Judgement, decision, and integrity

Although Aristotle did not mention it, integrity can be understood in an Aristotelian framework. Seeing it in these terms will show that it is an executive virtue which concerns the existential well being of an agent. This analysis is not offered as an exegesis of Aristotle's text, but as an attempt to use an Aristotelian framework to understand a virtue deemed important today. This account will have the benefit of solving some problems relating to motivational internalism and, as such, will contribute to that recent current of thought which has been highlighting the importance of virtue thinking in moral theory. I will distinguish moral judgement from decision and show that moral judgement is dependent upon virtue more strongly than it is upon impartial rationality. I will suggest that integrity is the virtue to which moral judgement gives expression and is the virtue which links judgement to decision so as to overcome akrasia.

Decision making in health care: limitations of the substituted judgement principle

The substituted judgement principle is often recommended as a means of promoting the self-determination of an incompetent individual when proxy decision makers are faced with having to make decisions about health care. This article represents a critical ethical analysis of this decision-making principle and describes practical impediments that serve to undermine its fundamental purpose. These impediments predominantly stem from the informality associated with the application of the substituted judgement principle. It is recommended that the principles upon which decisions are made about health care for another person should be transparent to all those involved in the process. Furthermore, the substituted judgement principle requires greater rigour in its practical application than currently tends to be the case. It may be that this principle should be subsumed as a component of advance directives in order that it fulfils its aim of serving to respect the self-determination of incompetent individuals.

Measuring moral judgement and the implications of cooperative education and rule-based learning

The Defining Issues Test (DIT), developed by Rest (1986), measures a person's level of moral development using hypothetical social dilemmas. Although the DIT is useful for measuring moral development in social settings, it might not adequately capture an individual's moral judgement abilities in solving work-related problems (Weber, 1990; Trevino, 1992; Welton et al., 1994). In the present study, the moral judgement levels of 97 accounting students were measured over a 1 year period using two separate test instruments, the DIT and a context-specific instrument developed by Welton et al. (1994). The test scores are significantly higher on the DIT than the Welton instrument (between the instruments and over time), suggesting that accounting students use higher levels of moral reasoning in resolving hypothetical social dilemmas and lower levels of moral reasoning in resolving context-specific dilemmas. The difference in test scores was highest during cooperative education (work placement programme), implying that the environment is a significant determinant on students' test scores.

Nurses' critical event risk assessments : a judgement analysis

Aims. To explore and explain nurses' use of readily available clinical information when deciding whether a patient is at risk of a critical event.

Background. Half of inpatients who suffer a cardiac arrest have documented but unacted upon clinical signs of deterioration in the 24 hours prior to the event. Nurses appear to be both misinterpreting and mismanaging the nursing-knowledge 'basics' such as heart rate, respiratory rate and oxygenation. Whilst many medical interventions originate from nurses, up to 26% of nurses' responses to abnormal signs result in delays of between one and three hours.

Methods. A double system judgement analysis using Brunswik's lens model of cognition was undertaken with 245 Dutch, UK, Canadian and Australian acute care nurses. Nurses were asked to judge the likelihood of a critical event, 'at-risk' status, and whether they would intervene in response to 50 computer-presented clinical scenarios in which data on heart rate, systolic blood pressure, urine output, oxygen saturation, conscious level and oxygenation support were varied. Nurses were also presented with a protocol recommendation and also placed under time pressure for some of the scenarios. The ecological criterion was the predicted level of risk from the Modified Early Warning Score assessments of 232 UK acute care inpatients.

Results. Despite receiving identical information, nurses varied considerably in their risk assessments. The differences can be partly explained by variability in weightings given to information. Time and protocol recommendations were given more weighting than clinical information for key dichotomous choices such as classifying a patient as 'at risk' and deciding to intervene. Nurses' weighting of cues did not mirror the same information's contribution to risk in real patients. Nurses synthesized information in non-linear ways that contributed little to decisional accuracy. The low-moderate achievement (Ra) statistics suggests that nurses' assessments of risk were largely inaccurate; these assessments were applied consistently among 'patients' (scenarios). Critical care experience was statistically associated with estimates of risk, but not with the decision to intervene.

