Ethics in decision making and risk taking

“Ethics in decision making and risk taking”

A/Prof Michael Robertson

University of Sydney and the Recovre Group / Medicolegalopinions

Outline

› Ethics, Values and Knowledge

› Risk from an epistemological perspective

› Risk from a clinical perspective

› Towards an ethics of “risk”

2

1. Knowledge, Values and Ethics

3

Basic questions in ethics

› How do I live a good life?

› How do I behave as a good citizen?

› How do I make good decisions?

› How do I know what I know is good?

› What is the true nature of things?

› What are the values upon which I base my conception of ‘the good’?

4

What is good?

› Divine command

› Naturalistic phenomenon?

› Self-Interest and the golden rule?

› Rational excellence and virtue?

› Socially constructed notion of ‘the good life’

5

Ethics versus values

› Values are conceptually prior to ethics

› 'Ethical’ is to act consistently in light of values

› Values – what we see as important, maxims, rules, dispositions to act or think

› Values either socially constructed or contextual

6

Values

VALUES

Individual Psychology

Social and Cultural

Professional and

Disciplinary

7

Australian ‘values’

8

The virtuous person – the virtuous citizen

9

“Descriptive” versus normative ethics

› What is done rather than what ought be done

› Departs from the “grand theories” of ethics

› Derives from Aristotle’s Nicomachean Ethics

› The observation of the habits and dispositions of great individuals and their deeds

› The basis of empirical studies of ethics

10

Knowledge

11

Plato’s Cave

12

Plato

13

Francis Bacon - Novum Organum (1620)

Idols of the cave

Idols of the tribe

Idols of the market place

Idols of the theatre

Idolata

14

› Idols of the Tribe : Tendency to perceive more order and regularity in systems than truly exists.

› Idols of the Cave : Individuals' personal weaknesses in reasoning due to particular personalities, likes and dislikes.

› Idols of the Marketplace : Confusions in the use of language.

› Idols of the Theatre : Following of dogma or orthodoxy and rather than sceptcism.

15

How do I know what I know?

› Sense perception and its flaws

› "Realism” versus “Idealism”

› Reason being ‘slave of the passions’ (Hume)

› Bounded rationality

› Cognitive bias

› Power and knowledge

› Knowledge as a form of “discourse”

16

The many faces of ‘risk’

17

The problem of language

› “Risk” as a polysemous term with multiple discourses

› Multiple meanings in multiple context

› Emotive and with connotation

› “Risk assessment” as a definitive act in different settings e.g actuarial, financial, political

› Term abused eg ”risk issues”

18

Risk

›An evaluative concept that speaks of probability of a “negative” event

›Risk = (probability) x (impact)

Understanding risk

› Semantically, the conceptual understanding of risk is open to a multitude of converse possibilities and interpretations

- Positive and negative elements, noun and verb

- To hazard, endanger, to expose to chance of injury or loss, to take or run risks

- To venture upon, take the chances of, to venture to bring into some situation

- Has increasingly come to refer to something negative, risk as a hazard

› Many faces of risk testament to its elusive character as a conceptual phenomenon

(Althaus, 2005)

20

› The term 'risk' has causative properties

› Identification of risk creates a moral obligation to act

› Failure to understand or modify risk has potential commercial, social and legal implications e.g. MH 17

21

Risk

Risk

The risk society

› A cultural phenomenon described by sociologists Ulrich Beck (1992) and Anthony Giddens(1999).

› In the light of progression in technology, much of our life experience arises from human agency and therefore we face “manufactured risk”.

› This necessitates our constant reflexive alterations to how we act.

24

“Drilling down” into the problem

Risk Assessment

›An appraisal of the potential for risk

›Passive “actuarial” approach

›Interventionist approach

26

Components of risk assessment - harm

Static

•Age•Gender•Ethnicity• Intellectual disability•Social class•Educational level•Developmental trauma•Criminal history•History of previous dangerousness

Dynamic Stable

•Treatment non-responsiveness•Personality• Interpersonal support network• Impulsivity•Problem solving capacity•Cognitive schema•Attribution style•Attachment style• Immature or primitive psychological defences

Dynamic Changable

•Psychotic symptoms•Mood or anxiety symptoms•Substance use•Acute crisis•Social isolation•Unsatisfactory living situation•Treatment non-adherence

Risk Assessment/Intervention in the work place

28

Static

• Nature of the business

• The Broad culture• History of

bullying/stress• Global economy

Dynamic Stable

• Institutional culture• Economic climate• Legislative

environment• Local trading

conditions• Growth or evolution of

business• Extant risk of

workplace• Problematic

personnel

Dynamic Changable

• Problematic interpersonal dynamics

• Ineffective management of conflict

• Poor management of acute change

• Problem person

29

Towards ‘an ethics of risk’

An ethics of risk

› Descriptive – observe what is done well

› Linguistic – careful use of clear language and communication

› Epistemic – awareness of the limits of knowledge and the effects of context

› Moral action – methodology of risk mitigation rather than risk assessment

30

γνώθι σαυτόν

31