Practical Judgment Research Articles

Uncertainty and objectivity in clinical decision making: a clinical case in emergency medicine.

The evidence-based practice and evidence-based medicine (EBM) movements have promoted standardization through guideline development methodologies based on systematic reviews and meta-analyses of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement. In this paper, we argue that the protagonists of EBM position their mission as reducing uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and uncertainty as integral parts of medical practice. We question the appropriateness of attempts to standardize professional practice through a discussion of the importance of uncertainty. Greenhalgh’s taxonomy of uncertainty is used to inform an analysis of the clinical reasoning occurring in a potentially life threatening emergency situation with a young patient. The case analysis is further developed by the use of the Canadian philosopher Bernard Lonergan’s theory about understanding and objective knowing. According to Lonergan it is not by getting rid of or even by reducing uncertainty, but by attending systematically to it and by relating to it in a self-conscious way, that objective knowledge can be obtained. The paper concludes that uncertainty is not a regrettable and unavoidable aspect of decision making but a productive component of clinical reasoning.

A Note on the Use of Religions in the Phronocene

A Note on the Use of Religions in the Phronocene Anthony Lioi In a burst of ecumenical categorization, the humanities, social sciences, and natural sciences are adopting the term Anthropocene for our current geologic epoch. The term entered the arena of discourse in the year 2000 when Paul Crutzen, an atmospheric chemist who won the Nobel Prize for his work on ozone, leapt up a professional meeting and declared that the Holocene—the era after the most recent ice age—was over, replaced by the anthropos kainos, the New Epoch of Humanity. In making this claim, Crutzen emphasized the rise of humanity as a geophysical power, a species that changes the face of the earth, the depths of the sea, and the substance of the air. Though it has served as a useful rallying point for academics concerned with climate change, ocean acidification, and species extinction, Anthropocene has an unpleasant aftertaste. Marxists argue that it is capital and industry, not “humanity,” that have granted some of us the status of natural force. Advocates for indigenous peoples and the Global South observe that environmental destruction is a product of colonization, genocide, and empire. Feminist critics aver that it is “man” in the non‐inclusive sense, not humanity as such, that has wielded anthropic power in an attempt to master nature. In an important sense, however, the horse has left the barn. In recognition of an imperfect but necessary term, the French historians Christophe Bonneuil and Jean‐Baptiste Fressoz observe: “The great advantage of the concept of the Anthropocene is that it abolishes the futile distinction between modernity and reflexive modernity, forcing us to consider the contemporary situation from a historical standpoint, less as a threshold in the acquiring of environmental awareness than as the culminating point of a history of destruction” (170). In other words, we should stop arguing about the distinction between modernity and post‐modernity; rather, we ought to forge an understanding of this history of destruction in order to see what must be done about it. To that end, Bonneuil and Fressoz wrote The Shock of the Anthropocene (), in which they critique the term by way of expansion, producing a panoply of other names that reveal its productive tensions. One of these terms is Phronocene, which they name after the Greek phronesis, the exercise of prudence or practical judgment (171). In doing so, they suggest that the advent of the “Anthropocene” may inaugurate an era of environmental phronesis in which we teach ourselves how best to cope with the damage the anthropos (whoever that is) has caused. In editing this special issue of CrossCurrents, I contend that religions will inevitably play a part in the creation of the Phronocene. As the Australian ecocritic Kate Rigby says in “Religion and Ecology: Toward a Communion of Creatures”: “For better or ill, religion informs the environmental views, values, relations, and behavior of an overwhelming majority of people around the world, often in profound ways. For this reason alone, studies in religion and ecology should comprise a crucial component of the wider work of the environmental humanities” (Rigby n.p.). Readers familiar with the transdisciplinary fields of religion and ecology and ecotheology may balk at this claim. Are not such studies already on the scene? To take only a few examples: Mary Evelyn Tucker and John Grim have edited the magisterial series “Religions of the World and Ecology” out of the Harvard University Center for the Study of World Religions for several decades. Lynn White, Jr.'s seminal essay “The Historical Roots of Our Ecological Crisis,” which pinned responsibility for the Anthropocene squarely on Christianity, has sparked debate for as long as this author has been alive. The colossus of Oxford University Press gave its imprimatur to the field with Roger S. Gottlieb's The Oxford Handbook of Religion and Ecology (2006). Indeed, the flourishing of feminist theology is barely conceivable without the ecological feminist contributions of such figures as Alice Walker, Susan Griffin, Arundhati Roy, Leslie Marmon Silko, Vandana Shiva, Rosemary Radford Ruether, Maria Mies, Sallie McFague, Starhawk (Miriam Simos), Dolores Williams, Mary Daly, Carol P. Christ, Mary Grey, Judith Plaskow, Rigoberta Menchú, Charlene Spretnak, Berta Cáceres, Ishimure Michiko, Ariel...