Conclusion. Nurses overestimated the risk and the need to intervene in simulated paper patients at risk of a critical event. This average response masked considerable variation in risk predictions, the need for action and the weighting afforded to the information they had available to them. Nurses did not make use of the linear reasoning required for accurate risk predictions in this task. They also failed to employ any unique knowledge that could be shown to make them more accurate. The influence of time pressure and protocol recommendations depended on the kind of judgement faced suggesting then that knowing more about the types of decisions nurses face may influence information use.

Relevance to clinical practice. Practice developers and educators need to pay attention to the quality of nurses' clinical experience as well as the quantity when developing judgement expertise in nurses. Intuitive unaided decision making in the assessment of risk may not be as accurate as supported decision making. Practice developers and educators should consider teaching nurses normative rules for revising probabilities (even subjective ones) such as Bayes' rule for diagnostic or assessment judgements and also that linear ways of thinking, in which decision support may help, may be useful for many choices that nurses face. Nursing needs to separate the rhetoric of 'holism' and 'expertise' from the science of predictive validity, accuracy and competence in judgement and decision making.

Renegade judgement : a study of madness in medicine and literature

Explores socio-historical understandings and treatments of madness, examining literary works alongside contemporary medical texts. Incorporating notions of scientific objectivity, individual subjectivity and social totality, the thesis shows conceptual overlaps between art and science, identifying continuities and conflicts between fictional, clinical and cultural investigations into madness.

Representation and judgement : 'privileged' Jews in Holocaust writing and film

This thesis analyses the ways in which moral judgements of so-called privileged Jews are constructed in Holocaust representations. ‘Privileged’ Jews include those prisoners in the camps and ghettos who held positions which gave them access to material and other benefits. Subject to extreme levels of coercion, these victims were compelled to act in ways that have often been judged as both self-serving and harmful to fellow inmates. Such controversial figures constitute an intrinsically important, frequently misunderstood and hastily judged facet of the Holocaust. Scholars have neglected the problem of judgement in relation to ‘privileged’ Jews; nonetheless, Holocaust texts frequently portray these liminal figures.

Of crucial importance to the thesis is Primo Levi’s paradigmatic essay entitled ‘The Grey Zone,’ which directly engages with the complex and sensitive issue of ‘privileged’ Jews. Levi argues that due to the extreme ethical dilemmas that ‘privileged’ Jews confronted, any judgement of these victims needs to be suspended. However, if, as Levi suggests, judgement is at times impossible, the thesis challenges Levi’s assumption by contending that representations of ‘privileged’ Jews inevitably take a moral position. In this way, the thesis conceptualises judgement as a ‘limit’ of representation. Indeed, it is shown that Levi himself cannot abstain from judging those for whom he argues judgement should be suspended.

The thesis takes Levi’s concept of the ‘grey zone’ as a point of departure in order to examine the problems of judgement and representation in relation to ‘privileged’ Jews. Analysis focuses on Raul Hilberg’s influential historical work and examples of documentary and fiction films. The thesis examines how Hilberg and several filmmakers employ conventions as a means of conveying judgement. It is argued that self-reflexive representations of ‘privileged’ Jews in film, particularly fictional dramatisation, have the potential to provide a nuanced representation of ‘privileged’ Jews, which engages with Levi’s ideas by questioning the possibility of judgement.

Confronting 'choiceless choices' in Holocaust videotestimonies : judgement, 'privileged' Jews, and the role of the interviewer

'Privileged' Jews include those prisoners in the camps and ghettos who held positions which gave them access to material and other benefits. Subject to extreme levels of coercion, these victims were compelled to act in ways that have been judged as both self-serving and harmful to fellow inmates. Such situations, which exemplify what influential theorist Lawrence Langer terms 'choiceless choices', are the chief concern of Primo Levi's paradigmatic essay on the 'grey zone'. In light of these key conceptualizations of the ethical dilemmas of Holocaust victims, the paper analyses the representation of 'privileged' Jews in several videotestimonies recorded at the Jewish Holocaust Museum and Research Centre (JHMRC) in Melbourne, Australia. It will be shown that judgements of victims in extremis cause considerable problems for attempts to testify to the complex situations and experiences of 'privileged' Jews. The role of the interviewer is a crucial factor in this, particularly when interviewers are themselves Holocaust survivors. The paper reveals that while it might be argued that moral evaluations of 'privileged' Jews should be suspended, judgements are often imposed on Holocaust testimonies in various ways and have a significant impact on their content.

