Paper, Rock, Scissors, Ethics! How we make decisions

When it comes to decision-making, paper-rock-scissors is a great standby. Otherwise, you can turn to long traditions in philosophy, psychology, sociology, and neurobiology that begin to sort out how we humans make decisions, and if we can even do so.

Robert Sapolsky, for starters, thinks we can only make a limited number of decisions. Most are driven by our hormones, neuroanatomy, cultural inheritance, and experience. If this angers you, we can kick it all the way back to Plato, Aristotle and Thomas Aquinas (and many more) who looked at free will and our role in society and often debated more towards our control of it. Psychologists like Abraham Maslow and Carl Rogers not only stand by free will, but feel it’s required for self actualization in stark contrast to BF Skinner and Pavlov (think Skinner box, bells, and Smashing Pumpkin’s Rat in a Cage). This debate carries into disciplines like sociology where it gets framed as agency versus structure. And, we see this continue into political science with our theories about government, rights, and self-determination.

Today, we’ll assume we can make decisions, and rational ones to boot. How on earth do we do this if people can’t even agree that we’re capable? We discussed the difference between values, ethics, and laws before, so we’ll dive right in.

Values > Laws

When it comes to decision-making, our values will drive the most emotional ones. These values represent who we are and are deeply embedded in our being. We rarely even think about them and can have a rough time verbalizing them, even – especially when emotional. We get angry when our values get stepped on.

When we protest a law, we’re saying something about our values disagrees with the law or rule. Martin Luther King Jr. provides one of the best dialogues on this:

One may well ask: “How can you advocate breaking some laws and obeying others?” The answer lies in the fact that there are two types of laws: just and unjust. I would be the first to advocate obeying just laws. One has not only a legal but a moral responsibility to obey just laws. Conversely, one has a moral responsibility to disobey unjust laws. I would agree with St. Augustine that “an unjust law is no law at all.”

Now, what is the difference between the two? How does one determine whether a law is just or unjust? A just law is a man made code that squares with the moral law or the law of God. An unjust law is a code that is out of harmony with the moral law. To put it in the terms of St. Thomas Aquinas: An unjust law is a human law that is not rooted in eternal law and natural law. Any law that uplifts human personality is just. Any law that degrades human personality is unjust.

(Letter from a Birmingham Jail)

We ourselves can only step on our values so long. It’s uncomfortable and we often feel compelled to take some type of action. Interpreters get presented this scenario quite a bit:

Patient X has (communicable/terminal disease) and is so ill at this immediate time that direct communication isn’t going to happen. You, the interpreter, know all about patient X. Do you volunteer a health history?

For the non-interpreter population, most see this as a non-issue. Of course you’d provide the information! Interpreters face a challenge – they are there to support communication, and also the patient’s autonomy and privacy. That health information falls under privileged communication and we’re using working memory when we pass it, so our recall of the events isn’t always reliable. This is why you rarely question interpreters, as many can’t recall if certain things were affirmative or negative. We’re not decision-makers for the person, nor do we have any clue of this person’s wishes or past experiences outside our limited scope. At first brush, we may see this as a sanctity of life issue, the ‘do no harm’ type of sharing. Autonomy and privacy force us to stop and ask if someone more qualified can provide this information, such as family members, other medical providers, and ideally the patient at a later time.

A Return to Innocence Ethics

What we’ve seen above is the start of ethical decision-making. It can feel uncomfortable, because what we’re saying is we can’t fast-track one value. We have to look at others, even when it’s outright terrifying.

You’ll see values get catalogued a lot in Codes of Ethics. Words like beneficence, autonomy, confidence, justice, sanctity of life, and integrity are common. In healthcare, such as the test above, we can see how these interplay. Treatments might infringe on autonomy, beneficence, sanctity of life, and even justice, such as sharing patient information or sorting out who gets an organ transplant. When we create decision-making tools on work performance, we could have similar effects if we create a standard that causes injury or harm to achieve the job in an appropriate time.

As we do our work, it may help to consider:

1. Who is this (data collection, visualization, algorithm) benefitting?
2. Who is being analyzed and what controls do they have over this data?
3. This data represents (hours worked, treatments, costs) which is collected by (person, system) in what setting?
4. I am using this to evaluate (performance, success, areas of improvement) which may lead to the following decisions (employee terminations, denial of transplants, labor standards that guarantee failure or injury). What needs considered – besides this data – to provide the appropriate context to make it fair?
5. Can I trace this back to someone and name them even without their name?
6. Have I checked and shown all the steps in my work?
7. Are all the right people involved and represented?
8. Where can this go wrong?

Some of these are harder to answer than others. Some, we may have no control of. Others, we may be able to provide quiet guidance, such as clarifying data collection methods. We may not control the data or even know how it’s collected, but we can definitely ask and start the conversation.

So far, we’ve kept this conversation confined to ourselves and situations. But, as professionals, we can’t develop in isolation, so next we’ll dig more into why professions standardize and create meaningful associations.