“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”

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1. Knowledge, Values and Ethics

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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’?

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What is good?

› Divine command

› Naturalistic phenomenon?

› Self-Interest and the golden rule?

› Rational excellence and virtue?

› Socially constructed notion of ‘the good life’

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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

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Values

VALUES

Individual Psychology

Social and Cultural

Professional and

Disciplinary

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Australian ‘values’

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The virtuous person – the virtuous citizen

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“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

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Knowledge

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Plato’s Cave

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Plato

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Francis Bacon - Novum Organum (1620)

Idols of the cave

Idols of the tribe

Idols of the market place

Idols of the theatre

Idolata

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› 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.

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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”

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The many faces of ‘risk’

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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”

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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)

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› 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

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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.

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“Drilling down” into the problem

Risk Assessment

›An appraisal of the potential for risk

›Passive “actuarial” approach

›Interventionist approach

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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

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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

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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

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γνώθι σαυτόν

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