Decision Dilemma Research Articles

Ethical Decision Dilemma for Tax Consultants in Tax Planning

Tax consultants contribute to assisting taxpayers in overcoming difficulties caused by the complexity of tax rules. Reliable tax consultants tend to provide aggressive advice. Tax consultants as professionals must uphold the code of ethics and applicable tax rules. In this condition, tax consultants are faced with a dilemma in making ethical decisions. This study aims to interpret more deeply how the integrity of tax consultants in facing ethical decision dilemmas in conducting tax planning using a transcendental phenomenological approach. The results of this study show that tax consultants face several dilemmas, including: ethical decision dilemmas due to unclear regulations and client interest factors and responsibility to the state for tax revenue. Experienced tax consultants can overcome the dilemma by continuing to exercise good self-control, and still adhere to the rules and code of professional ethics.

Ideals of joint decision making in clubhouse communities.

This article explores the ideological dilemmas of decision making identified in members' and staff's talk in Clubhouse communities. The data are drawn from a corpus of 10 video-recorded focus group interviews with Clubhouse members and staff, which were collected at five Finnish Clubhouses in 2020. The method used is discursive psychology, and the analysis identifies interpretative repertoires and ideological dilemmas. Clubhouse members and staff express diverse opinions regarding decision making at the Clubhouse. We identified six interpretative repertoires and three ideological dilemmas between these repertoires. The first dilemma deals with participation and efficiency, advancing the idea that everybody should be allowed to participate in decision making, but the decision making should be efficient. The second dilemma regards the passivity or activity of the participants, suggesting that decision-makers should be allowed to be themselves, but participation in decision making requires activity. The third dilemma is associated with power structures in decision making, proposing that joint decision making requires active resistance against power structures, but these structures are both inexorable and partially necessary. In introducing a discursive perspective to joint decision making in the Clubhouse community, this study makes visible the conflicting ideals of decision making. The acknowledgment of these dilemmas can guide interventions aiming at improving genuinely participatory joint decision-making practices at the Clubhouse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Dilemmas in Decision Making: An In-depth Exploration of Abortion, End-of-lifecare, and Euthanasia in Medical Ethics

This comprehensive study delves into the multifaceted ethical considerations surrounding abortion, end-of-lifecare, euthanasia in the field of medical ethics. Through an in-depth exploration, it has been dissected the nuanced interplay between patient autonomy and healthcare provider's moral obligations. additionally, we analyze the impact of legal and cultural factors on ethical perspective, offering a thorough examination of global variations. By addressing the broader societal implications and ethical responsibilities of healthcare professionals, this research contributes a holistic perspective to the ongoing discourse. framed within established bioethical frameworks, the study not only uncovers the complexities of decision-making but also underscores the need for a compassionate and patient-centred approach in navigating these ethically challenging scenarios.

Does severe anemia necessitate red cell transfusion before therapeutic leukocytapheresis in patients with hyperleukocytosis and suspected tumor lysis syndrome? Addressing a transfusion decision dilemma

Does severe anemia necessitate red cell transfusion before therapeutic leukocytapheresis in patients with hyperleukocytosis and suspected tumor lysis syndrome? Addressing a transfusion decision dilemma

Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU: A User-Centered Design for Rapid Prototyping

