Towards wise decision-making Tim LeBon & David Arnaud

1) Decision analysis

Many people come to consultant philosophers for help with decision-making. An individual agonising over a career switch may visit a philosophical counsellor, an organisation may call in a dilemma trainer to enhance their staff's ability to make good ethical decisions, and managers may call in an expert in dialogue to help teams of co-workers make joint decisions in a manner which leads to better results. We will look at a variety of models and methods that have been proposed to enhance such decision-making in a series of articles in Practical Philosophy. Our aim is to be sympathetic yet critical to each approach considered so as to obtain some 'learning points' from each. In the final article in the series we shall draw on these to present our own integrated model of wise decision-making. In this, the first article, we examine decision analysis. What is decision analysis ? Decision analysis (sometimes also called decision theory) is "the attempt to assess utilities and probabilities of outcomes, in order to calculate the expected utility of decision options" (Baron, 1988, p.302). It comprises two main stages: first, searching for options and then evaluating them in terms of the likelihood and utilities of consequences. Decision analysis has been used to help with public decisions such as the location of international airports (Baron,1988); in a pioneering paper Marinoff has described how it might also help individuals with personal dilemmas in a counselling setting (Marinoff, 1995). It is this latter arena, that of individual decision-making, which will be our main focus here; can decision analysis help individuals make wise decisions about, for example, a career choice or an ethical problem ? A case study : John and his sick mother (adapted from Marinoff, 1995) John has been looking after his elderly mother. She is wheelchair-bound with a degenerative neurological disease; her condition is deteriorating and symptoms include hysteria, fainting and amnesia. John's mother, when lucid, says she wishes to remain at home, but John cannot be with her all the time or afford to pay someone else to supervise her. Recently she was found by John, when he returned home, at the bottom of stairs, with the wheelchair on top of her, unconscious and bleeding. She was taken to hospital and found to have no serious injuries. However, extensive tests were carried out on her, and unanimous professional opinion recommended her being kept in hospital until a permanent chronic care place became available in several months time. John suspects this may be convenient for them rather then in his mother's interests; he also thinks that the authorities underestimate his own ability to care for his mother. John knows that his mother would stridently oppose being in a chronic care unit and whilst he realises that institutionalisation is inevitable, is fearful that staying in hospital whilst waiting for the place would lead to her psychological deterioration and depression. John wondered whether a better course of action would be to bring his mother home for one 'last summer' together, where he could furnish her with additional personal care and gradually broach with his mother the need to move into the chronic care unit. John is faced with a difficult ethical decision: whether to follow expert advice, and keep his mother in hospital, or follow his own and his mother's wishes and allow her back home. Decision analysis appears to offer us a rational way out, assessing each of the options in terms of the likelihood and utility of their consequences and choosing the option which promises the highest utility. Staying in hospital offers the benefit of medical supervision but the possibility of psychological deterioration; it also deprives both John and his mother of the prospect of a wonderful 'last summer' together. On the other hand bringing the mother home risks a fatal accident for the mother and severe guilt for John. Full decision analysis would require evaluating the probability of each of these outcomes and their attendant utility; however Marinoff recognises that quantification is possible only in 'ideal conditions'. In other cases, this presumably being one, it is argued that qualitative analysis can be carried out usefully. One such method is 'best case' and 'worst case' analysis, which is what Marinoff undertook for John. The following table sums up John's situation (this table appears in the account of the case in Plato Not Prozac!) Possible consequences
Best outcome
Worst outcome
John's Choices
i)bring mother home
It appears that bringing John's mother home would be best on a 'best-case' analysis (the wonderful last summer) but on a worst-case analysis would lead to the least desired outcome, a serious or fatal accident. Marinoff does not tell us what John eventually chose, but says that decision analysis helped clarify John's options and their consequences; though it had not solved the problem, "John . indicate(d) that he now possessed a clearer appreciation of the ethical implications of his possible choice, and he expressed definite (and visible) relief at the prospect of shortly being able to arrive at a decision that would be morally justifiable to him". (Marinoff, 1995, p.187) This result was achieved after just two sessions. Discussion The first observation to make is that Marinoff's counselling was successful in so far as in a very short space of time John moved from "uncertainty and anxiety" to clarity and relief. This is important; since one of the bad things about the sad situation John found himself in was the effect it was having on him, and sharing the problem with a counsellor was clearly beneficial. From the point of view of this series of articles, though, we also need to ask: is decision analysis likely to help John (and others) make wise decisions ? Let us examine this by looking at the two stages of decision analysis in turn: the clarification and the evaluation of options. 