Judgment, Imagination and the Search for Justice

The multiplicity of demands and claims in ultra-pluralistic societies complicates the search for justice. Furthermore, the normative force of competing ideals gives rise to an aporia at the heart of the idea of justice’s federating force. In this article, I argue that exemplary moral and political acts evince these ideals by reason of their fittingness with respect to the demands of the situations to which they respond. As such, these acts lay claim to their normative value by exemplifying the “rule” that each act summons. Drawing upon aesthetic experience’s lateral transposition onto the planes of ethics and politics, I show how imagination is operative in practical judgments (phronesis). Accordingly, I relate the search for justice to an eschatology of non-violence, which for Paul Ricœur takes the place of the critique of ideology in its opposition to an ontology of lingual understanding.

Conscience and Experience: Choosing the True and the Good

This essay examines the practical judgment called conscience that binds a person to do or not to do a particular action. Drawing from the Wesleyan Quadrilateral, scripture, tradition, reason/science, and human experience, it focuses on the connection between communal human experience and conscience. It concludes that the teaching that no one is to be forced to act contrary to her or his conscience and that no one is to be restrained from acting according to her or his conscience is a long-standing Catholic moral tradition.

La conciencia moral y el problema de la norma desde la perspectiva rosminiana

The article defends, first of all, that the moral conscience is a theoretical judgment about the practical or effective judgment, and not a practical judgment, as is often usually considered. And in second place, the article expose in what sense can we speak about the error of the judgment of conscience, for which a Rosminian posture is adopted. DOI : http://dx.doi.org/10.21747/21836892/fil33a5

La conciencia moral y el problema de la norma desde la perspectiva rosminiana

The article defends, first of all, that the moral conscience is a theoretical judgment about the practical or effective judgment, and not a practical judgment, as is often usually considered. And in second place, the article expose in what sense can we speak about the error of the judgment of conscience, for which a Rosminian posture is adopted. DOI: http://dx.doi.org/10.21747/21836892/fil33a5

Optimal Allocation of Tunnel Safety Provisions Based on a Quantitative Risk Assessment Model

This paper addresses the issue of optimally selecting the tunnel safety provisions. Tunnel safety provisions are the assets of urban road tunnels which are installed and implemented to reduce the tunnel risks, which are basically selected by expert judgment in practice. An optimization model is proposed to obtain the optimal solution for the selection of tunnel safety provisions. The objective function is to minimize the life cycle costs of tunnel safety provisions, which is subject to the requirements for tunnel safety provisions and the safety targets. Finally, by taking advantage of the special structure of the optimization model, a Bi-Section Search and Bound Algorithm (BSSBA) is designed to efficiently solve the problem.

Practical Judgment, Narrative Experience and Wicked Problems

Practical Judgment, Narrative Experience and Wicked Problems

Kant's Demonstration of Free Will, Or, How to Do Things with Concepts

ABSTRACT:Kant famously insists that free will is a condition of morality. The difficulty of providing a demonstration of freedom has left him vulnerable to devastating attack: critics charge that Kant's post-Groundwork justification of morality amounts to a dogmatic assertion of morality's authority. My paper rebuts this objection, showing that Kant offers a cogent demonstration of freedom. My central claim is that the demonstration must be understood in practical rather than theoretical terms. A practical demonstration of x works by bringing x into existence, and what the demonstration of freedom brings into existence is a moral will, a will regulated by the moral law and capable of acting in accordance with it. Since to act morally is to act freely, bringing a moral will into existence actualizes our capacity for freedom and demonstrates that we possess it. To confirm the viability of such a demonstration, Kant must establish that agents can regulate their wills by practical principles, and that practical judgments are efficacious of themselves (i.e., that non-Humean motivational internalism is true). Kant, I argue, is successful on both counts.