ObjectiveRenal replacement therapy (RRT) is increasingly adopted for critically ill patients diagnosed with acute kidney injury, but the optimal time for initiation remains unclear and prognosis is uncertain, leading to medical complexity, ethical conflicts, and decision dilemmas in intensive care unit (ICU) settings. This study aimed to develop a decision aid (DA) for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians. MethodsDevelopment of DA employed a systematic process with user-centered design (UCD) principle, which included: (i) competitive analysis: searched, screened, and assessed the existing DAs to gather insights for design strategies, developmental techniques, and functionalities; (ii) user needs assessment: interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs; (iii) evidence syntheses: integrate latest clinical evidence and pertinent information to inform the content development of DA. ResultsThe competitive analysis included 16 relevant DAs, from which we derived valuable insights using existing resources. User decision needs were explored among a cohort of 15 family surrogates, revealing four thematic issues in decision-making, including stuck into dilemmas, sense of uncertainty, limited capacity, and delayed decision confirmation. A total of 27 articles were included for evidence syntheses. Relevant decision-making knowledge on disease and treatment, as delineated in the literature sourced from decision support system or clinical guidelines, were formatted as the foundational knowledge base. Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT, possible outcomes, and reasons to choose. The DA was drafted into a web-based phototype using the elements of UCD. This platform could guide users in their preparation of decision-making through a sequential four-step process: identifying treatment options, weighing the benefits and risks, clarifying personal preferences and values, and formulating a schedule for formal shared decision-making with clinicians. ConclusionsWe developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting. Future studies are needed to evaluate its usability, feasibility, and clinical effects of this intervention.

Joint or not: unpacking the decision-making mechanism of pandemic control between two nations – from the perspective of cost optimization

Joint control has been proposed to alleviate the negative spillover of the pandemic. The authority faces a decision dilemma on whether to undertake joint control, which is overlooked by the scientific community. This paper, aiming to clarify the decision-making mechanism under cost optimization, draws on the optimization theory to find the optimal strategies and start time under independent and joint scenarios with an improved infectious disease model. Besides, a simulation analysis, based on the survey in Ruili – a border area between Myanmar and China, is employed. The crucial findings highlight that (1) The control measures contribute to reducing the peak number or peak time of confirmed patients under optimal decision. (2) As the delay of start time, the epidemic control for both countries undergoes from validity to failure. (3) More cost-savings come with earlier joint control but with uneven distribution. Joint strategy mitigates the cost for the one with severe epidemics, but the effect is insignificant for the other. This study, concentrating on cost optimization, provides a novel insight into pandemic control. The results enrich the decision analysis in the context of pandemic joint governance while providing inter-regional control support for the decision-maker to tackle various epidemics.

Application of Ethical Standards in Patient Information Management: Legal Perspectives and Medical Practice

This study investigates the ethical dilemmas that arise in the management of patient information in daily clinical practice, with a focus on the balance between the need for rapid access to medical information and the protection of patient privacy. Through case study analysis, surveys of health practitioners, and collaboration between health and legal institutions, this research aims to understand how doctors and medical personnel understand, confront, and overcome these ethical dilemmas in clinical decision making

The Decision Dilemma: Disinvestment or Turnaround?

The case describes the journey of one of the most ambitious public sector undertakings, Heavy Engineering Corporation Limited (HECL), in the earlier unified state of Bihar, India. Despite being a leading manufacturer and supplier of capital equipment and experiencing growth in the initial years, the company incurred losses for over 17 consecutive years. In the year 2006–2007, the company briefly bounced back to profits, but those revival hopes faded within five years, leaving the company in dire need of an immediate strategic rethink and a complete overhaul. This case specifically focuses on the problems and challenges faced by the cash-strapped public sector enterprise, HECL. It addresses issues such as its negative net worth, the rising wage and incentive bills of its employees, declining product competitiveness at the global level and other persistent financial difficulties and bureaucratic hurdles that created inflexibilities in decision-making. The need for agile and lean management approaches that could increase overall organizational performance, efficiency and value deliverables was also explored.

