"ACT Administrative Appeals Tribunal Decisions." Ethos: Official Publication of the Law Society of the Australian Capital Territory, (200), pp. 42.

Decision Theory and Rationality offers a challenging new interpretation of a key theoretical tool in the human and social sciences. This accessible book argues, contrary to orthodoxy in politics, economics, and management science, that decision theory cannot provide a theory of rationality.

Decision theory aims at a general account of rationality covering humans but to begin makes idealizations about decision problems and agents' resources and circumstances. It treats inerrant agents with unlimited cognitive power facing tractable decision problems. This book systematically rolls back idealizations and without loss of precision treats errant agents with limited cognitive abilities facing decision problems without a stable top option. It recommends choices that maximize utility using quantizations of beliefs and desires in cases where (...) probabilities and utilities are indeterminate and using higher-order utility analysis in cases of limited access to probabilities and utilities. For agents burdened with mistakes, it advocates reasonable attempts to correct unacceptable mistakes before deciding. In decision problems without a stable top option, a topic of game theory, it proposes maximizing self-conditional utility among self-supporting options. In games of strategy, the new principles lead to solutions that are Pareto optimal among equilibria composed of jointly self-supporting strategies. Offering an account of bounded rationality, the bookmakes large strides toward realism in decision theory. (shrink)

Decision-making assisted by algorithms developed by machine learning is increasingly determining our lives. Unfortunately, full opacity about the process is the norm. Would transparency contribute to restoring accountability for such systems as is often maintained? Several objections to full transparency are examined: the loss of privacy when datasets become public, the perverse effects of disclosure of the very algorithms themselves (“gaming the system” in particular), the potential loss of companies’ competitive edge, and the limited gains in answerability to be (...) expected since sophisticated algorithms usually are inherently opaque. It is concluded that, at least presently, full transparency for oversight bodies alone is the only feasible option; extending it to the public at large is normally not advisable. Moreover, it is argued that algorithmic decisions preferably should become more understandable; to that effect, the models of machine learning to be employed should either be interpreted ex post or be interpretable by design ex ante. (shrink)

In recent years, some have argued that supported decision-making can be ethically superior to surrogate decision-making with respect to decisions involving adults with cognitive and intellectual impairments or disabilities. In this paper, we argue that supported decision-making could also be ethically superior to surrogate decision-making in the context of clinical research that involves greater than minimal net risks. In current practice, adults who lack decisional capacity are often excluded from research that involves greater than minimal net (...) risks (call this the minimal risk requirement). While this approach is intended to protect them, it can be ethically problematic, in part because excluding adults who cannot consent blocks scientifically valuable research that needs to enroll them and undermines the generalizability of the research that excludes them. With this concern in mind, we argue that supported decision-making can provide an ethical means to enroll adults who cannot independently consent in greater than minimal net risk research. Supported decision-making thus offers a valuable modification to the surrogate enrollment requirement, and provides good reason to reject the minimal risk requirement as well. (shrink)

Decision theory and the theory of rational choice have recently been the subjects of considerable research by philosophers and economists. However, no adequate anthology exists which can be used to introduce students to the field. This volume is designed to meet that need. The essays included are organized into five parts covering the foundations of decision theory, the conceptualization of probability and utility, pholosophical difficulties with the rules of rationality and with the assessment of probability, and causal (...) class='Hi'>decision theory. The editors provide an extensive introduction to the field and introductions to each part. (shrink)

Evidential Decision Theory is a radical theory of rational decision-making. It recommends that instead of thinking about what your decisions *cause*, you should think about what they *reveal*. This Element explains in simple terms why thinking in this way makes a big difference, and argues that doing so makes for *better* decisions. An appendix gives an intuitive explanation of the measure-theoretic foundations of Evidential Decision Theory.

