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As artificial intelligence (AI) plays an increasing role in operations on battlefields, we should consider how it might also be used in the strategic decisions that happen before a military operation even occurs. One such critical decision that nations must make is whether to use armed force. There is often only a small group of political and military leaders involved in this decision-making process. Top military commanders typically play an important role in these deliberations around whether to use force. These commanders are relied upon for their expertise. They provide information and guidance about the military options available and the potential outcomes of those actions. This article asks two questions: (1) how do military commanders make these judgements? and (2) how might AI be used to assist them in their critical decision-making processes? To address the first, I draw on existing literature from psychology, philosophy, and military organizations themselves. To address the second, I explore how AI might augment the judgment and reasoning of commanders deliberating over the use of force. While there is already a robust body of work exploring the risks of using AI-driven decision-support systems, this article focuses on the opportunities, while keeping those risks firmly in view.
In this article, we maintain that the anticipated integration of artificial intelligence (AI)-enabled systems into state-level decision making over whether and when to wage war will be accompanied by a hitherto neglected risk. Namely, the incorporation of such systems will engender subtle but significant changes to the state’s deliberative and organisational structures, its culture, and its capacities – and in ways that could undermine its adherence to international norms of restraint. In offering this provocation, we argue that the gradual proliferation and embeddedness of AI-enabled decision-support systems within the state – what we call the ‘phenomenon of “Borgs in the org”’ – will lead to four significant changes that, together, threaten to diminish the state’s crucial capacity for ‘institutional learning’. Specifically, the state’s reliance on AI-enabled decision-support systems in deliberations over war initiation will invite: (i) disrupted deliberative structures and chains of command; (ii) the occlusion of crucial steps in decision-making processes; (iii) institutionalised deference to computer-generated outputs; and (iv) future plans and trajectories that are overdetermined by past policies and actions. The resulting ‘institutional atrophy’ could, in turn, weaken the state’s responsiveness to external social cues and censure, thereby making the state less likely to engage with, internalise, and adhere to evolving international norms of restraint. As a collateral effect, this weakening could contribute to the decay of these norms themselves if such institutional atrophy were to become widespread within the society of states.
This article prefaces our Special Issue on “AI and the Decision to Go to War.” We begin by introducing the prospect of artificial intelligence (AI)-enabled systems increasingly infiltrating state-level decision making on the resort to force, clarifying that our focus is on existing technologies, and outlining the two general ways that this can conceivably occur: through automated self-defense and AI-enabled decision-support systems. We then highlight recent, on-going developments that create a backdrop of rapid change and global uncertainty against which AI-enabled systems will inform such deliberations: (i) the widespread tendency to misperceive the latest AI-enabled technologies as increasingly “human”; (ii) the changing role of “Big Tech” in the global competition over military applications of AI; (iii) a conspicuous blind spot in current discussions surrounding international regulation; and (iv) the emerging reality of an AI-nuclear weapons nexus. We suggest that each factor will affect the trajectory of AI-informed war initiation and must be addressed as scholars and policymakers determine how best to prepare for, direct, and respond to this anticipated change. Finally, turning to the pressing legal, ethical, sociotechnical, political, and geopolitical challenges that will accompany this transformation, we revisit four “complications” that have framed the broader project from which this Special Issue has emerged. Within this framework, we preview the other 13 multidisciplinary research articles that make up this collection. Together, these articles explore the risks and opportunities that will follow AI into the war-room.
Willingness to help a needy person may depend on whether the person is perceived as responsible for their predicament. However, information regarding the cause is not always available, and people often ‘look the other way’ when it is. The present research explores whether potential donors choose to obtain information about the cause of the other’s need and, more importantly, how this choice to pursue information is affected by the donors’ feelings of entitlement. Across four studies, we find that decision makers who pursue information about why others are in need are more likely to offer help. Yet we also measure and manipulate the feelings of entitlement and find that those who are high in entitlement are more likely to seek the information regarding the person in need. Their higher tendency to pursue more information makes them more likely to help than they would otherwise.
