ETHICAL ASPECTS OF DECISION MAKING

Ethics - a moral philosophy, -a science of judging the relationship of means to ends, - The art of controlling means so they will serve human ends. ETHICAL THEORIES 1. Deontological theories from the Greek deon or duty - Focus on the intent of the action and are duty and right based. - Emphasis is on the dignity of human beings. - The intention of the action rather than the end of the action is considered. 2. Teleological theories from the Greek telos or end - Derive the rules and norms for conduct from utilitarian consequence of actions. - Favors the common good. - Right has good consequences, and wrong has bad consequences. - The greatest amount of good and the largest amount of happiness are good. 3. Principlism emerging theory - The ethical principles control ethical decision making more than the ethical theories. - The principles are moral norms, including autonomy, beneficence, fidelity, justice, normaleficence, paternalism, respect for others, utility and veracity. - Each principle can be used individually, but they are often used in concert. 4. Egoism based on self-interest and self-centeredness. - Decisions are made for personal comfort. - Based on the principle that the right decision is the one that brings pleasure to the decision maker. 5. Obligationism Tries to balance distributive justice (dividing equally among all citizens regardless of age, gender, race, religion, or socioeconomic status) and beneficence (doing good and not harm). - One should do what is good and prevent harm and evil. - Useful for determining public policy. 6. Social Contract theory based on a concept of original position and considers the least advantaged person in society as the norm. - The determination of what is right or wrong is from the perspective of the least advantaged people, such as children and handicapped people. - Based on distributive justice and supports giving the most to the least advantaged. Natural law virtue of ethics. - Actions are considered right when in accord with human nature. - People should do good, avoid evil, and have opportunities to reach their potential. - Happiness occur when people think rationally and make conscious choices rather than responding to instincts.

ETHICAL PRINCIPLES 1. 2. 3. 4. 5. 6. 7. Autonomy involves personal freedom, freedom of choice, and responsibility for ones choices. Beneficence indicates that the actions one takes should be in an effort to promote good. Fidelity keeping ones commitments and promises. Justice treating people equally and fairly. - Distributive justice Normaleficence means if you cannot do good at least do no harm. Paternalism allows one to make decisions for another, limits freedom of choice. Most see it as justified only to keep another person from harm. Respect for others- considered the highest principle that incorporates all the other principles. - Acknowledges the rights of people to make their own decisions and to live by their decisions. - It transcends cultural, gender, and racial issues. Utility indicates that what is best for the common good outweighs what is best for the individual. Veracity indicates that people should tell the truth.

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ETHICAL POSITIONS 1. Utilitarianism community-oriented position that focuses on the consequences and prefers the greatest amount of good and happiness for the most people, or the least amount of harm. 2. Egoism seeks solutions that are best for oneself without regards for others. Ones own pleasure is the concern. 3. Formalism considers the nature of the act and the related principles without thought to personal position or consequences of the actions: be honest, remember the golden rule. 4. Rule ethics expects obedience to laws, rules, professional codes, and authority. 5. Fairness considers distribution of benefits and liabilities from the viewpoint of the least advantaged population. Benefit to the least advantaged group is the norm.

ETHICAL RELATIONSHIPS 1. Priestly Model manager is paternalistic and makes decisions without considering others values or seeking others input. 2. Engineering Model suggests that one person presents facts to another and sets aside her own code of ethics to do what the other wants. 3. Contractual Model provides a contract that identifies general obligations and benefits for two or more people. 4. Collegial Model individuals share mutual goals and reach decisions through discussions and concensus.

MORAL REASONING Levels of moral development: a. Premoral or Preconventional behaviour is motivated by social or biological impulses with no sense of obligations to rules. b. Conventional person accepts standards of the group with little critical reflection, uses literal obedience to the rules, and feels obligation. c. Autonomous person thinks and judges for herself, consider the purpose and consequences of the rules, and do not accept group standards without reflection. Moral choice involves selecting one or two or more values that conflict. Ten universal moral values: 1. Distributive justice 2. Law 3. Liberty 4. Life 5. Property 6. Punishment 7. Roles and concerns of affection 8. Roles and concerns of authority 9. Gender 10. Truth ETHICS COMMITTEE Complex ethical issues regarding patient care and policy making must be addressed. Institutional ethics committees deal with ethical questions that often require painful choices for patients, particularly for infants and those older adults who are unable to make their own decisions. The following issues must be addressed within the institutions philosophy, both when forming an institutional ethics committee and through ongoing study and evaluation of the existing committee: - Responsibility - Accountability - Economic costs - Efficacy - Role of the committee in patient care decisions - Privacy for the patients and families - Committee composition, structure, meeting and access