Algorithm Decision Making (ADM) systems designed to augment or automate human decision-making have the potential to produce better decisions while also freeing up human time and attention for other pursuits. For this potential to be realised, however, algorithmic decisions must be sufficiently aligned with human goals and interests. We take a Principal-Agent (P-A) approach to the questions of ADM alignment and trust. In a broad sense, ADM is beneficial if and only if human principals can trust algorithmic agents (...) to act faithfully on their behalf. This mirrors the challenge of facilitating P-A relationships among humans, but the peculiar nature of human-machine interaction also raises unique issues. The problem of asymmetric information is omnipresent but takes a different form in the context of ADM. Although the decision-making machinery of an algorithmic agent can in principle be laid bare for all to see, the sheer complexity of ADM systems based on deep learning models prevents straightforward monitoring. We draw on literature from economics and political science to argue that the problem of trust in ADM systems should be addressed at the level of institutions. Although the dyadic relationship between human principals and algorithmic agents is our ultimate concern, cooperation at this level must rest against an institutional environment which allows humans to effectively evaluate and choose among algorithmic alternatives. (shrink)

Federal disability anti-discrimination laws expect clinical trials to render study processes and sites accessible to potential participants, including through the provision of reasonable accommodations. Nonetheless, people with disabilities, and particularly people with mental illness, are often excluded from clinical trials. Supported decision-making, a strategy that allows people to select trusted others to help them understand and communicate decisions, is an important accommodation to further inclusion. However, because mental illness can be dynamic and vary widely in nature (e.g., diagnosis, symptom (...) severity, functional impairment) and duration (e.g., short-term, intermittent, progressive, permanent), supported decision-making is neither a one-size-fits-all strategy nor one that can serve as a reasonable accommodation in every situation. While prior work on supported decision-making has focused predominantly on adults with intellectual and developmental disabilities or dementias, people with mental illness may also benefit from supported decision-making, although the variability in decision-making capacity in mental illness presents nuanced challenges. Here, we explore supported decision-making in the case of people with intermittent or episodic mental illness that may impact decision-making capacity to varying degrees at different times. (shrink)

Causal decision theory (CDT) cares only about the effects of a contemplated act, not its causes. The article constructs a case in which CDT consequently recommends a bet that the agent is certain to lose, rather than a bet that she is certain to win. CDT is plainly giving wrong advice in this case. It therefore stands refuted. 1 The Argument2 The Argument in More Detail2.1 The betting mechanism2.2 Soft determinism2.3 The content of P 2.4 The argument again3 The (...) Descriptive Premise3.1 Causal decision theory3.2 Causal decision theory prefers A14 The Normative Premise5 Objections5.1 Table 1 and Table 2 are misleading5.2 The agency theory of causation5.3 The payment mechanism5.4 Newcomb’s problem5.5 Against the normative premise5.6 Drop soft determinism. (shrink)

Decision-making capacity (DMC) is the gatekeeping element for a patient’s right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally (...) differs from existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one’s judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one’s own subjectivity may be experienced as unsettling. (shrink)

Epistemic decision theory (EDT) employs the mathematical tools of rational choice theory to justify epistemic norms, including probabilism, conditionalization, and the Principal Principle, among others. Practitioners of EDT endorse two theses: (1) epistemic value is distinct from subjective preference, and (2) belief and epistemic value can be numerically quantified. We argue the first thesis, which we call epistemic puritanism, undermines the second.

Shared decision-making (“SDM”) has increased in acceptance and become a gold standard in medical decision-making over the last two decades. Despite this, there continues to be disagreement about several facets of SDM that many existing models or versions do not sufficiently address, including: that there is a lack of agreement about which version or model of SDM to utilize in practice; that there are practical limitations on when SDM ought to be utilized; that SDM may be required to (...) use different “harm thresholds” when making decisions for patients who have lost decision-making capacity or competence, or for those who have never had such capacity in the first place; and that many existing models of SDM succumb to what is known as the “framing problem,” among other concerns. Elsewhere, this author presented a model of SDM titled, the Professionally-Driven Zone of Patient or Surrogate Discretion (or, Professionally-Driven ZPSD) as a more comprehensive and defensible way forward. This article sets out to expand on the expected benefits of the model, and apply it to several case studies in the acute-care setting in order to demonstrate its functionality as a model of SDM. (shrink)