Uni Style Image – a savvy fashion brand poised to stay buoyant

Learning outcomes This case study covers marketing concepts, including marketing mix, segmentation, targeting and brand positioning and communication. After completion of the case study, the students will be able to understand the importance of segmentation and targeting; recognize the differences between business-to-business (B2B) and business-to-customers (B2C) segments; gain knowledge about the points of parity and points of difference while positioning; and examine the elements of a marketing mix. Case overview/synopsis The case centered around Mr. Ashvinder Singh, founder and director of Uni Style Image (USI), who initiated the polo T-shirt business in 1990 in Okhla, Delhi. The brand expanded across the country, but from 2010, USI faced fluctuating demand due to the rise of online marketing and intense competition from global fashion brands. Revenues dropped massively, leading to a significant downsizing from over 300 employees to just 11 by the end of fiscal year 2016–2017. In 2018, Singh explored the B2B model; however, the onset of the COVID-19 pandemic in 2020 impacted many small- and mid-sized apparel businesses, including USI. In the fiscal year 2021–2022, the B2B segment accounted for 90% of total revenue, but the business size could not cover significant operating expenses. Despite only 10% of revenue coming from the B2C segment, Singh wanted to leverage the online space. In September 2022, Singh closed his factory in Noida, National Capital Region, Delhi. Amid the uncertainty, Singh explored various opportunities in the Indian market. In 2023, he even engaged a consultancy for expertise in marketing initiatives. He had to choose the target segment/s, develop a positioning strategy and create an effective marketing mix with very limited resources. Complexity academic level This case is designed for undergraduate and postgraduate students, offering a valuable teaching tool for essential marketing concepts, such as the marketing mix, segmentation, positioning and brand communication. It can be used in both core marketing courses and elective courses like brand management, consumer behavior and integrated marketing communication. The decision dilemma presented in the case enriches the understanding of these concepts, making it a valuable resource for marketing education. Supplementary materials Teaching notes are available for educators only. Subject code CSS 8: Marketing.

Workforce diversity in specialist physicians: Implications of findings for religious affiliation in Anaesthesia & Intensive Care.

Minority ethnic identification between physician and patient can reduce communication and access barriers, improve physician-patient relationship, trust, and health outcomes. Religion influences health beliefs, behaviours, treatment decisions, and outcomes. Ethically contentious dilemmas in treatment decisions are often entangled with religious beliefs. They feature more in medical specialties such as Anaesthesia & Intensive Care, with issues including informed consent for surgery, organ donation, transplant, transfusion, and end-of-life decisions. We investigate diversity in religious affiliation in the UK medical workforce, using data from the General Medical Council (GMC) specialist register and Health Education England (HEE) trainee applications to medical specialties. We performed conservative Bonferroni corrections for multiple comparisons using Chi-squared tests, as well as normalised mutual-information scores. Robust associations that persisted on all sensitivity analyses are reported, investigating whether ethnicity or foreign primary medical qualification could explain the underlying association. The only significant and robust association in both GMC and HEE datasets affecting the same religious group and specialty was disproportionately fewer Anaesthesia & Intensive Care physicians with a religious affiliation of "Muslim", both as consultants (RR 0.57[0.47,0.7]) and trainee applicants (RR 0.27[0.19,0.38]. Associations were not explained by ethnicity or foreign training. We discuss the myriad of implications of the findings for multi-cultural societies. Lack of physician workforce diversity has far-reaching consequences, especially for specialties such as Anaesthesia and Intensive Care, where ethically contentious decisions could have a big impact. Religious beliefs and practices, or lack thereof, may have unmeasured influences on clinical decisions and on whether patients identify with physicians, which in turn can affect health outcomes. Examining an influencing variable such as religion in healthcare decisions should be prioritised, especially considering findings from the clinician-patient concordance literature. It is important to further explore potential historical and socio-cultural barriers to entry of training medics into under-represented specialties, such as Anaesthesia and Intensive Care.

Self-Unaware Adversarial Multi-Armed Bandits With Switching Costs.

