility Model (MAU). The effectiveness of DECAID was investigated for personnel selection problems varying in complexity (number of alternatives and number of attributes). Results show that the decision aid was most successful for problems of medium complexity. DECAID significantly affected the thoroughness of the decision, preference formation, and the perceived difficulty of the decision problem for medium complex problems. This was not the case for highly complex problems. Next, a process analysis is presented of unaided decision making focusing on the selection and evaluation of information. This process analysis of verbal protocols was based on the same decision problems as the first study. Results indicate that problem complexity had a significant impact on the decision process. Increasing complexity resulted in a less thorough evaluation, and selective information processing. Subjects tended to focus on one or two most promising alternatives. Furthermore, evaluation strategies diverged from those used in DECAID in terms of standard of comparison. The paper concludes with implications for the design of decision aids.     

Ill-placed democracy: ethics consultations and the moral status of voting

As groups around the country begin to craft standards for clinical ethics consultations, one focus of that work is the proper procedure for conducting ethics consults. From a recent empirical look into the workings of ethics consult services (ECSs), one worrisome finding is that some ECSs rely on a committee vote when making a recommendation. This article examines the practice of voting and its moral standing as a procedural strategy for arriving at a clinical ethics recommendation. I focus here on the type of clinical ethics conflicts that are most likely to lead an ECS to vote, namely, conflicts involving ethical uncertainty--or, in the Greek, aporia. I argue that in cases of aporia, voting on an ethics conflict is not a morally justifiable procedure. Then on the same grounds that I use to show that voting is ethically problematic, I raise broader concerns about the common practice of making recommendations by other procedures. In contrast to the standard approach of adjudicating between moral claims, I argue that ECSs can best resolve aporetic conflict through the process of clinical ethics mediation.     

The notion of the moral: the relation between virtue ethics and virtue epistemology

In this paper I argue that virtue ethics should be understood as a form of ethics which integrates various domains of the practical in relation to which virtues are excellences. To argue this it is necessary to distinguish two senses of the “moral”: the broad sense which integrates the domains of the practical and a narrow classificatory sense. Virtue ethics, understood as above, believes that all genuine virtue should be understood as what I call virtues proper. To possess a virtue proper (such as an excellent disposition of open-mindedness, an epistemic virtue) is to possess a disposition of overall excellence in relation to the sphere or field of the virtue (being open to the opinions of others). Overall excellence in turn involves excellence in integrating to a sufficient degree, standards of excellence in all relevant practical domains. Epistemic virtues, sporting virtues, moral virtues, and so on are all virtues proper. In particular it is impossible for an epistemic virtue to be a moral (narrow sense) vice.     

Decision ecology: Foraging and the ecology of animal decision making

In this article, I review the approach taken by behavioral ecologists to the study of animal foraging behavior and explore connections with general analyses of decision making. I use the example of patch exploitation decisions in this article in order to develop several key points about the properties of naturally occurring foraging decisions. First, I argue that experimental preparations based on binary, mutually exclusive choice are not good models of foraging decisions. Instead, foraging choices have a sequential foreground-background structure, in which one option is in the background of all other options. Second, behavioral ecologists view foraging as a hierarchy of decisions that range from habitat selection to food choice. Finally, data suggest that foraging animals are sensitive to several important trade-offs. These trade-offs include the effects of competitors and group mates, as well as the problem of predator avoidance.     

Amenable to reason: Aristotle's rhetoric and the moral psychology of practical ethics.

An Aristotelian conception of practical ethics can be derived from the account of practical reasoning that Aristotle articulates in is Rhetoric and this has important implications for the way we understand the nature and limits of practical ethics. an important feature of this conception of practical ethics is its responsiveness to the complex ways in which agents form and maintain moral commitments, and this has important implications for the debate concerning methods of ethics in applied ethics. In particular, this feature enables us to understand casuistry, narrative, and principlism as mutually supportive modes of moral inquiry, rather than divergent and mutually exclusive methods of ethics. As a result, an Aristotelian conception of practical ethics clears the conceptual common ground upon which practical ethicists can forge a stable and realistic self-understanding.     

Information sampling and group decision making: the effects of an advocacy decision procedure and task experience

Group discussions tend to focus on information that was previously known by all members (shared information) rather than information known by only 1 member (unshared information). If the shared information implies a suboptimal alternative, this sampling bias is associated with inaccurate group decisions. The present study examines the impact of 2 factors on information exchange and decision quality: (a) an advocacy group decision procedure versus unstructured discussion and (b) task experience. Results show that advocacy groups discussed both more shared and unshared information than free-discussion groups. Further, with increasing experience, more unshared information was mentioned in advocacy groups. In contrast, there was no such increase in unstructured discussions. Yet advocacy groups did not significantly improve their decision quality with experience.     

Brain, emotion and decision making: the paradigmatic example of regret

Human decisions cannot be explained solely by rational imperatives but are strongly influenced by emotion. Theoretical and behavioral studies provide a sound empirical basis to the impact of the emotion of regret in guiding choice behavior. Recent neuropsychological and neuroimaging data have stressed the fundamental role of the orbitofrontal cortex in mediating the experience of regret. Functional magnetic resonance imaging data indicate that reactivation of activity within the orbitofrontal cortex and amygdala occurring during the phase of choice, when the brain is anticipating possible future consequences of decisions, characterizes the anticipation of regret. In turn, these patterns reflect learning based on cumulative emotional experience. Moreover, affective consequences can induce specific mechanisms of cognitive control of the choice processes, involving reinforcement or avoidance of the experienced behavior.