DECISION-MAKING TOOLS 1. Probability Theory - Applied when risk or uncertainty is present in a decision. - Operates on the assumption that factors occur in accordance with a predictable pattern - e.g. If a person tosses a coin 200 times, we can predict that it can show heads 100 times and tails 100 times. 2. Simulations, Models, and Games a. Simulation: way of using models and games to simplify problems by identifying the basic components and using trial and error to determine a solution. - Through simulation, the manager may compare alternatives and their consequences. - These methods may be used to study organizational changes, scheduling, assembly line management and time sequences. b. Model: represents something else, most commonly objects, events, processes or systems. It is a technique of abstraction and simplification for studying something under varying conditions. Developed to describe, explain and predict phenomena. c. Game theory: is a simulation of system operations. The player tries to develop a strategy that will maximize gains and minimize losses, regardless of what the computer does.

3. Gantt Chart - Named for their developer, Henry Gantt - Highly developed schedules that allow one to visualize multiple tasks that have to be done. - Grid with columns for tasks, assigned responsibility and time frame (min., hrs., days, weeks, months, years, decades, depending on the longevity of the project) - A line is drawn through the time frame while a task is in process. - An X is put to a point where that task is completed. Task Collect information Type report Responsible ME ME X Mon Tue Wed Th Fri

Revise report Submit report

ME ME

X X

4. Decision Trees - Graphic method that can help managers visualize the alternative available, outcomes, risks, and information needs for a specific problem over a period of time. - Helps to see the possible directions that actions may take from each decision point and to evaluate the consequences of a series of decisions. - Process begin with a primary decision having at least 2 alternatives, then the predicted outcome for each decision is considered, and the need for further decisions is contemplated.

A1

A2 A3 Decision Point 1 A4

Alternatives Chance events Probable consequences

5. Program Evaluation and Review Technique - A network system model for planning and control under uncertain conditions. - Involves identifying the key activities in a project, sequencing the activities in a flow diagram, and assigning the duration of each phase of work. - Recognizes that certain tasks must be completed before the total project can be completed and, further, that subtasks must be completed before others can be started. - The key events are identified, numbered, labelled, or numbered and labelled on the flow chart.

- The activities that cause the progress from one event to another are indicated by arrows, with the direction of the arrow showing the direction of the work flow. - PERT also deals with the problem of uncertainty with respect to time by estimating the time variances associated with the expected time of completion of the subtasks. 3 projected time are determined: 1. The optimistic time (to), which estimates the completion time without complications 2. The most likely time (tm), which estimates the completion time with normal problems 3. The pessimistic time (tp), which estimates the completion time given numerous problems -Thus, the shortest, average, and longest times needed to complete an activity are calculated. -Expected time (te) is calculated by:

Te= to + 4(tm) + tp
Crowded but dry

6
Rain Indoors

No bugs Proud of decision Crowded, stuffy No rain Lacks picnic atmosphere Regrets for not having outside Wet participants Ruined food No rain Dampened spirits

Have a work picnic Rain Outdoors

Pleasant party

6. Critical Path Method - Closely related to PERT, calculates a single time estimate for each activity, the longest possible time. - A cost estimate is figured for both normal and crash operations.

- Normal means least-cost method, and crash refers to conditions in less-tyhan-normal time. - Useful where cost is a significant factor and experience provides a basis for estimating time and cost. - Network analysis techniques facilitate planning and result in objective plans by making it possible to identify the critical path and show interrelationships among parts, thus facilitating improvements in structure and communications. 7. Queuing Theory - Deals with waiting lines or intermittent servicing problems. - A mathematical technique for determining the most efficient balance of factors related to intermittent service. - Particularly applicable when units to receive service arrive in a random fashion but the time required for service is predictable. - Balances the cost of waiting versus the prevention of waiting by increasing service - Acknowledges that although delays are costly, eliminating them may be even more costly

8. Linear Programming - Uses matrix algebra or linear mathematical equations to determine the best way