We study a family of adversarial (a.k.a. nonstochastic) multi-armed bandit (MAB) problems, wherein not only the player cannot observe the reward on the played arm (self-unaware player) but also it incurs switching costs when shifting to another arm. We study two cases: In Case 1, at each round, the player is able to either play or observe the chosen arm, but not both. In Case 2, the player can choose an arm to play and, at the same round, choose another arm to observe. In both cases, the player incurs a cost for consecutive arm switching due to playing or observing the arms. We propose two novel online learning-based algorithms each addressing one of the aforementioned MAB problems. We theoretically prove that the proposed algorithms for Case 1 and Case 2 achieve sublinear regret of O(√[4]KT3lnK) and O(√[3](K-1)T2lnK) , respectively, where the latter regret bound is order-optimal in time, K is the number of arms, and T is the total number of rounds. In Case 2, we extend the player's capability to multiple observations and show that more observations do not necessarily improve the regret bound due to incurring switching costs. However, we derive an upper bound for switching cost as c ≤ 1/√[3]m2 for which the regret bound is improved as the number of observations increases. Finally, through this study, we found that a generalized version of our approach gives an interesting sublinear regret upper bound result of [Formula: see text] for any self-unaware bandit player with s number of binary decision dilemma before taking the action. To further validate and complement the theoretical findings, we conduct extensive performance evaluations over synthetic data constructed by nonstochastic MAB environment simulations and wireless spectrum measurement data collected in a real-world experiment.

Pooled mean group estimation of an energy-globalization-emissions nexus: Evidence from the selected South- and South-East Asian countries

Although globalization is widely credited for unprecedented global economic growth, it also bears responsibility for climate change. Today, the primary emphasis of contemporary research is to find ways that help to reduce climate change adversaries without compromising the globalization-led economic development agenda. Thus, this study takes the case of 12 emerging economies selected based on their emissions profile and vulnerability to climate change. Covering annual data from 1972 to 2018, this study accounts for globalization's economic, social, and political aspects and empirically tests their relationship with carbon footprints and energy demand in the panel countries. The results confirm the long-run equilibrium relationship among all the underlying variables and find that economic globalization significantly contributes to energy demand and carbon emissions. However, such an effect can be overcome through social globalization. Whereas political globalization reduces the energy demand but spurs carbon emissions. Our results rule out the ant-globalization narrative and support pro-globalization chronicles for sustainable development policy agenda in emerging economies. We suggest that the emerging countries that are mainly facing the decision dilemma to choose between sustainable economic growth and a sustainable environment, are better off if they equally integrate socially and politically with the global economy. Moreover, the model is checked for robustness using FMOLS and found validated. It warrants that the results are appropriate for policy control use.

Nurses' Perceptions of Ethical Conflicts When Caring for Patients with COVID-19.

The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses' ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi's descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi's phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

Neural correlates of bribe-taking decision dilemma: An fNIRS study

Bribe-taking decision is a social dilemma for individuals: the pursuit of economic self-interest vs. compliance with social norms. Despite the well-known existence of the conflict in deciding whether to accept bribes, little is known about its neural responses. Using functional near-infrared imaging (fNIRS) technology and the bribe-taking decision game (economic gambling game as a control condition), the current study dissociated the neural correlates of the different motivations in the bribery dilemma, as well as the inhibitory effect of social norms on bribery and its underlying brain mechanisms in supra-cortical regions. Findings revealed that if individuals are more motivated by economic interest, rejecting money (vs. accepting money) accompanies higher activity in the dorsolateral prefrontal cortex (DLPFC) and frontopolar cortex (FPC), which reflects impulse inhibition and decision evaluation; whereas, if individuals are more consider social norms, their DLPFC is more active when they accept bribes (vs. reject bribes), which reflects their fear of punishment. Additionally, the key brain region where social norms inhibit bribery involves the left DLPFC. The current findings contribute to the literature on the neural manifestations of corrupt decisions and provide some insights into the anti-corruption movement.

