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Abstract: This chapter provides an account of Dewey’s treatment of deliberation in Human Nature and Conduct (1922). Dewey presents deliberation as a dynamic, imaginative process of self-discovery rather than mere calculation. Instead, deliberation functions as a dramatic rehearsal of possible actions, shaping both our choices and our character. Rejecting mechanistic views that treat deliberation as weighing pros and cons, Dewey argues that it involves moral experimentation – imagining different paths and exploring what kind of person we wish to become. It is a process of self-constitution, revealing both external facts and internal values. As Heney illustrates, deliberation, for Dewey, is not just about decision-making but about shaping identity and moral growth. Dewey highlights deliberation’s social dimensions, emphasizing that moral understanding develops through interactions with others. The chapter illustrates how this aligns with his pragmatist ethics, which values flexibility, inquiry, and adaptation over rigid principles. Heney situates Dewey’s view within contemporary decision-making debates. While other approaches focus on responding to reasons, Dewey sees deliberation as transformative. Hard choices are not just about selecting the best option – they are opportunities to construct a meaningful life and actively shape the world we inhabit.
To explore cancer patients’ understanding of Advance Care Planning (ACP) and identify the main barriers hindering its effective implementation in clinical practice.
Methods
This qualitative descriptive study included Brazilian women with breast cancer aged 18–75 years, all with preserved functional status, recruited by convenience sampling. Exclusion criteria were difficulty using online calls or significant communication impairment. Data collection involved a sociodemographic questionnaire and a follow-up interview. After receiving an informational brochure, participants were contacted by video call 14 days later and asked, “How do you understand what ACP is?” Interviews were conducted confidentially at home, transcribed, and analyzed according to qualitative research reporting guidelines.
Results
Sixty-one women participated. Most had difficulty understanding ACP; nearly 40% could not define it. Main barriers included cultural resistance to discussing death, reliance on family members or physicians for decision-making, and lack of clear information. Many participants confused ACP with preventive care. A conceptual multilevel model was developed, showing how cultural taboos, family dependence, and systemic inertia interact to sustain barriers through a feedback loop in which cultural avoidance reinforces structural gaps and institutional neglect.
Significance of results
This study provides evidence on how ACP is understood and misinterpreted by cancer patients in a middle-income Latin American setting, an area that remains underrepresented in the literature. By demonstrating that misconceptions, cultural taboos, and systemic barriers operate through a reinforcing multilevel process, the findings offer a conceptual framework that explains why ACP remains marginal in routine oncology care. The model highlights critical points for intervention, including patient education, professional communication, and institutional support, and is directly applicable to similar sociocultural contexts characterized by strong family involvement and biomedical dominance. These results have clear implications, supporting the integration of ACP as a proactive, relational, and value-based process rather than a late end-of-life intervention.
To investigate the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.
Background:
Nurse independent prescribers in UK general practice are facing increasing complex clinical decision-making when assessing patients presenting acutely with undifferentiated and undiagnosed conditions as multimorbidity and polypharmacy becomes increasingly common. This qualitative study investigated the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.
Methods:
Fourteen general practice nurse prescribers were recruited through purposive sampling. Think aloud in response to staged vignettes was used followed by semi-structured interviews. Thematic analysis was used to analyse think aloud and interview data.
Findings:
Participants were experienced nurses with a range of clinical exposure and training who mostly made appropriate diagnostic and prescribing decisions. Pockets of expertise were revealed which reflected participants’ clinical experience, but there was a high rate of referral to the GP for some vignettes. Participants’ decision-making was underpinned by both analytical and intuitive processes, the quality of which was dependent on their individual knowledge and experience. A reliance on pattern recognition, aligned to intuitive decision-making, to determine the content of the consultations was identified as an area of risk and showed all participants to be inconsistent in their identification of complex factors. Omission of these factors could have important implications for prescribing decision-making. Organizational issues such as time-limited clinics also shaped the content of participants’ consultations, encouraged a limited, problem-focused approach, and reduced the opportunity for mentorship. Comprehensive knowledge, clinical experience, and mentorship are critical to ensure nurse prescribers make optimal decisions in the context of patients with multimorbidity. A team approach to the management of acute presentations in these patients is recommended to improve patient experience and maximize nurse prescribers’ contribution to the general practice workforce.