Judgement, reflexivitiy and interdisiciplinarity : reframing construction management education

A core skill of the construction management professional is decision making. Disciplinary content knowledge provides the basis for effective decision making, but is largely insufficient in contexts where projects demand a responsive and flexible approach to scenarios as they evolve and change. As Beckett and Hager suggest, ‘professional practice requires a much richer set of phenomena – a capacity to make judgements, sensitivity to intuition and an awareness of the purposes of the actions are all involved ‘(2002: 12). This paper begins by exploring judgement to develop a conceptual model for initiating and developing decision making skills for construction management professionals. The capacity to respond to change in a structured and self aware manner is examined through the concept of reflexivity, a concept borrowed from sociology. Reflexivity is an individual’s capacity to be aware, responsive and adaptability to constant changing and evolving environments. Coupled with this is the challenge for all built environment professionals in the need to integrate knowledge and processes from various specialist knowledge domains, particularly design domains. The conceptual model is then refined by synthesising concepts from interdisciplinary research.

The aim of this paper is to describe a framework to analyse and review current undergraduate and postgraduate coursework programs offerings from Deakin University in the School of Architecture and Building. Following Boud and Falchikov (2007) this framework starts with practice, that is, the actual ‘doing’ of construction management as the basis for shaping curriculum development.

The role of assessment in the development of judgement

This paper introduces an integrated assessment model developed within a project management discipline stream in a Construction Management course. Following Boud and Falchikov (2007) this model starts with practice, that is, the actual ‘doing’ of project management as the basis for shaping assessment that equips students to learn for the rest of their lives. Practice is understood as a holistic conception of what professionals do in particular contexts, and a theoretical construct that provides a method of framing ways in which we can investigate the world (Schatzki, 2001). This approach opens the way for considerations of assessment that engage with, and cultivate, certain kinds of professional learning and identity formation including the development of judgement. Integral to the model is the non-sequential nature of assessment activities, evolving team formation and ongoing self and communal reflection. The paper concludes that the use of an authentic and integrated assessment model creates a compelling learning environment that contributes meaningfully to the development of skills, knowledge and identities for future professional learning.

Unconscionable conduct : an evolving moral judgement

Statutory unconscionable conduct has been a controversial component of Australia's consumer laws since well before the first provision was introduced in 1986. Nevertheless, it has survived numerous reviews and has expanded beyond its early focus on consumers to provide small business - and, more recently, any business other than a listed company - statutory protection against unconscionable conduct occurring in trade or commerce.

Technophilia, neo-Luddism, eDependency and the judgement of Thamus

Purpose – The purpose of this paper is to reflect on society's relationship with technology and particularly our increasing dependence on electronic technology – so-called eDependency. The paper argues that technology is not neutral and we must engage with the moral issues that arise from our relationship with it.

Design/methodology/approach – Society's relationship with technology is examined through the lens of Socrates' consideration of the technology of writing. It identifies “technophilia” as a major theme in society and “neo-Luddism” as the Socrates-like examination of the benefits of technology.

Findings – While rejecting both technology determinism and technology presentism the paper argues technology is not neutral and does afford social change within a particular social ecology. The authors suggest that ultimately the use of all technology, including the technology underpinning eDependency, leads to important moral questions which deserve considered debate. The paper concludes by arguing that the Information Systems (IS) discipline should take the mantle of King Thamus and that the study of these issues should become a key concern for the discipline.

Originality/value – In an age of technophilia, this paper calls considered debate on the moral issues that arise from our relationship with technology, how it is appropriated, to whose benefit, and how we change it and will be changed by it.

Screening women’s complicity in the holocaust : the problems of judgement and representation

This essay analyses the representation of female perpetrators in Holocaust fiction films, particularly in relation to the persecution of prisoners in the Nazi camps. The screening of women in general, and female perpetrators in particular, is shown to be problematic due to their frequent marginalisation and the gendered, voyeuristic ways in which women's bodies are often objectified in Holocaust films. While the actions of female perpetrators and their depiction in films pose acute problems of judgement and representation that need to be acknowledged, it is argued that films have the potential to effectively explore the issue of women's complicity in the Holocaust.