Beardo’s strategic partnership with Marico

Learning outcomes • The students will be able to compare various perspectives and concepts of strategic alliance as a tool of corporate expansion. • The students will be able to identify the trade-offs between financial and non-financial gains and losses for corporate expansion. • The students will be able to identify strategic partnership as a better alternative in comparison to acquisition and vice versa according to the different situations being faced by the companies. • The students will be able to identify different approaches for brand building. Case overview/synopsis Shah and Valani, owners of Zed Lifestyle Pvt Ltd which owned Beardo, had to decide whether they should accept the offer of a strategic partnership with Marico Industries, a fast-moving consumer goods company (FMCG) in the global beauty and wellness space. Marico nurtured leading brands across categories of hair care, skin care, edible oils, healthy foods, hygiene, male grooming and fabric care. The decision was not easy as Marico was a leader in the FMCG segment in India and had a strong brand presence in both online and offline distribution channels. Beardo, on the other hand, had its presence marked mostly on the online channel with a hundred offline salon outlets. Partnering with Marico would ensure access to the massive distribution channel owned by Marico but, on the other hand, would lead to possible loss of independence and an early exit from their business. They were not prepared to let go of their ownership as there was no clarity on what would happen if the projected growth figures were not met. There were many other questions too that crossed their minds which had to be answered before they decided on a yes or a no. The case highlighted the decision dilemma faced by the brand owners, the market scenario, competitive landscape and the situational facts so as to help the students critically analyse the decision situation and develop decision-making competencies by evaluating the possible course of actions and their possible outcomes. Complexity academic level Corporate-level strategies. Supplementary materials Teaching notes are available for educators only. Subject code CSS 11: Strategy.

Multimorbidität im Versorgungsalltag – Definitionen, Strategien und Grenzen

The challenge of multimorbidity, the occurrence of multiple medical conditions, lies in its complexity, considering their type and severity, their interactions, and the patient's social status and characteristics. Although the number of combinations appears unlimited, there emerge so-called multimorbidity patterns, that group diseases, that often coincide.The prevalence of multimorbidity will increase dramatically because of the demographic change and the medical progress, leading to exploding costs in healthcare. The definition and the therapeutic approaches of the field are ambiguous, while it also lacks an established assessment.The complex needs of a patient with multimorbidity are not addressed appropriately with the established one-disease-approach. Clinical guidelines can suggest conflicting treatment strategies, which result in decision dilemmas in daily work.Time, communication and decisions adapted to the patient's situation are the key to a successful treatment of multimorbidity. An integrated approach must be based on a comprehensive geriatric assessment. Action strategies and the integration of guidelines are needed and will support the clinician during the decision-making processes. Furthermore, clinical studies should include older adults with multimorbidity and should particularly consider their relevant outcomes.Geroscience is a new research area that addresses the hallmarks of aging with therapeutic approaches to delay or even avoid the onset of multimorbidity.

Management of Aggressive Vertebral Haemangioma and Assessment of Differentiating Pointers Between Aggressive Vertebral Haemangioma and Metastases - A Systematic Review.

Systematic review. Vertebral haemangioma has been classified into typical and aggressive vertebral haemangioma (AVH). Management options for AVH are many and the clinician has decision dilemma in choosing the right one. Metastases mimic AVH in clinical and radiological presentation. Differentiating pointers between them has not been clearly delineated in literature. Aim of our review is to identify treatment options; to formulate a management algorithm for AVH based on clinical presentation and to identify radiological differentiating pointers between them. Systematic review was conducted according to PRISMA guidelines. We systematically reviewed all available literature from the year 2001 to 2020. Relevant articles were identified as per laid down criteria from the medical databases. After inclusion, first and second authors went through full text of each included article. Of 139 studies reviewed, eight met our criteria for review of management and three separate studies for radiological differentiating pointers. 99 patients with 88 AVH had undergone treatment. Back pain with myelopathy is the presenting symptom in majority of patients. Patients with backpain - myelopathic symptoms had improved following surgery; patients with back pain alone had improved with either percutaneous vertebroplasty or CT guided alcohol ablation. Dynamic contrast MRI, Diffusion weighted MRI and ratio of signal intensity between T1w and fat suppression T1w MR help the clinician in differentiating them. Management of AVH can be based on the patient's clinical presentation. Patients presenting with AVH and back pain can be managed with either Percutaneous vertebroplasty or CT guided alcohol ablation. Patients presenting with AVH and neurological symptoms could be managed with surgery. Dynamic contrast enhanced MR, Diffusion weighted MR, ratio of signal intensity between T1w and Fat suppression T1w MR imaging could help the clinician in differentiating the two before contemplating biopsy. C.