What shapes military attitudes of trust in artificial intelligence (AI) used for strategic-level decision-making? When used in concert with humans, AI is thought to help militaries maintain lethal overmatch of adversaries on the battlefield as well as optimize leaders’ decision-making in the war room. Yet it is unclear what shapes servicemembers’ trust in AI used for strategic-level decision-making. In October 2023, I administered a conjoint survey experiment among an elite sample of officers attending the US Army and Naval War Colleges to assess what shapes servicemembers’ trust in AI used for strategic-level deliberations. I find that their trust in AI used for strategic-level deliberations is shaped by a tightly calibrated set of technical, operational, and oversight considerations. These results provide the first experimental evidence for military attitudes of trust toward AI during crisis escalation, which have important research, policy, and modernization implications.
Jane was in imminent danger of an impending thyroid storm from her goiter and was experiencing intermittent psychosis. The clinical team was focusing on capacity evaluations as they found Jane to be angry, hostile, and difficult, and believed an involuntary hold was necessary as she was not consistently consenting to the surgery and trying to leave. As soon as Jane had the thyroidectomy she would return to her baseline as if nothing had happened. When I was training, I shared with a few close colleagues and mentors my nervousness about how I would be received as a clinical ethicist. I was cognizant that there would be some patients who may not appreciate my disability or see it as of value. In reality, Jane had a big ally in me and my disability helped me untangle some aspects of the case in a way that validated her experience. Nonetheless, clinical ethicists have a responsibility to actively assess and check for implicit bias within ourselves. As we caution our clinical colleagues not to be paternalistic in their practice, we, too, must not be paternalistic in ours.
Decision-making in oncology care is at best consequential and complex. This chapter explores a clinical ethics consultation exploring the difficult task of determining cancer directed therapy for a patient with a profound neurocognitive disability. The case highlights the ethics consultant’s and the multidisciplinary team’s missteps and failure to recognize that the true ethical question was not only “How can we ensure that this patient is treated equitably and receives the standard of care treatment,” but also “Is surgery really the right treatment option for this patient?” While disability rights activists have long proclaimed that all individuals should be granted equal access to healthcare, it is ethically permissible to tailor standards of care to meet the specific and unique needs of the patient sitting in front of you. This chapter illustrates the noble intent of clinicians and the limitations of substituted judgment in deciding for others.
“Moral distress” was introduced in nursing ethics to describe the experience of having the moral conviction about the right thing to do while having limited agency to enact it. It exists at the intersection of moral philosophy, moral psychology, and moral communities that influence our desires to act. Although moral distress has significantly impacted bioethics scholarship, it has had almost no presence in business ethics scholarship. We argue that moral distress is useful for understanding important problems of business ethics. We claim it may be missing from business ethics discourse not because it is not present but rather because it is ever-present, an existential condition brought on by the tension between profit maximization and other moral purposes. We consider how the moral communities of medicine and business can be morally supportive or distressing and set forth a taxonomy of moral conditions involving the relationship between knowledge, action, and desire.
Accountability in grant-making requires a valid, fair and transparent selection process. This study proposes a four-step framework for validating such a process: determine standards for qualified applicants, assess inter-reviewer reliability, assess factorial validity, and assess reliability. This framework is applied to the Corporation for National and Community Service’s 2013 RSVP grant-making process. The standards were close to the highest points of reliability. Inter-reviewer reliability was above 0.90, a common threshold for high-stakes measurement. After conducting confirmatory factor analysis, the final model merged two of the original five domains of selection criteria, resulting in four domains. The final model was found to have strict measurement invariance, high convergent validity, and measurement reliability between 0.88 and 0.93 for all domains. The results validate the 2013 review process and indicated that the scores exhibited high degrees of reliability, giving public assurance that the process was sufficiently objective and accurately reflected program priorities.
This article investigates the combined effect of experiential and reflective learning on student learning in international politics. It proceeds from the premise that students need a more realistic view of decision-makers so as to understand the logic and context of foreign policy-making better. A board game was used to model the foreign policy decision-making environment, and written and oral reflections were utilised to link students’ personal experience to abstract concepts of foreign policy analysis. Using a quasi-experimental design, both qualitative and quantitative data were used to test the hypotheses about students’ altered views of decision-making and their interest in and learning about foreign policy analysis. Results show that, in comparison with the impact of traditional lecturing combined with discussions, the benefits of experiential and reflective learning are very small. The little support for the existence of such benefits that was uncovered comes from qualitative data and a few statistical measures based on student self-evaluation. Quantitative analyses based on objective measures provided little evidence for a difference between the two teaching approaches. The article concludes with a call for improving the effectiveness and evaluation of reflective learning methods and putting the theories of reflective learning into practice more profitably in international relations.