Our decision-theoretic states are not luminous. We are imperfectly reliable at identifying our own credences, utilities and available acts, and thus can never be more than imperfectly reliable at identifying the prescriptions of decision theory. The lack of luminosity affords decision theory a remarkable opportunity — to issue guidance on the basis of epistemically inaccessible facts. We show how a decision theory can guarantee action in accordance with contingent truths about which an agent is arbitrarily uncertain. (...) It may seem that such advantages would require dubiously adverting to externalist facts that go beyond the internalism of traditional decision theory, but this is not so. Using only the standard repertoire of decision-theoretic tools, we show how to modify existing decision theories to take advantage of this opportunity. These improved decision theories require agents to maximize conditional expected utility — expected utility conditional upon an agent’s actual decision situation. We call such modified decision theories ‘self-confident’. These self-confident decision theories have a distinct advantage over standard decision theories: their prescriptions are better. (shrink)

Algorithmic decision-making based on profiling may significantly affect people’s destinies. As a rule, however, explanations for such decisions are lacking. What are the chances for a “right to explanation” to be realized soon? After an exploration of the regulatory efforts that are currently pushing for such a right it is concluded that, at the moment, the GDPR stands out as the main force to be reckoned with. In cases of profiling, data subjects are granted the right to receive meaningful (...) information about the functionality of the system in use; for fully automated profiling decisions even an explanation has to be given. However, the trade secrets and intellectual property rights (IPRs) involved must be respected as well. These conflicting rights must be balanced against each other; what will be the outcome? Looking back to 1995, when a similar kind of balancing had been decreed in Europe concerning the right of access (DPD), Wachter et al. (2017) find that according to judicial opinion only generalities of the algorithm had to be disclosed, not specific details. This hardly augurs well for a future right of access let alone to explanation. Thereupon the landscape of IPRs for machine learning (ML) is analysed. Spurred by new USPTO guidelines that clarify when inventions are eligible to be patented, the number of patent applications in the US related to ML in general, and to “predictive analytics” in particular, has soared since 2010—and Europe has followed. I conjecture that in such a climate of intensified protection of intellectual property, companies may legitimately claim that the more their application combines several ML assets that, in addition, are useful in multiple sectors, the more value is at stake when confronted with a call for explanation by data subjects. Consequently, the right to explanation may be severely crippled. (shrink)

For counselors, the welfare of clients and the protection of the community are grounded in comprehension and implementation of ethical principles in practice. Counselors face increasing ethics complexity as organizational and political influences conflict with client’s self-interest. Two thought-experiments involving a Tarasoff-like dilemma were used to explore factors related to ethical decision-making by clinicians in definitive and ambiguous duty-to-warn situations. Outcomes demonstrated that legal, moral, and social factors influenced ethical decision-making in a non-probability sample of 221 U.S. counselors (...) who participated in the thought-experiment study. Increasing ethical uncertainty was related to a decrease in direct action, stronger influence of moral and social factors, and the stronger influence of ethical self-efficacy on decision-making. This study bridges the cognitive model of moral reasoning and social cognitive theory, extending the concept of agency into the ethical domain and suggesting refinements to moral reasoning models. Implications are discussed. (shrink)

Surrogate decision-making refers to authorizing a third person (a proxy) to make decisions about the healthcare treatment provided by a professional to a patient who is unable to express his or her wishes as a result of being, say, a minor, mentally incapacitated, senile, or no longer self-aware. Such a proxy can be a close family member biologically (parents and children), legally (spouses), or affectively (a close family member or friend). The proxy can perform this role informally or when (...) legally designated formally. (shrink)

The decision making process is an important aspect of the managerial function that is becoming increasingly complex due to technological and global impacts. It is essential, therefore, to understand why various managers approach the decision making process differently. One area that is related to how managers perceive and process the information that is associated with decision making, is that of decision style.It is not enough, however, to explore decision style in isolation, as some of the (...) decisions that managers make often entail ethical components concerning the ability to balance the interests of diverse groups. Moral reasoning is therefore important for every manager, and could impact the decision style that is employed by such managers. The relationship between managerial decision style and moral development is one that could provide unique insights into the area of decision making, yet it is an area that has remained relatively unexplored. (shrink)