JUSTICE, REALISM, AND FAMILY CARE FOR THE AGED

Abstract:Starting with a particular case of familial care for the aging, the discussion points to the difficulties in deriving practical judgments from ideal theory in cases where there seems to be injustice, but where there are multiple competing dimensions of value and cost. The essay argues that the problems discussed are deeply embedded in modern western cultures, where life expectancy has risen dramatically and has been coupled with a range of other social and demographic changes that make familial care for the aged difficult and burdensome, and where our thinking about justice and rights are integral to the conflicted ways in which people construct and experience these situations, rather than standing independently as a solution to them. The essay argues for a set of partial, limited, and “realist” responses that reduce some elements of burden, without pretending to provide a solution that is in any sense ideal or wholly just. The argument from a case is integral to the essay’s case for realism in moral and political philosophy.

Capturing judgement strategies in risk assessments with improved quality of clinical information: How nurses’ strategies differ from the ecological model

BackgroundNurses’ risk assessments of patients at risk of deterioration are sometimes suboptimal. Advances in clinical simulation mean higher quality information can be used as an alternative to traditional paper-based approaches as a means of improving judgement. This paper tests the hypothesis that nurses’ judgement strategies and policies change as the quality of information used by nurses in simulation changes.MethodsSixty-three student nurses and 34 experienced viewed 25 paper-case based and 25 clinically simulated scenarios, derived from real cases, and judged whether the (simulated) patient was at ‘risk’ of acute deterioration. Criteria of judgement “correctness” came from the same real cases. Information relative weights were calculated to examine judgement policies of individual nurses. Group comparisons of nurses and students under both paper and clinical simulation conditions were undertaken using non parametric statistical tests. Judgment policies were also compared to the ecological statistical model. Cumulative relative weights were calculated to assess how much information nurses used when making judgements. Receiver operating characteristic (ROC) curves were generated to examine predictive accuracy amongst the nurses.ResultsThere were significant variations between nurses’ judgement policies and those optimal policies determined by the ecological model. Nurses significantly underused the cues of consciousness level, respiration rate, and systolic blood pressure than the ecological model requires. However, in clinical simulations, they tended to make appropriate use of heart rate, with non-significant difference in the relative weights of heart rate between clinical simulations and the ecological model. Experienced nurses paid substantially more attention to respiration rate in the simulated setting compared to paper cases, while students maintained a similar attentive level to this cue. This led to a non-significant difference in relative weights of respiration rate between experienced nurses and students.ConclusionsImproving the quality of information by clinical simulations significantly impacted on nurses’ judgement policies of risk assessments. Nurses’ judgement strategies also varied with the increased years of experience. Such variations in processing clinical information may contribute to nurses’ suboptimal judgements in clinical practice. Constructing predictive models of common judgement situations, and increasing nurses’ awareness of information weightings in such models may help improve judgements made by nurses.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0243-1) contains supplementary material, which is available to authorized users.

The good life in balance

Happiness in the Japanese context can usefully be understood as deriving from a series of negotiations or “balancing acts” between contrastive values and orientations to the world. Of particular importance for older Japanese is a tension between a narrative orientation or attitude, involving sense-making and social activities such as reminiscing or reflecting; and an immediate attitude, implying a focus of attention on the present moment. Further balances are sought between sociality and the burden of over-closeness, intimacy and a sense of freedom, and dependence and autonomy, among others. Because the poles of these tensions encapsulate important social and moral values that are in some ways incommensurable, they cannot be resolved through a straightforward choice between them. Instead, their negotiation—and thus the pursuit of happiness itself—is a matter of practical moral judgment.

Towards a Kantian Theory of Judgment: the Power of Judgment in its Practical and Aesthetic Employment

Human beings orient themselves in the world via judgments; factual, moral, prudential, aesthetic, and all kinds of mixed judgments. Particularly for normative orientation in complex and contested contexts of action, it can be challenging to form judgments. This paper explores what one can reasonably expect from a theory of the power of judgment from a Kantian approach to ethics. We reconstruct practical (prudential and moral) judgments on basis of the self-reflexive capacities of human beings, and argue that for the subject to see himself as committed to prudential goods it is necessarily implied that he understands himself as committed to moral judgment. However, to understand the normativity of understanding oneself as a being with practical commitments at all, the aesthetic judgment is introduced: the power of judgment in its pure form of selfreflexivity. We claim that aesthetic reflection and judgment is conditional on the possibility for human beings to enter the space of reasons, and therewith for practical self-understanding as such. The paper concludes with a preliminary sketch of different conceptual possibilities in fleshing out the role of the power of judgment in its aesthetic employment in developing mixed judgments.