This study presents an interdisciplinary systematic review of the literature on donation-based and reward-based crowdfunding. The literature to date has explored differences in crowd’s behavior and incentives for participating in the platform, as well as the factors governing funding and post-funding success. The authors summarize the main findings to date and synthesize the different theoretical explanations for the decision-making behavior of the crowd. The investigation reveals how the literature to date has upheld the importance of crowdfunding as a social and democratic tool, one that demonstrates wise judgment and clairvoyance in recognizing potential successes and creating value for society.
The importance of associations in contemporary democratic societies is out of the question. Still, there is a need for a new approach that considers them as a specific and singular organization type, different from business firms and government agencies. There is also a need to evaluate their performance. Based on case studies and diverse theoretical insights, this article lays out some criteria for assessing the effects on associational performance of cohesion, decision-making and relation to environment.
Multi-party coalitions are an increasingly common type of government across different political regimes and world regions. Since they are the locus of national foreign-policy-making, the dynamics of coalition government have significant implications for International Relations. Despite this growing significance, the foreign-policy-making of coalition governments is only partly understood. This symposium advances the study of coalition foreign policy in three closely related ways. First, it brings together in one place the state of the art in research on coalition foreign policy. Second, the symposium pushes the boundaries of our knowledge on four dimensions that are key to a comprehensive research agenda on coalition foreign policy: the foreign-policy outputs of multi-party coalitions; the process of foreign-policy-making in different types of coalitions; coalition foreign policy in the ‘Global South’; and coalition dynamics in non-democratic settings. Finally, the symposium puts forward promising avenues for further research by emphasising, for instance, the value of theory-guided comparative research that employs multi-method strategies and transcends the space of Western European parliamentary democracies.
This article explores processes of coalition governance in foreign policy. Specifically, it argues that such processes are shaped by two interrelated dimensions of coalition set-up: first, the allocation of the foreign ministry to the senior or a junior coalition partner and, second, the degree of policy discretion which is delegated to that ministry. Bringing these two dimensions together, the article distinguishes four types of coalition arrangement for the making of foreign policy, which are expected to have predictable implications for the process of foreign policy-making and, ultimately, for the foreign policy outputs of multi-party coalitions and their quality.
Women face a variety of sociocultural and individual obstacles that can trap them in violent relationships. In this study, we aimed to explore the role of cognitive distortions in women’s decision-making (loyalty and exit) within their current relationships, distinguishing between those who experienced intimate partner violence (IPV) and those who did not. Additionally, we examined the moderating effects of the traditional female role and the dependency between the group condition (IPV victims versus nonvictims) and cognitive distortions. Results showed that the IPV victims present higher levels of the traditional female role, dependency, cognitive distortions, and use of loyalty and exit strategies to a greater extent compared with the nonvictims. Similarly, two explanatory models were tested, revealing that women who were victims of IPV by their current partner (compared to the nonvictims group) exhibited greater cognitive distortions and, consequently, were more likely to use loyalty and exit strategies. The moderating effects of the traditional female role among the group of IPV victims and cognitive distortions were obtained. These findings contribute to a better understanding of how cognitive distortions and adherence to the traditional female role can influence women’s decision-making (loyalty and exit), reinforcing the notion that they are responsible for maintaining the relationship.
Integrated pest management (IPM) is the dominant pest management paradigm in agriculture, and adoption of IPM is a policy goal at various levels of government. However, with over 67 definitions, what is considered IPM varies, and some implementations of IPM fail to achieve desired results (e.g., reduced pesticide use). The natural complexity of agriculture and pest management leads growers to rely on professionals, usually certified crop advisors (CCAs), to help make management decisions. Though communication with crop advisors is one way to improve IPM, this effort requires an understanding of CCA education, knowledge, and information sources. Previous surveys in North America found most crop advisors were very experienced (>20 years), which may present a concern for the adequate supply of crop advisors in the future, since they will very likely retire in the coming decades. In this survey, nearly 95% of CCAs earned a bachelor’s level degree (or higher). Independent crop advisors reported spending about 43% less time communicating with growers than CCAs employed by consultancies. Most crop advisors gave appropriate, but incomplete, definitions of IPM, and adoption of specific guidelines (i.e., scouting recommendations for red sunflower seed weevil, Smicronyx fulvus) was also low. Some CCAs expressed an opinion that universities (and the federal government) were less valued than other sources of information (e.g., their own CCA network). Collectively, survey responses show room for improvement to IPM through CCA education, but because crop advisors are most likely to be influenced through their network of peers, outreach might be best accomplished through targeting early adopters of IPM practices among the CCA population.