Over the last three decades, European Union regulation of the internal market has become highly pervasive, affecting practically all domains of European citizens' lives. Many studies have focused on understanding the process and causes of regulatory change, but with limited attempts to analyse the more general sources of regulatory reform. This article focuses on the determinants of stability and change in EU regulation. An original dataset of 169 pieces of legislation (regulations, directives and decisions) across eight different sectors is developed and the dynamics of regulatory reform in the EU are analysed. Using time‐series analysis of count data, evidence is found that the number of winning coalitions in the Council and the size of EU membership have a significant impact on regulatory reform in the EU. By contrast, the ideological composition of the EU's legislative bodies is not systematically related to regulatory reform.
Although evidence shows that it is challenging to implement, many authors state that participatory management is a distinctive attribute of social enterprises. This paper presents case study research exploring how participatory management is manifest in Chile, a country where a paternalistic and autocratic management style prevails thereby constraining the adoption of more collaborative approaches. We found that a majority of the twenty social enterprises considered, despite having very different sizes, governance structure and activity sectors, involved employees and stakeholders in shared decision-making processes. Participatory management was exhibited in distinctive and diverse ways ranging from common agreement on strategic decisions through to the presentation of new proposals by members. We conclude that social enterprises in Chile differ from conventional enterprises not only in their focus on trying to solve social problems, but also in the fact that they may provide a vehicle to promote more innovative and participatory approaches to decision making.
This article suggests theoretical refinements to the multiple streams framework (MSF) that make it applicable to parliamentary systems and the decision‐making stage of the policy process. Regarding the former, the important role of political parties in parliamentary democracies is highlighted. Party policy experts are expected to be members of the policy communities in the policy stream and to promote viable policy alternatives in their respective parties, while the party leadership is concerned with adopting policies in the political stream. With regard to the latter, the introduction of a second coupling process to analyse decision making more rigorously is suggested. Moreover, the article provides operational definitions of the framework's key concepts when applied to parliamentary systems and derives a systematic set of falsifiable hypotheses for agenda‐setting and decision making in these systems, thus addressing one of the main critiques against the MSF – namely that no hypotheses can be derived from it.
This article explores the different ways governments express dissent in the Council of the European Union (EU) through ‘No’ votes, abstentions and recorded negative statements. A game‐theoretical model is presented that studies voting behaviour and analyses how the national parliaments’ levels of control over their governments’ EU policies affect it. It is concluded that governments that are strongly controlled by their parliaments are not more likely to express dissent. However, when they do express dissent, they vote ‘No’ more often. Parliamentary control depends on the presence of formal oversight institutions as well as the motivation of parliamentarians to hold their governments accountable. Empirical support is found in an analysis of votes on 1,387 legislative proposals that represent more than a decade of Council decision making in the period 2004–2014. This article contributes to the discussion on the involvement of national parliaments in EU affairs, and clearly distinguishes the different forms of dissent in Council decision making.
Humanitarian NGOs face difficult choices about whom to help and whom not on a daily basis. The research question in this article is how humanitarian NGOs make these difficult decisions and why in a particular way. March’s study on consequential and appropriate decision-making processes is used to analyze the nature and course of NGO decision making. Since March’s two models are often explicitly or implicitly linked to certain types of organizational settings—as reflected in an organization’s formal structure, compliance and coordination mechanisms—this article particularly zooms in on the relationship between NGO decision-making processes and these settings. The theoretical framework is illustrated and discussed by means of an exploratory comparative case study of two international humanitarian NGOs: Médecins Sans Frontières Holland (MSF Holland) and Acting with Churches Netherlands (ACT Netherlands).
In recent years, transparency (or the lack thereof) has become a central concern of the European Union and its attempts to increase the democratic legitimacy of the legislative decision‐making process. The claim regularly made is that increasing transparency increases the potential for holding decision makers to account. This study investigates the manner in which transparency in the decision‐making process affects the policy positions taken by negotiators at the outset of negotiations. The findings presented suggest that increasing transparency tends to lead to polarisation of negotiations, with negotiators taking more extreme positions when they know that their positions can be observed by outside parties. The implication of this result is that advocates of transparency should be aware that there is an inherent trade‐off between increasing transparency, on the one hand, and increasing the incentives to grandstand during negotiations, on the other.
