What Clinical Ethics Can Learn From Decision Science

Michele C. Gornick and Brian J. Zikmund-Fisher
AMA J Ethics. 2019;21(10):E906-912.
doi: 10.1001/amajethics.2019.906.

Abstract

Many components of decision science are relevant to clinical ethics practice. Decision science encourages thoughtful definition of options, clarification of information needs, and acknowledgement of the heterogeneity of people’s experiences and underlying values. Attention to decision-making processes reminds participants in consultations that how decisions are made and how information is provided can change a choice. Decision science also helps reveal affective forecasting errors (errors in predictions about how one will feel in a future situation) that happen when people consider possible future health states and suggests strategies for correcting these and other kinds of biases. Implementation of decision science innovations is not always feasible or appropriate in ethics consultations, but their uses increase the likelihood that an ethics consultation process will generate choices congruent with patients’ and families’ values.

Here is an excerpt:

Decision Science in Ethics Practice

Clinical ethicists can support informed, value-congruent decision making in ethically complex clinical situations by working with stakeholders to identify and address biases and the kinds of barriers just discussed. Doing so requires constantly comparing actual decision-making processes with ideal decision-making processes, responding to information deficits, and integrating stakeholder values. One key step involves regularly urging clinicians to clarify both available options and possible outcomes and encouraging patients to consider both their values and the possible meanings of different outcomes.

‘But you can’t do that!’ Why immoral actions seem impossible

Jonathan Phillips

Aeon

Originally posted September 29, 2017

Suppose that you’re on the way to the airport to catch a flight, but your car breaks down. Some of the actions you immediately consider are obvious: you might try to call a friend, look for a taxi, or book a later flight. If those don’t work out, you might consider something more far-fetched, such as finding public transportation or getting the tow-truck driver to tow you to the airport. But here’s a possibility that would likely never come to mind: you could take a taxi but not pay for it when you get to the airport. Why wouldn’t you think of this? After all, it’s a pretty sure-fire way to get to the airport on time, and it’s definitely cheaper than having your car towed.

One natural answer is that you don’t consider this possibility because you’re a morally good person who wouldn’t actually do that. But there are at least two reasons why this doesn’t seem like a compelling answer to the question, even if you are morally good. The first is that, though being a good person would explain why you wouldn’t actually do this, it doesn’t seem to explain why you wouldn’t have been able to come up with this as a solution in the first place. After all, your good moral character doesn’t stop you from admitting that it is a way of getting to the airport, even if you wouldn’t go through with it. And the second reason is that it seems equally likely that you wouldn’t have come up with this possibility for someone else in the same situation – even someone whom you didn’t know was morally good.

So what does explain why we don’t consider the possibility of taking a taxi but not paying? Here’s a radically different suggestion: before I mentioned it, you didn’t think it was even possible to do that. This explanation probably strikes you as too strong, but the key to it is that I’m not arguing that you think it’s impossible now, I’m arguing that you didn’t think it was possible before I proposed it.

The article is here.

Executive whistle blowing: what to do when no one listens

By Andrea Bonime-Blanc on Nov 5, 2013
The Ethical Corporation

I recently heard a keynote address by the former chief executive of Olympus, Michael Woodford. Woodford was the Olympus boss who within months of his appointment blew the whistle on the company’s multi-year $1bn-plus financial fraud. After exposing the company’s fraud, Woodford wrote about it in the book Exposure, soon to become a movie.

This example underscores the difficulty that all whistleblowers (or people who dare to speak up) experience within their organisations. Speaking up about perceived or actual wrongdoing can be one of the most difficult and vexing ethical, moral, legal and personal dilemmas anyone can face in their lifetime. The stories of those who have blown the whistle only to be ostracised, demoted or terminated are the stuff of the bestseller lists and box office blockbusters.

The entire article is here.