Is Bayesian decision theory a panacea for many of the problems in epistemology and the philosophy of science, or is it philosophical snake-oil? For years a debate had been waged amongst specialists regarding the import and legitimacy of this body of theory. Mark Kaplan had written the first accessible and non-technical book to address this controversy. Introducing a new variant on Bayesian decision theory the author offers a compelling case that, while no panacea, decision theory does in (...) fact have the most profound consequences for the way in which philosophers think about inquiry, criticism and rational belief. The new variant on Bayesian theory is presented in such a way that a non-specialist will be able to understand it. The book also offers new solutions to some classic paradoxes. It focuses on the intuitive motivations of the Bayesian approach to epistemology and addresses the philosophical worries to which it has given rise. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts (...) about who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first address the question which components should be part of IDM in the context of cancer screening. Departing from two diverging interpretations of the value of autonomy—as a right and as an (...) ideal—we describe how this value is operationalized in the practice of informed consent in medicine and translate this to IDM in population-based cancer screening. Next, we specify components of IDM, which is voluntariness and the requirements of disclosure and understanding. We argue that whereas disclosure should contain all information considered relevant in order to enable authentic IDM, understanding of basic information is sufficient for a valid IDM. In the second part of the paper we apply the capability approach in order to argue for the responsibility of the government to warrant equal and real opportunities for invitees for IDM. We argue that additional conditions beyond mere provision of information are needed in order to do so. (shrink)

Supported decision making is a model of decision making in which an adult with impaired capacity enters freely into an agreement with a closely trusted person or persons (the “s...

Decision-making capacity (DMC) is normally taken to include (1) understanding (and appreciation); (2) the ability to deliberate or weigh up; and (3) the ability to express a choice. In an article published recently in PPP, Jacinta Tan and her colleagues (2006) suggest that DMC requires also (4) the absence of 'pathological values' (i.e., values that arise from mental disorder). In this paper, I argue that although (1)–(3) might be necessary for DMC, (4) is not necessary (barring cases where pathological (...) values interfere with (1)–(3)). My argument will simply be that (4) fails to be supported by the empirical data provided by Tan et al., which I claim supports the view that people with pathological values do often have DMC. I also consider but reject the claim that pathological values entail incapacity because they are not 'authentic' to the person. I conclude that the absence of pathological values does not constitute an additional element of DMC and that we cannot justify compulsory treatment of people who have (1)–(3), but not (4), on the grounds they lack DMC. (shrink)

Ethical decision-making descriptive theoretical models often conflict with each other and typically lack comprehensiveness. To address this deficiency, a revised EDM model is proposed that consolidates and attempts to bridge together the varying and sometimes directly conflicting propositions and perspectives that have been advanced. To do so, the paper is organized as follows. First, a review of the various theoretical models of EDM is provided. These models can generally be divided into rationalist-based ; and non-rationalist-based. Second, the proposed model, (...) called ‘Integrated Ethical Decision Making,’ is introduced in order to fill the gaps and bridge the current divide in EDM theory. The individual and situational factors as well as the process of the proposed model are then described. Third, the academic and managerial implications of the proposed model are discussed. Finally, the limitations of the proposed model are presented. (shrink)

Decision theory has at its core a set of mathematical theorems that connect rational preferences to functions with certain structural properties. The components of these theorems, as well as their bearing on questions surrounding rationality, can be interpreted in a variety of ways. Philosophy’s current interest in decision theory represents a convergence of two very different lines of thought, one concerned with the question of how one ought to act, and the other concerned with the question of what (...) action consists in and what it reveals about the actor’s mental states. As a result, the theory has come to have two different uses in philosophy, which we might call the normative use and the interpretive use. It also has a related use that is largely within the domain of psychology, the descriptive use. This essay examines the historical development of decision theory and its uses; the relationship between the norm of decision theory and the notion of rationality; and the interdependence of the uses of decision theory. (shrink)