Use of metaphors is a staple feature of how we understand policy processes – none more so than the use of ‘policy stages’/'cycles’ and ‘multiple streams’. Yet even allowing for the necessary parsimony of metaphors, the former is often criticised for its lack of ‘real world’ engagement with agency, power, ideology, turbulence and complexity, while the latter focuses only on agenda‐setting but at times has been utilised, with limited results, to understand later stages of the policy process. This article seeks to explore and advance the opportunities for combining both and applying them to the policy‐formation and decision‐making stages of policy making. In doing so it examines possible three, four and five stream models. It argues that a five stream confluence model provides the highest analytical value because it retains the simplicity of metaphors (combining elements of two of the most prominent models in policy studies) while also helping capture some of the more complex and subtle aspects of policy processes, including policy styles and nested systems of governance.
Diagnosing, treating, and caring for individuals with dementia-related syndroms raises unique legal and ethical questions. Individuals with dementia may be more likely to lack decision-making capacity. Additionally, along with their families, individuals with dementia will face complicated health care related decisions – complicated by limited therapy options. This chapter identifies key legal and ethical questions that come up in the clinical and non-clinical setting relevant to dementia-related syndromes.
As the variety of specific treatments in a disease area increases, there may be a growing interest in employing treatment sequencing within health economic models. The aim of this review was to identify and thematically analyze patterns regarding the approaches to modeling treatment sequencing in National Institute for Health and Care Excellence (NICE) appraisals.
Methods
A review of NICE technology appraisals (TAs) published between 1 January 2020 and 13 March 2023 was conducted.
Results
A total of twenty-four TAs incorporating treatment sequencing were included, most commonly in autoimmune and oncology indications. Primary justifications for companies employing treatment sequencing were precedence and alignment with clinical practice, whilst lack of appropriate clinical data was cited to justify its exclusion. Relatedly, External Assessment Groups commonly criticized treatment sequences for oversimplifying clinical practice. Notably, almost half of identified TAs assumed that the relative efficacy of an intervention was maintained regardless of disease severity or position within the treatment sequence.
Conclusion
A substantial proportion of TAs employed treatment sequencing, but it is challenging to determine the impact of current approaches on the overall uncertainty associated with any health economic model. The challenges identified in this review could be used to inform future formal guidance and associated methodology for the implementation of treatment sequencing modeling, which could improve the comparability and reliability of models and their results.
Public attitudes toward nuclear weapons remain a critical issue in international security, yet the thinking behind individuals’ support or opposition to their use is not well understood. This study examines how the American public reasons about whether to deploy nuclear weapons in a hypothetical war between the United States and Iran. Participants were asked to state their preference between continuing a ground war, deploying a nuclear strike resulting in 100,000 civilian casualties, or deploying a strike killing 2 million civilians. They then provided an open-ended answer where they described the reasons for their decision. Using Structural Topic Modeling, we identified 10 distinct patterns in participants’ thinking. Some responses emphasized concerns about deterrence or saving lives, while others focused on national security, or retaliation, among other reasons. The type of thinking participants employed was found to be related to their preceding choice, as well as to individual characteristics, such as gender, political affiliation, punitive–authoritarian–nationalist attitudes, and the influence of the relative emotional impact of the 2 bombs (i.e., the better bomb effect). These findings highlight the complexity of the thinking underlying nuclear decision making and help shed light on potential avenues for reducing the risk of a nuclear weapon being deployed again.
