Integrating Contextual Issues in Ethical Decision Making

Many issues in ethics arise in relation to the contexts in which psychologists work. However, most ethical decision-making models reproduce the way in which psychologists tend to approach ethics by focusing on ethical dilemmas and proposing a step-by-step response to deal with them. Although these models might be useful, their emphasis on reactive approaches and their lack of contextualization constitute significant limitations on their applicability. In this article, an approach to ethical decision making that highlights the importance of the context in developing proactive strategies to solve ethical issues is proposed. This approach is further explained through its application to medical and rural settings. The implications of these suggestions to the training in ethics are finally discussed.     

Moral Orientation as a Component of Ethical Decision Making

Morals are foundational to professional and ethical counseling practice. Moral orientation may play an integral role in ethical decision making. The authors review the literature regarding moral orientation and discuss the connection to ethical decision making. Implications for counselor preparation and practice are addressed.     

Intercultural Model of Ethical Decision Making: Addressing Worldview Dilemmas in School Counseling

The role of school counselors has expanded and deepened over the past few decades, just as the K–12 student population has become more diversified. Professional school counselors regularly encounter ethical dilemmas related to the intersection of their transformed role and students' needs. School counselors, therefore, need assistance and support to develop the skills and problem‐solving strategies to effectively, ethically, and respectfully negotiate these dilemmas. The authors propose the Intercultural Model of Ethical Decision Making as a practical, user‐friendly tool to help school counselors meet these complex challenges.     

Illuminating the Complexities of Ethical Decision Making

Hospital-based professionals who manage cases of family violence are often unclear about the benefits and costs of particular interventions to their clients. Operating under conditions of potential lethality, both to them and family members, clinicians often experience conflict between legal and ethical recommendations or between strategies intended to provide safety to victims of domestic (spousal) violence and those meant to protect children from abuse. This article presents a situation of family violence and the dilemmas of decision-making confronting both social worker and lawyer. It discusses such issues as professional role, reporting requirements, and duties to warn, emphasizing the difficulty of implementing a plan and of predicting its consequences. It recommends substantive and procedural guidelines that may help protect victims while allowing professionals to emotionally sustain themselves during the management ordeal.     

Toward Modeling and Automating Ethical Decision Making: Design, Implementation, Limitations, and Responsibilities

One recent priority of the U.S. government is developing autonomous robotic systems. The U.S. Army has funded research to design a metric of evil to support military commanders with ethical decision-making and, in the future, allow robotic military systems to make autonomous ethical judgments. We use this particular project as a case study for efforts that seek to frame morality in quantitative terms. We report preliminary results from this research, describing the assumptions and limitations of a program that assesses the relative evil of two courses of action. We compare this program to other attempts to simulate ethical decision-making, assess possibilities for overcoming the trade-off between input simplification and output reliability, and discuss the responsibilities of users and designers in implementing such programs. We conclude by discussing the implications that this project highlights for the successes and challenges of developing automated mechanisms for ethical decision making.     

By-Person Factor Analysis in Clinical Ethical Decision Making: Q Methodology in End-of-Life Care Decisions

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues.

Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix.

Setting: University medical center.

Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center.

Interventions: Presented with four hypothetical cases involving urgent decision making near the end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases.

Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r ² < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study.

Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies.     

多维视野下的临床决策

临床决策是临床实践的重要组成部分之一,随着时代和科学技术的发展,临床决策的内涵和方法也发生了深刻的变化.有许多的因素影响或决定临床决策的质量,如何正确处理好循证医学证据与经验、传统方法和现代技术、创新与人文主义精神、技术与费用等关系是一个十分复杂的课题,需要从临床、经济、社会和法律等多方面加以研究和探索.     

多维视野下的临床决策

临床决策是临床实践的重要组成部分之一,随着时代和科学技术的发展,临床决策的内涵和方法也发生了深刻的变化。有许多的因素影响或决定临床决策的质量,如何正确处理好循证医学证据与经验、传统方法和现代技术、创新与人文主义精神、技术与费用等关系是一个十分复杂的课题,需要从临床、经济、社会和法律等多方面加以研究和探索。     

Clinical Decision Making in Alzheimer's Disease

In the treatment of Alzheimer's Disease the occupational therapy goal is to enable persons to function as optimally as possible. Maximizing the patient's functioning in daily life necessitates a framework for clinical reasoning. Clinical reasoning currently emphasizes what persons can do but may fail to recognize the complex factors involved in what a person actually will do. A framework to guide clinical decision making for persons with Alzheimer's disease based on the model of human occupation was developed. The use of this framework is illustrated through a case application.     

为临床决策的科学化而努力

当今,我国的临床医学实践正面临着深刻的挑战.摆在我们面前的现实是:一方面,医学科学的快速发展,为许多疾病的诊断和治疗提供了多种选择,为诊疗最优化提供了广阔的空间;另一方面,我们在应用医学发展提供的科学成果为病人诊治时,由于医生的学术基础、临床经验、诊疗决策、治疗动机的差异,其效果差别极大.辽宁省抗癌协会最近的一项抽样调查表明,该省癌症的规范化治疗率仅为32.46%,其中A级医院不规范治疗为53.21%,B级医院不规范治疗为66.49%,C级医院不规范治疗高达96.69%.     

