Archive for the ‘Decision Making’ Category

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How well do physicians inform surrogate decision-makers about the principles of surrogate decision-making?

October 12, 2012

Thomas Cunningham

Background: Bioethical theory suggests there are three hierarchically ordered standards for surrogated decision-making (SDM): a patient’s advance directive (stated preferences), substituted judgment, or best interests. Empirical studies of SDM indicate flaws in this theory. However, to date, studies have failed to measure the extent to which surrogates are informed about these standards, information that is itself important for understanding ethical SDM in practice. Objective: To measure the extent to which physicians inform surrogates about the normative principles of surrogate decision-making in a sample of 73 ICU family conferences. Methods: An interdisciplinary team of researchers developed a coding framework for assessing values-based surrogate decision-making, including whether ethical standards for surrogate decision-making were explained, discussed, or referred to; two coders then applied the framework to 73 transcribed conferences. Results: In 49% of conferences, physicians did not explicitly explain any of the three principles; in 37% they explained one; in 13% they explained two, and in no conferences (0%) did they explain all three principles. Additional data show that physicians did discuss or refer to the principles in a higher percentage of conferences. Conclusions: Physician-surrogate communication is rich and complex, including some explanation of the principles of surrogate decision-making, but more often only implicit use of them.

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Philosophy of Science in the Courtroom: From Falsification to Methodological Naturalism

February 17, 2012

Haixin Dang

Karl Popper had gone as far as setting the demarcation problem—distinguishing science from non-science— as the key to solving most of the fundamental problems in the philosophy of science (Popper 1962: 42). Although many contemporary philosophers of science reject falsification as an appropriate demarcation criterion, it remains one of the most influential ideas in philosophy as well as a powerful tool in public debates about the nature of science. Most notably, falsification was adopted by Judge William Overton in a remarkable decision in 1982 which ruled that creation-science is not science and therefore cannot be taught in Arkansas public schools and cannot receive equal-time treatment as evolution. This project will trace the various demarcation criteria employed in three major American court cases: Scopes (1925), McLean (1981), Dover (2005). I will also be giving a brief history of the creationism movement in 20th century America and the philosophical development of the intelligent design. I will at the end offer some suggestions on how we can–or should–move on from methodological naturalism.

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The Likelihood Principle (Prospectus Preview)

January 19, 2012

Greg Gandenberger

This talk will provide an overview of the ideas I plan to develop in my prospectus. The presentation will be informal and will feature at least one leaping cat. Feel free to share both feedback on the content and general advice on writing a prospectus, forming a committee, and so on.

Abstract

Debates between frequentists and Bayesians often revolve around prior probabilities, but the frequentist and Bayesian positions also differ in that Bayesian methods conform to the Likelihood Principle while frequentist methods do not. There are strong arguments for the Likelihood Principle that do not depend on the familiar coherence arguments for Bayesianism. These arguments are controversial and raise many deep issues that are ripe for philosophical scrutiny. They constitute a strong case for the Likelihood Principle, but they do not directly address key questions about the performance characteristics of likelihood-based methods. If it turns out that likelihood-based methods perform well even without appealing to priors, then frequentist methods are in serious trouble. If it turns out that likelihood-based methods perform poorly despite the strong first-principles arguments for the Likelihood Principle, then the choice between frequentist and Bayesian/likelihoodist methods involves a genuine tradeoff between evidentialist and reliabilist considerations. Widespread acceptance of the Likelihood Principle would have many important effects on science, including that it would allow ethically superior sequential clinical trials to be performed without elaborate and restrictive pre-trial planning.

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What is ‘Group Decision-Making?’

March 25, 2011

Thomas Cunningham

This paper has two goals, motivated by thinking about the “Shared Decision-Making Model” of medical choice (SDM). One, I argue the topic of medical decision-making is an excellent case study in individual and group rationality, which serves well as a case for philosophical reflection. Also, I consider the empirical foundations of SDM and argue that while they sufficiently demonstrate that treatment decisions are social in nature, SDM fails to articulate a normative position for why such decisions should be social rather than simply are social. I conclude by sketching a line of reasoning for providing this missing normative account.

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Defining the “Evidence” in EMB and EBP

February 25, 2011

Lisa Lederer

Nancy Cartwright has been a key figure in the Evidence-Based Policy movement, an effort to formulate philosophically-respectable guidelines for translating social scientists’ conclusions into policy. In his contributions to the Evidence-Based Medicine movement, John Worrall anticipated Cartwright in criticizing how evidence produced from within the scientific community is used outside of it. Worrall’s criticisms are strikingly different from Cartwright’s; while he focuses almost exclusively on methodology in Randomized Controlled Trials, Cartwright’s main concern is more general, with any study that she would call a “method-of-difference” study (after J.S. Mill’s Method of Difference) comparing two groups. Yet although Cartwright’s and Worrall’s main concerns recommend different corrective measures, they derive from the same source: researchers’ inability to identify and understand all the causal factors that produce an effect in the world. Worrall stresses the inevitable existence of unknown causal factors, while Cartwright stresses scientists’ limited knowledge of how even known ones combine. Her defense of the kinds of causal laws uncovered through social science research points to the necessity of “expert judgment” for interpreting these ceteris paribus laws, and thus leaves open the question of just whose expertise is appropriate for predicting their effects in the world. Pace Cartwright, the proper role of philosophers in facilitating the translation of social science results to practice and policy, instead of telling practitioners and policy-makers how to proceed, may be to clarify what kinds of expert judgment they should seek.

*actual quotes taken from the Onion. Just priming you to be careful about your evidence!