Diffusion decision models are widely used to characterize the cognitive and neural processes involved in making rapid decisions about objects and events in the environment. These decisions, which are made hundreds of times a day without prolonged deliberation, include recognition of people and things as well as real-time decisions made while walking or driving. Diffusion models assume that the processes involved in making such decisions are noisy and variable and that noisy evidence is accumulated until there is enough for a decision. This volume provides the first comprehensive treatment of the theory, mathematical foundations, numerical methods, and empirical applications of diffusion process models in psychology and neuroscience. In addition to the standard Wiener diffusion model, readers will find a detailed, unified treatment of the cognitive theory and the neural foundations of a variety of dynamic diffusion process models of two-choice, multiple choice, and continuous outcome decisions.
Many important decisions, for example, applying to college, require an individual to simultaneously submit several applications. These decisions are unique as each application is risky because acceptance is uncertain while also being rival as one can only attend a single college. In an influential theoretical analysis of these problems, Chade and Smith (2006) establish the No Safety Schools Theorem which suggests larger portfolios are riskier than single choices. We offer experimental evidence, using several experiments, that this theorem is routinely violated. In fact, the majority of our subjects violate this theorem. However, performance improves with practice, advice, and feedback.
Patients with locally advanced laryngeal malignancy may be offered total laryngectomy or chemoradiotherapy. Laryngeal dysfunction is a consequence of non-surgical treatment and can result in issues with airway, voice, and swallow.
Methods
Semi-structured qualitative interviews explore the experiences of patients who have undergone functional laryngectomy for non-functional larynx in one UK health board.
Results
3 patients were identified and interviewed. Thematic Analysis generated four main themes: Preparation for treatment, Tipping Points, Post-Operative Quality of Life and Attitudes to Future Healthcare. These themes uncover the functional and psychological experiences of patients undergoing functional laryngectomy.
Conclusion
This study explores the many facets of the decision to undergo functional laryngectomy; namely recognising a patient’s tipping point and changes in attitudes towards surgical intervention. Ultimately this enhances our understanding of the rationale of patient’s choices, which can aid in the counselling of future patients.
Health technology assessment (HTA) can occur at different stages of a technology’s lifecycle. In the accompanying paper, Grutters and colleagues present a consensus definition of “early HTA” as a health technology assessment conducted to inform decisions about subsequent development, research, and/or investment by explicitly evaluating the potential value of a conceptual or actual health technology. Early HTA is particularly relevant to non-medicine technologies, which are often developed more iteratively than medicines. This article explores some of the ways in which early HTA is already being conducted on non-medicine technologies in the United Kingdom, as well as future perspectives and possible challenges in using early HTA.
Triage approaches for treating individuals in disaster settings historically have been focused on identifying acute decompensation, injuries, and death. For displaced populations that had limited function prior to ta disaster event, the emphasis during and after a disaster becomes identification of the proper level of support needed to survive in a shelter and selection of an appropriate post-shelter destination. The US Public Health Service Rapid Deployment Force team PHS-1 developed tools to address the needs of such displaced populations. The tools, described in detail in this report, address assessment, tracking, planning, resource utilization, and decision making and were field tested over the course of multiple deployments to refine them and validate their utility.
Traditional project management literature often portrays heuristics as flawed shortcuts leading to errors, advocating for rational, debiasing strategies to prevent cost overruns and benefit shortfalls. This is problematic as heuristics can be effective. Building on Gigerenzer’s concept of fast-and-frugal heuristics, this study examines the use of such smart heuristics by senior managers in a large engineering consultancy firm during the early bid/no-bid decision-making phase of infrastructure projects. Employing a qualitative method from the naturalistic decision-making program, the research uncovers a decision strategy termed "thresholding." This strategy distills extensive experience and interpretation of ambiguous information into binary decisions, effectively de-selecting projects that could be potentially disastrous. The approach also gives credence to agency, as it only deselects disasters but keeps many potential alternatives in the portfolio to mature into potentially ‘good projects’. At the same time, it addresses Flyvbjerg’s call for some scrutiny at the front end of projects to avoid catastrophic projects that start on the wrong premises. Our chapter adds to the debate on the Hiding Hand by not being concerned with the “hidden”, but instead, with what can be known in the early fuzzy front-end of projects.