1) The clarification of options One of the strengths of decision analysis is its ability to deal with a number of options. In this respect it is superior to a method which merely looked at the pros and cons of one particular option. In the case of John, Marinoff is content to leave the options at the two presented by John. In this respect it is, according to Marinoff, 'non-prescriptive' counselling - another case, where he adds options himself, he terms 'prescriptive counselling'. Whilst this distinction is useful, there seems to be a third alternative not mentioned; a joint exploration of options, in a Socratic vein, where the counsellor is neither prescriptive nor non-prescriptive but instead the participants are working together in the spirit of mutual enquiry. Moreover it would be quite permissible - perhaps even wise - for the counsellor to suggest ways of generating possible options - for example brainstorming and lateral thinking. Indeed there seems no good (philosophical) reason for limiting the dialogue to just the counsellor and client; expert opinion and other parties could usefully be involved in the search for good options. Anthony Weston, in an excellent recent book, A Practical Companion to Ethics, has convincingly argued that when generating options we should bear in mind that a dilemma may be more apparent than real (Weston, 1997). In other words, the best option may be the one that denies that the dilemma is real. In the case of John, it is conceivable that there are options that would allow John and his mother to spend quality time together (though perhaps not a whole summer) without putting her physical or emotional health at high risk. Having clarified options, decision analysis proceeds to evaluate them in terms of probabilities and utilities. It is at this stage that many critics accuse decision analysis of attempting to quantify the unquantifiable. The defender of decision analysis would point out that we implicitly do this kind of thing in our head every time we decide, for example, to watch TV rather than go to the pub. What we normally do is think about such things as whether our best friend will be at the pub, whether we might have to wait 10 minutes for a bus, and so on. All decision analysis is doing is making this thinking more explicit and therefore more systematic. It is important to realise that there are two different things being quantified - the likelihood and utility of events. Probabilities may often be hard to assess - for example, it is hard for us to know the likelihood of John's mother having a bad accident if she stayed with John. Nevertheless a wise decision should not duck the issue; rather it should attempt to make as good an estimate as possible. In this case, it would seem that the expert opinion of medical professionals could usefully be sought. Whilst the alternative sorts of analysis - for example best and worst case analysis - are interesting, we certainly need some idea of probabilities before making a decision. It is even possible that the best case and worst case scenario may both recommend one option, yet the wisest option may be the other one, if neither the best nor worst case are at all likely. The difficulties surrounding quantifying utility are of a different order, because of the conceptual ambivalence of the term 'utility'. What exactly is it that we are trying to measure? In the context of philosophical counselling there seem to be a number of possibilities: (i) The things that initially seem to matter to the client (ii) The things that matter, according to our client, after reflection (iii) The things that actually matter, regardless of what the client thinks There seems little reason to suppose that basing decisions on what seems to matter to the client will lead to a wise decision. Indeed one of the reasons clients may be seeking philosophical counselling is because they recognise that their closeness to the situation prevents them from perceiving the case in an impartial, fair-minded manner. In John's case, one wonders whether his desire for a 'last summer' may rest on a rose-tinted, 'On Golden Pond' vision of what it would be like. Wise decision-making would require exploration of what time spent with his mother would really be like. Consequently it would seem far preferable to base decisions on what the client thinks matters after reflection. John may come to recognise that the so-called 'last summer' may be more like a hellish 'last winter' for them both. There is nothing to prevent the philosophical counsellor using decision analysis from taking a Socratic rather than a Rogerian line about what the client thinks matters; however this raises the question of why what the client thinks matters should be taken into account at all. For example, it might actually be important (as Marinoff suggests in Plato Not Prozac!) that John's mother be allowed to decide for herself on grounds of autonomy, regardless of what John wants. If John did not accept this, where does this leave decision analysis? To be fair, the problem is not specifically that of decision analysis. In general the philosophical counsellor is trying to stay on the narrow path which avoids either paying too much respect for the client's (possibly mistaken) initial views and imposing their own (also possibly mistaken) views. The most promising way out of this impasse is for the counsellor to avoid imposing their own views on content, but to use their philosophical expertise to frame the right sort of questions that need to be asked - (such as: what would other parties in the case say? what would you say if the main protagonist was someone other than yourself? what would your best friend say?). This may seem to have taken us a long way from the notion that what matters can be quantified in terms of some common currency. However it is not of the question for clients to agree at least on an ordering of 'what matters'. It would then be entirely feasible to use these orderings, together with the probability estimates, to try to assess the best option. For example, it may be agreed that what mattered most was that John's life is not severely adversely affected, and that the next most important factor is that his mother's emotional health does not suffer. Options could then be assessed in terms of how likely they were to bring about the desirable outcomes and avoid undesirable ones. Decision analysis offers a number of important learning points for the consultant philosopher interested in helping individuals make wise decisions. On the positive side, it
shows the value of looking at options and of trying to assess the probabilities of possible
outcomes. It also highlights the difficulty of evaluating outcomes both in terms of
quantification and paying sufficient respect to the views of the client and the desire to
produce a wise decision. We believe the process would benefit from a 'Socratic' spirit
where all parties (not necessarily just client and counsellor) try to investigate in an open-
minded manner what the situation really is and what really matters. We have also argued
that there is considerable scope for using methods from creative thinking to generate
options that satisfy as much as possible of what matters. It's entirely possible that a
method which incorporated such insights would not be recognisable as 'decision analysis'
- but what really matters, surely, is not the name but the capacity to produce truly wise
Baron, J (1988) Thinking and Deciding, Cambridge University Press
Marinoff, L (1995), 'On the emergence of Ethical Counselling: Considerations and Two
Case Studies', Essays on Philosophical Counselling (ed) Lahav, R & Tillmans, M University
Press of America
Marinoff, L (1999) Plato Not Prozac, Harper-Collins
Weston, A (1997) A Practical Companion to Ethics, OUP


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