Ethical decision-making research has centered on Rest’s framework that represents a rational, nonaffective model for ethical decision making. However, research in human cognition suggesting a “dual-processing” framework, composed of both rational and affective components, has been relatively ignored in the ethical decision-making literature. Examining dual-processing literature, it seems affect might be an important factor in decision making when a person’s mood is congruent with the task or situational context frame. Given that ethical decisions are serious and (...) complex tasks, it is proposed here that inducing a negative affective state might produce mood congruence, reinforce the salience of emotion for ethical decision makers, and lead to differences in decision processing. Evidence is presented documenting differences in the decisions made by ethical decision makers in a negative affective state as compared to those in either a positive or neutral affective state. (shrink)

Orthodox decision theory gives no advice to agents who hold two goods to be incommensurate in value because such agents will have incomplete preferences. According to standard treatments, rationality requires complete preferences, so such agents are irrational. Experience shows, however, that incomplete preferences are ubiquitous in ordinary life. In this paper, we aim to do two things: (1) show that there is a good case for revising decision theory so as to allow it to apply non-vacuously to agents (...) with incomplete preferences, and (2) to identify one substantive criterion that any such non-standard decision theory must obey. Our criterion, Competitiveness, is a weaker version of a dominance principle. Despite its modesty, Competitiveness is incompatible with prospectism, a recently developed decision theory for agents with incomplete preferences. We spend the final part of the paper showing why Competitiveness should be retained, and prospectism rejected. (shrink)

Decision-making Capacity matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; and (...) concern for sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy. (shrink)

Newcomb's problem and similar cases show the need to incorporate causal distinctions into the theory of rational decision; the usual noncausal decision theory, though simpler, does not always give the right answers. I give my own version of causal decision theory, compare it with versions offered by several other authors, and suggest that the versions have more in common than meets the eye.

Causal decision theory is one of our most prominent theories of rational choice and the “why ain’cha rich?” argument is one of the most prominent objections to this theory. According to WAR, CDT is not an adequate theory of rational choice because it leads agents to make decisions that foreseeably leave them less well off than agents that decide in some other manner. Some philosophers take WAR to decisively undermine CDT. On the other hand, others take WAR to fail (...) to resolve the debate over CDT’s adequacy. In this paper, I will defend this second view: WAR does not resolve the debate at hand but instead leads to deadlock. Then, in the second half of this paper, I will show that this deadlock is not broken by a recent variant on WAR due to Caspar Hare and Brian Hedden. Not only does this result have implications for the debate over CDT’s adequacy but this discussion also casts light on the broader success/rationality link. (shrink)

I defend counterfactual decision theory, which says that you should evaluate an action in terms of which outcomes would likely obtain were you to perform it. Counterfactual decision theory has traditionally been subsumed under causal decision theory as a particular formulation of the latter. This is a mistake. Counterfactual decision theory is importantly different from, and superior to, causal decision theory, properly so called. Causation and counterfactuals come apart in three kinds of cases. In cases (...) of overdetermination, an action can cause a good outcome without the latter counterfactually depending on the former. In cases of constitution, an action can constitute a good outcome rather than causing it. And in cases of determinism, either the laws or the past counterfactually depend on your action, even though your action cannot cause the laws or the past to be different. In each of these cases, it is counterfactual decision theory which gives the right verdict, and for the right reasons. (shrink)

Bayesian decision theory operates under the fiction that in any decision-making situation the agent is simply given the options from which he is to choose. It thereby sets aside some characteristics of the decision-making situation that are pre-analytically of vital concern to the verdict on the agent's eventual decision. In this paper it is shown that and how these characteristics can be accommodated within a still recognizably Bayesian account of rational agency.