The possible neural and neurochemical bases of the hubris syndrome are reviewed by considering relevant evidence from behavioural and cognitive neuroscience in relation to biological psychiatry. This multidisciplinary evidence includes studies of brain-damaged patients and functional neuroimaging and identifies the prefrontal cortex as a crucial region of a brain network undertaking decision-making. The prefrontal cortex is also identified as important for the subjective and behavioural expression of relevant personality traits such as narcissism and impulsivity. Factors that adversely affect so-called executive functions of the prefrontal cortex, such as stress, drug abuse and illness, are also taken into account to highlight possible neurochemical and endocrine influences. A novel hypothesis is presented which postulates a key role for the chronic stress of leadership status depleting monoamine neurotransmitters such as serotonin, dopamine and noradrenaline, which interact with pre-existing temperamental traits, to produce dysfunctional modulation of decision-making circuits controlled by the ventromedial prefrontal cortex
CEO hubris is a vital construct in research on the psychology of organisational decision-makers. Hubristic CEOs influence strategic decisions, from acquisitions to product and geographic market entry. To date, research has mainly focused on how and when CEO hubris impacts CEOs and their organisations. I offer a framework in which CEOs predisposed to inflated self-evaluation engage in behavioural processes that yield overconfident strategic decisions associated with hubris. The framework reviews and summarises how such evaluations stem from CEOs’ psychological and social circumstances. It then links inflated self-evaluation to the three drivers of over-confidence that are associated with hubris: over-estimation, or the tendency to exaggerate prospective outcomes; over-placement, or the tendency to rank one’s capabilities and situation ahead of others; and over-precision, or the tendency to issue unduly bounded or narrow forecasts which tend to be inaccurate. The framework is illustrated by the case study of Elizabeth Holmes, formerly founder and CEO of Theranos, who was lauded as a celebrity entrepreneur before being convicted of crimes associated with her hubris.
Periviable births, occurring between 20 and 25 weeks of gestation, present significant challenges due to varying survival rates and potential morbidities for survivors. Medical decision-making in this context raises ethical and legal questions, including considerations of sanctity of life versus quality of life and challenges in the clinician-parent relationship. This article outlines the complex ethical and legal landscape surrounding parental medical decision-making for periviable infants in the United States, discussing the evolution of federal and state laws. Existing laws highlight a vitalist approach that prioritizes life preservation despite potential harm and overlook non-heteronormative and non-traditional family structures, complicating decision-making. The impact of post-Dobbs state abortion bans on parental and clinician autonomy have exacerbated these challenges. We advocate for legislative support for inclusive definitions of legal parenthood to facilitate evidence-based decision-making centered on patients and families. Also needed are legal frameworks that accommodate the intricacies of periviable birth decisions while respecting patient autonomy and medical expertise, especially amidst the evolving legislative environment.
The objective of this study is to evaluate the feasibility of implementing Hospital-Based Health Technology Assessment (HB-HTA) within Ukraine’s healthcare system, focusing on its potential to strengthen evidence-based decision-making regarding clinical effectiveness, safety, cost-efficiency, and organizational and strategic impact of health technologies (HTs) in healthcare facilities (HCFs).
Methods
We collected and synthesized key initiatives implemented between 2021 and 2025, outlining the main steps involved in introducing HB-HTA in Ukraine.
Results
The article describes the landscape of the Ukrainian healthcare system and shares the experience of the initial steps of HB-HTA introduction amid tight budgets and increasing demands. Drawing on international models and adapting them to the national context, we outline key implementation strategies, the development of scientific and methodological approaches for HB-HTA, and the integration of a pilot HB-HTA project within a leading national HCF known for its high-level diagnostic and operational capabilities.
Conclusions
The conducted pilot laid the groundwork for integrating HB-HTA into Ukraine’s healthcare system and demonstrated its role in empowering HCFs to guide smarter budget allocation and procurement decisions, especially in the context of decentralization. With continued investment in expertise, legal integration, and streamlined methodology, HB-HTA can become a cornerstone of transparent, cost-effective decision-making across the HCFs of the National healthcare system. The experience gained in Ukraine provides valuable insights that can support other countries in effectively adopting and utilizing HTs at the hospital level.
In this chapter, we define our key concepts (e.g., interstate crisis and major-state war), justify our case selection strategy, establish and explain our methodological approach (i.e., the logic of discovery), and outline the conceptual/theoretical framework that guides our analysis of each crisis case. The framework involves a set of variables that commonly appear in studies of international conflict. We therefore introduce these variables, organize them, and explain the questions through which we look for their influence on crisis (de-)escalation in each case.