The ethics of surrogate decision making in medicine : autonomy, paternalism, or a different approach?

Knowing who to involve in treatment decisions when a patient is incapacitated has been the subject of discussion in bioethical, health law and clinical research. The major issues tend to revolve around the tension between exercising a degree of medical paternalism and respecting patient autonomy. Patients are encouraged to exert their autonomy even when they may not be capable of doing so, by means of surrogate consent or advanced directives. While liberal concepts of autonomy are exemplified in western bioethics and legal systems, clinically these decisions remain difficult, and input from medical professionals is sought, raising the issue of paternalism. A framework of bioethics, which places the patient in a relational context rather than a strictly autonomous one, may be a more helpful way of deliberating these difficult decisions

Security as an element in environmental assessment and decision making

he prominence of global warming as an environmental issue has illustrated the close relationship between natural resources, ecosystems and global security. Whilst environmental decision making often uses techniques such as economic valuation and risk management, the security component is often not considered, at least not from a security analyst’s perspective. Yet environmental security considerations can be global, regional and/or national in impact. Environmental change and policy can effect human health and well being as well as initiating conflict; it can affect the existence of life itself. These aspects are firmly in the domain of the security discipline although the protection of the global ecosystem has not traditionally been considered by those who create security policy. The idea of environmental/ecological security ranges from the eco-centric approach which examines the impact of human activities that impact on the security of the natural systems to the more traditional anthropocentric perspectives that look at varied issues such as conflict caused by natural resource competition and environmental degradation, and the greening of military operations. This paper will assert that the inclusion of the security factor in policy creation and environmental assessments is essential to give richer solutions to these complex socio-economic and ecological situations. Systems theory over the last few decades has emphasised the inclusion of as many perspectives on messy problems as possible to provide truly systemic outcomes. It is posited that the addition of such concepts as threat analyses will produce more effective and sustainable outcomes.

Lawyers and ethics in practice : the impact of clinical and ethics curricula on lawyers’ ethical decision-making

The authors have conducted a longitudinal study exploring the relationships between values and ethical behaviour for early-career legal practitioners. The study comprised a representative Australian cohort of final-year law students and tracked them through their first two years of employment or further study. It examined changes to ethical decision-making by presenting participants with hypothetical scenarios that provided ethical dilemmas. A questionnaire utilising hypothetical situations was presented in 11 scenarios. This chapter examines responses to the scenarios across the three years of the study, particularly exploring changes over time. Of particular interest were the effects of gender and prior ethics education on changing responses. Findings suggested significant differences between males and females in their ethical responses. They also suggested that involvement in clinical practice, in particular during the law degree, may have a positive impact on future willingness to assist access to justice (insofar as such lawyers were more inclined to participate in later pro bono activity).

Enhancing juror decision-making through provision of transcripts

This thesis explored how much evidence jurors remember when instructed to reach a verdict. Results indicated that jurors required to rely on memory recalled significantly less evidence than jurors provided with access to the court transcript and were less confident than aided jurors that they had returned the 'right' verdict. The portfolio explored a possible association between chronic childhood challenging behaviours and later offending behaviour in individuals with intellectual disability. Includes four clinical case studies. The importance of early intervention is illustrated.

The influence of need-for-cognition on ethical decision-making in marketing

The research established that the work-related norms of marketers and their socialisation into the marketing profession are influenced beneficially by their need-for-cognition. The research revealed contradictions between corporate codes of ethics and the values espoused by professional associations. Better ways of managing corporate ethical standards and behaviour are suggested.

Accounting : a framework for decision making

Thoroughly updated and re-sequenced in response to market feedback, Accounting: A Framework for Decision Making is an ideal first year accounting principles text. Presented in a straightforward style, the third edition focuses on key concepts and illustrates each concept with clear graphical or textual explanations and examples. The latest AASB standards and accounting techniques underpin the content throughout and new and revised questions have been added to the end of chapter material. With an accessible technical focus, Accounting: A Framework for Decision Making has a clear and broad content structure that means the book lends itself to both majors and non-majors courses.

Game situation information in video-based perceptual decision making : the influence of criticality of decisions

This study examined the effects of game situation information, manipulated in terms of time and score, on decisions made in a video-based perceptual test in basketball. The participants were undergraduate university students (n=159) who viewed 21 offensive basketball plays, under two test conditions (low decision criticality; high decision criticality). To manipulate the conditions, prior to each clip, the
participants were presented with a description of the remaining time and score differential. High decision criticality situations were characterised by a remaining time of 60 seconds or less and score differentials of 2 points or less. Low decision criticality situations were characterised by remaining time of 5 minutes or more and score differentials of 5 points or more. The participants indicated their decision (pass, shoot, dribble) after the visual display had been occluded for each clip. The results indicated that decision profiles differed under the low and high decision criticality conditions. More pass decisions were made under high decision criticality situations and more shoot decisions under low decision criticality situations. These variations differed according to the type of main sport played but not for the basketball competition level. It was concluded that game situation information does influence decision making and should be considered in video-based testing and training.

A critical evaluation of the standardisation potential of business plan evaluation aids (BPEA) used in venture capital investment decision-making

The research objective was to perform a critical evaluation and comparison of four, representative Business Plan Evaluation Aids (BPEA) to facilitate constructive discussion of the proposition that greater standardisation of venture capital decision-making might be both desirable and possible.

The four BPEA were systematically compared using a structured, taxonomic process employing seven key criteria. The evidence of this investigation suggests a clear superiority for BPEAs, which are based on the known attributes of successful ventures and use actuarial modelling. Discussion centred on the importance of using BPEAs in a quest for greater consistency of venture capital investment decision-making.

Medical error and decision making : learning from the past and present in intensive care

Background : Human error occurs in every occupation. Medical errors may result in a near miss or an actual injury to a patient that has nothing to do with the underlying medical condition. Intensive care has one of the highest incidences of medical error and patient injury in any specialty medical area; thought to be related to the rapidly changing patient status and complex diagnoses and treatments.

Purpose : The aims of this paper are to: (1) outline the definition, classifications and aetiology of medical error; (2) summarise key findings from the literature with a specific focus on errors arising from intensive care areas; and (3) conclude with an outline of approaches for analysing clinical information to determine adverse events and inform practice change in intensive care.

Data source : Database searches of articles and textbooks using keywords: medical error, patient safety, decision making and intensive care. Sociology and psychology literature cited therein.

Findings : Critically ill patients require numerous medications, multiple infusions and procedures. Although medical errors are often detected by clinicians at the bedside, organisational processes and systems may contribute to the problem. A systems approach is thought to provide greater insight into the contributory factors and potential solutions to avoid preventable adverse events.

Conclusion : It is recommended that a variety of clinical information and research techniques are used as a priority to prevent hospital acquired injuries and address patient safety concerns in intensive care.