Most philosophers agree that causal knowledge is essential to decision-making: agents should choose from the available options those that probably cause the outcomes that they want. This book argues against this theory and in favour of evidential or Bayesian decision theory, which emphasises the symptomatic value of options over their causal role. It examines a variety of settings, including economic theory, quantum mechanics and philosophical thought-experiments, where causal knowledge seems to make a practical difference. The arguments make novel (...) use of machinery from other areas of philosophical inquiry, including first-person epistemology and the free will debate. The book also illustrates the applicability of decision theory itself to questions about the direction of time and the special epistemic status of agents. (shrink)

Is Bayesian decision theory a panacea for many of the problems in epistemology and the philosophy of science, or is it philosophical snake-oil? For years a debate had been waged amongst specialists regarding the import and legitimacy of this body of theory. Mark Kaplan had written the first accessible and non-technical book to address this controversy. Introducing a new variant on Bayesian decision theory the author offers a compelling case that, while no panacea, decision theory does in (...) fact have the most profound consequences for the way in which philosophers think about inquiry, criticism and rational belief. The new variant on Bayesian theory is presented in such a way that a non-specialist will be able to understand it. The book also offers new solutions to some classic paradoxes. It focuses on the intuitive motivations of the Bayesian approach to epistemology and addresses the philosophical worries to which it has given rise. (shrink)

Causal decision theory (CDT) is a general theory of rational decision, appropriate for simple or complex decision problems. It is an expected utility theory distinguished by its explicit attention to causal features of decision problems, and by the significance it attaches to those features. When the causal structure of a decision problem is uncomplicated, the recommendations of CDT and other theories generally agree. In more complex cases, however, CDT identifies rational decisions where other theories do (...) not. Several varieties of CDT have been offered; they differ in their ways of representing beliefs about causal influence, but as decision theories they are very similar. Each of them was developed as a subjective expected utility theory, and that approach will be assumed here. (shrink)

Medical decision-making for individuals lacking the capacity to consent often involves ethically and emotionally challenging deliberations, how to make appropriate surrogate decisions in acute settings, and how to plan in advance. This is particularly true for two patient populations: (1) adults who have lost their decision-making capacity and whose presumed wishes are unknown, and (2) individuals with congenital incapacity due to lifelong cognitive impairments. This study aimed to critically synthesize the existing literature on surrogate decision-making and advance (...) care planning (ACP) for these populations, as there are currently no detailed national guidelines for navigating such complex situations. A scoping review was conducted in accordance with PRISMA-ScR guidelines. Four databases (PubMed, Scopus, Web of Science, and Google Scholar) were searched. Eligible articles included those published in English or German since 2010 that addressed decision-making and documentation for adults lacking judgement capacity and whose preferences are unknown. 15 relevant publications were included. These addressed key concepts such as the best interest standard, substituted decision-making and quality of life, and reflected on the use of tools like Patient Preference Predictors. However, none offered detailed guidance on how to implement surrogate decision-making or ACP in practice for cognitively impaired individuals. Surrogate decision-making for individuals without known preferences or a living will remains insufficiently structured and ethically ambiguous. While the need for national guidelines is widely recognized, existing frameworks fail to translate ethical principles into practical, actionable steps. The development of detailed, transparent, and ethically grounded guidelines is urgently required to support decision-making in clinical practice. (shrink)

Evidential decision theory (EDT) says that the choiceworthiness of an option depends on its evidential connections to possible outcomes. Causal decision theory (CDT) holds that it depends on your beliefs about its causal connections. While Newcomb cases support CDT, Arif Ahmed has described examples that support EDT. A new account is needed to get all cases right. I argue that an option A's choiceworthiness is determined by the probability that a good outcome ensues at possible A‐worlds that match (...) actuality in the facts causally unaffected by your decision (the “unaffected facts”). Moreover, you should evaluate A on the assumption that A is compossible with the unaffected facts. This view entails that you should use EDT when evaluating A on the assumption that the unaffected facts determine your action, but use CDT when assessing A on the opposite assumption. A's choiceworthiness equals a weighted average of these conditional assessments. The weights are determined by your beliefs about whether the unaffected fact determine your action. This account gets both Newcomb and Ahmed cases right. According to an influential view, whether you take the unaffected facts to determine your action can make a difference to whether you can regard yourself as free and the action as being under your control. While my account is neutral on this issue, it entails that whether you take the unaffected facts to determine your action is important in a different way: it matters to whether you should follow EDT or CDT. (shrink)

The decision problem for provability logic remains PSPACE-complete even if the number of propositional atoms is restricted to one.

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity (...) care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)