Toward a Mechanistic Understanding of Human Decision Making: Contributions of Functional Neuroimaging

ABSTRACT— This article considers the contribution of functional neuroimaging toward understanding the computational underpinnings of human decision making. We outline the main processes likely underlying the capacity to make simple choices and describe their associated neural substrates. Relevant processes include the ability to encode a representation of the expected value or utility associated with each option in a decision problem, to learn such expectations through experience, and to modify action selection in order to choose those actions leading to the greatest reward. We provide several examples of how functional neuroimaging data have helped to shape and inform theories of decision making over and above results available from traditional behavioral measures.     

难治性肾病综合征典型病例的临床决策

难治性肾病综合征在肾内科临床实践中并不少见,其主要治疗是联合应用激素和细胞毒药物（如环磷酰胺、环孢素等）。少数患者,经以上联合治疗后仍不能达到临床缓解。而对于这些患者,长期使用激素及细胞毒药物不仅不能取得满意的效果,而且可能出现严重感染等并发症,甚至危及患者的生命,故在临床中应权衡利弊进行治疗决策。     

老年患者的外科治疗决策及围手术期处理

泌尿外科老年患者多,老年患者必然手术并发症多,手术死亡率高.虽然现在泌尿外科近70％的手术已进入了微创时代,手术时间大幅缩减,但是老年患者的临床决策仍常常是个非常纠结的问题,手术要达到什么目的?何时要做适当的放弃?除了充分的围手术期准备,医生要敢于承担,家属要充分理解和合作.     

老年患者的外科治疗决策及围手术期处理

泌尿外科老年患者多,老年患者必然手术并发症多,手术死亡率高。虽然现在泌尿外科近70％的手术已进入了微创时代,手术时间大幅缩减,但是老年患者的临床决策仍常常是个非常纠结的问题,手术要达到什么目的？何时要做适当的放弃？除了充分的围手术期准备,医生要敢于承担,家属要充分理解和合作。     

Ethical Decision Making in Autonomous Vehicles: The AV Ethics Project

Science and Engineering Ethics - The ethics of autonomous vehicles (AV) has received a great amount of attention in recent years, specifically in regard to their decisional policies in accident...     

An Interactive Model of Career Decision Making

The decision-making model described in this article highlights the interaction between contextual factors, decision triggers, establishing a perspective (frame) of the problem, reframing, and action planning. The interactive perspective is based on process and change and seems particularly relevant in the current social and economic situation. Career counseling with an interactive decision-making approach requires an acknowledgement of external influences as well as of individual variables.     

关于临床决策问题

医生在临床工作中做出明确诊断,并据此给予有效的处理均属于决策过程.制定决策的整个过程,同时也是进行决策思维的过程.近年来高新技术的迅猛发展以及医疗费用急剧增加,使制定决策更加复杂.如何进行正确的决策思维,做出最切实可行的和最佳的决策,对避免决策的盲目性、局限性及惰性具有重要的现实意义.     

Rawls and Religious Community: Ethical Decision Making in the Public Square

While most people may initially agree that justice is fairness,as an evangelical Protestant I argue that, for many religiouscomprehensive doctrines, the Rawlsean model does not possessthe resources necessary to sustain tolerance in moral decisionmaking. The weakness of Rawls's model centers on the reasonablepriority of convictions that arise from private comprehensivedoctrines. To attain a free and pluralistic society, peopleneed resources sufficient to provide reasons to tolerate actionsthat are otherwise intolerable. In addition to arguing for thedeficiency of the Rawlsean political model, I sketch out a preliminarymodel of ambassadorship that offers religious communities, andin particular Protestant evangelicals, the necessary resourcesto engage the broader society tolerantly while maintaining theirreligious convictions. As a citizen of the church and a memberof another kingdom, Christians serve as ambassadors to thosewho are not of the heavenly kingdom. I take this model to bemore ambitious than that of a sojourner who lives in the landbut is isolated as much as possible from society, while moremodest than that of reconstructionists who seek to implementtheir own sacred law on all others.     

临床诊疗决策中的常见失误浅析

就常见的临床诊疗决策失误,从四个方面探讨失误的原因.首先是对患者的发病过程的相关情况掌握不全面、不准确:其次是对患者的化验与检查结果用于诊断与治疗不尽合理:第三是未处理好对患者的诊断与治疗之间的相互关系:第四是未处理好如何发挥各级各类专家的智慧、学识与经验,用于整个临床诊断与治疗的决策过程.总而言之,影响临床决策的环节多,且贯穿于整个临床过程,医师们应重视循证医学证据,始终都要把握好,不可稍有粗疏,否则将不利于提升医疗质量,难以确保医疗安全.