RESEARCH ARTICLE: Ethical challenges faced by community mental health workers in urban Chennai.

Delivery of mental health interventions to youth in schools requires a cadre of community mental health workers (CMHWs) in addition to psychiatrists. Literature is sparse in the India context on the ethical and professional challenges faced by CMHWs, especially those working with youth. Hence, the aim of the study was to understand these challenges faced by CMHWs working in schools in urban Chennai and explore ways to overcome them. A qualitative study was done with CMHWs involved in the delivery of youth mental health (YMH) interventions, including mental health literacy, screening for mental disorders and mental health support to youth in schools in urban Chennai. Focus group discussions (FGDs) were conducted with the study participants and audio recorded. Transcription of the recording was done verbatim and coded for themes using a thematic analysis approach. Two FGDs were conducted with a total of eight participants. The mean (± standard deviation) age of the participants was 27 ± 3.7 years; all having a master's degree in either psychology, social work, or public health. The major themes that emerged were the meaning of ethics and professionalism, confidentiality, dilemma in decision making, incongruence between the requirements of student and school administration, and personal and professional challenges faced by CMHWs. Recommendations to overcome these challenges were also explored. The results indicate CMHWs face significant ethical challenges with confidentiality, and decision making while delivering YMH interventions in schools, highlighting the need for designing and implementing a framework to address these challenges.

Unnao Tanneries Limited: Post COVID Business Strategy

Unnao Tanneries Limited (UTL), formerly known as Monir Leather Works, was set up in the 1980s and has been a family-owned business for over four decades. The primary activity of UTL in the initial years was leather jackets and purses. It sold its products under the brand name Brown Cliff. It shifted its manufacturing units from Kanpur to the nearby town of Unnao to cut costs and increase capacity in 1990. It later expanded its product range to primarily include leather footwear, targeting the menswear market. It became one of the top players in the northern part of the country with a proper business strategy. The footwear segment was growing rapidly and profitably for UTL. The business was smooth for almost four decades with minor hiccups until the government imposed a ban on its functioning due to a sparse wastewater disposal system in May 2019. The initial ban was prolonged further due to the COVID-19 pandemic in the country in March 2020. As a result, UTL suffered a significant loss in sales and clients. Reviving demand for the products after the easing of partial lockdown in the country was a daunting task. UTL became a contractual manufacturer for CONTE to utilize its idle resources and reduce its financial burden. Later, UTL got an offer from Batla Leather Products Limited (BLPL) to become its contract manufacturer. BLPL was one of the top players in the national and international market and it was looked for facilities to quickly scale up its operations. This case allows the readers to put themselves in Mr Sadiq Monir’s shoes and analyse an unforeseen business situation. The choice between short-term profits and sustainability versus long-term growth of the family brand Brown Cliff had to be made. The case gives several macro and micro factors supporting the choices and the decision to be made. The decision dilemma has two facets—to gain expertise in improving operations and to have a steady flow of income for the next 2–3 years versus risking the loss of independence and dilution of the family brand Brown Cliff.

Emplacing Funsi: Antinomies of a District Capital and Transformation in Rural Ghana

Following ongoing debates on rural transformation, developing countries give priority to district capitals for their market viability and geographical centrality to empowering peripheral populations. Critics point out inherent electoral largesse in redistricting projects all the while ignoring hidden incentives from these exercises. Drawing on empirical data and local debates on decision dilemmas over a district capital in rural Ghana, the article raises two key points of interest. Rural district capitals undergird neither economic performance nor political participation of districts. A focus on their mundane governance processes, however, reveals hidden political incentives for local party buildout and individual political advancement. The insights enrich our understanding of in-built preferences in redistricting decisions beyond the widely perceived politico-economic attributes.