Predicting the Path of European Integration – in Retrospect

In the early Spring of 2015 the United Kingdom lost two of its best experts on European integration – John Pinder and Roger Morgan. Both brought academic expertise and great practical judgement to ...

Conservation compendium. Part 11: A career in ruins (challenges presented by derelict structures)

Our built heritage is a finite resource stretching back thousands of years. Protecting and conserving this heritage is a challenge requiring knowledge, skills and experience, together with an ability to bring practical engineering judgement and often creative and imaginative solutions. This paper sets out the challenges faced by engineers and some of the approaches taken in the appraisal and protection of ruins.

Application of imaging logging in reservoir geological research

With the ability to provide complete profiles of pseudocolor image formation, IL (imaging logging) measures directionally, thereby offering a possible alternative to drilling and coring. This paper, relying mainly on IL information but also referring to formation dip angle logging information, details sandstone lamina dips and identifies sedimentary body dips, and sums up a practical palaeo-provenance direction judgment method using heavy mineral data analysis. By identifying a fine sandstone reservoir through an IL lithological model, a bedding model and a rhyme model, a 1D pseudoresistivity curve (named the 'IL rhythm curve') is, according to IL image analysis, extracted to assist in the interpretation of sedimentary microfacies and to establish an IL single-well facies analysis profile, overcoming an observance difficulty of IL in silty sandstone regions and intuitively displaying whole-horizon sedimentary evolution. As for a glutenite formation, calibrating IL information by rock cores, a single-well facies sequence of IL is established by identifying the Bouma sequence, high-density turbidity succession, the middle fan braided channel, the outer fan mudstone and other microfacies sequences, finely dividing the sedimentary facies sequence about sedimentary stage.

The Epistemic Value of Public Opinion: Theoretical and Practical Considerations

This paper discusses the claim that citizens lack sufficient political knowledge to make sound judgements on public matters. It is contended that practical judgements raise essentially two types of claims, namely a claim to empirical truth and a claim to normative rightness, and that there are good reasons to believe that people's insufficient political knowledge undermines both of them. Yet, an examination of the dynamics of public opinion formation reveals that there is an epistemic potential in public opinion, though it is dependent upon the quality of public debate. Building on this idea and on the concept of deliberative responsiveness, two paths of political reform are proposed, which should illustrate the practical implications of the theoretical argument made in this paper by demonstrating how the quality of public debate and, thus, the epistemic value of public opinion could be enhanced.

Justice and Personal Responsibility. Ricoeur on Law and Morality from The Perspective of the Humanities

This paper will focus on the particular problem of how he makes use of the humanities in trying to draw his picture of the case in question. Three of his papers translated into English in the collection The Just,and one other short essay republished at the same time will play the major role in this analysis.They provide an insight into the way Ricoeur tried to negotiate his phenomenological and hermeneutic criticism of Kantian practical philosophy with a criticism of neo-Kantian analytical normative theories like that of Rawls, and with an Aristotelian analysis of practical judgement partly based on lessons drawn from Greek tragedies.

Jugement pratique et burn-out des médecins

The growing incidence of burn-out syndrome among physicians has become a major concern for public policy. The root causes are not fully understood. We make the assumption that the most powerful cause of their suffering at work is the challenging of physician's practical judgment. Practical judgment is the faculty, which connects knowledge and reason, science and experience, general and individual issues. It lies at the core of medical action and its exercise is closely associated with a pleasure at work. The evolution of medicine, particularly the proliferation of procedures, has a harmful influence on its training and its exercise.

Apprentices’ Learning of Occupationally Informed Practical Judgment

Learning to become trade workers requires developing the ability to make practical workplace-based judgments, often centred around difficult to articulate trade’know-how’ or tacit knowledge. Apprentices learn discipline specific ways of doing, thinking, feeling and being from experts, peers and through interactions with occupational artefacts and environments. Hence, distinct and specialised trade or discipline specific socio-cultural and socio-material factors influence how processes are followed, tools or equipment are deployed, materials are made or assembled and workplace relationships are transacted. Consequently, learning practical judgment is but one facet of expertise contributing to occupational identity. This article reports on apprentices’ perceptions of how they ‘learnt a trade’ and provides direction for the enhancement of learning occupationally-delineated practical judgment.