Uncertainty, insufficient information or information of poor quality, limited cognitive capacity and time, along with value conflicts and ethical considerations, are all aspects thatmake risk managementand riskcommunication difficult. This paper provides a review of different risk concepts and describes how these influence risk management, communication and planning in relation to forest ecosystem services. Based on the review and results of empirical studies, we suggest that personal assessment of risk is decisive in the management of forest ecosystem services. The results are (...) used together with a reviewof different principles of the distribution of risk to propose an approach to risk communication that is effective aswell as ethically sound. Knowledge of heuristics and mutual information on both beliefs and desires are important in the proposed risk communication approach. Such knowledge provides an opportunity for relevant information exchange, so that gaps in personal knowledge maps can be filled in and effective risk communication can be promoted. (shrink)

A key question for evidence-based medicine is how best to model the way in which EBM should‘[integrate] individual clinical expertise and the best external evidence’. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this (...) assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research together with information about patients’ values and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making, professional risk-taking and practice to be in accordance with‘science and proven experience’. In the paper, we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. How scientific evidence and clinical experience is integrated influences both the way we do risk assessment and risk management. In addition, the paper sketches the as yet unexplored historical background to VBE and EBM. (shrink)

The functional separation of risk assessment and risk management has long been at the heart of risk analysis structures. Equally long it has been criticized for creating technocratic risk management due to valuations being done in the risk assessment to which the stakeholders do not have access. The criticism has mostly been of an ethical nature. Arguably, in separating risk assessment and risk management, one hopes to fulfil two requirements: Social requirement: we want risk management to meet the goals and (...) needs of society. Scientific requirement: we do not want political views to influence the assessment of facts. We ask in this paper whether it is, in principle, possible to separate risk assessment from risk management. The crucial distinction between risk assessment and risk management we take to be between what kinds of values are involved in them and that separation is meant to shield risk assessment from risk management values and vice versa. Risk assessment is judged to be a scientific activity that should only involve scientific values. We go through a paradigmatic example of good science to see what those scientific values are and whether they are the only ones influencing science. We also present an example of a risk assessment in order to compare it to science. We conclude that the values involved in both science and risk assessment are of the same kind and that they both involve extra-scientific values. The paper ends with a short discussion of whether the above requirements can be met even though risk assessment and risk management are interdependent. (shrink)

The objective of our article is to show how “quality of evidence” and “imprecision,” as they are defined in Grading of Recommendations Assessment, Development, and Evaluation articles, may lead to confusion. We focus only on the context of systematic reviews.

In medical research, it is not unusual that risks are ruled out without any specification the exact risk that was ruled out. This makes it difficult to balance expected health benefits and risk of harm when choosing between alternative treatment options. International guidelines for reporting medical research results are sufficiently specific when it comes to establishing health benefits. However, there is a lack of standards for reporting on ruling out risks. We argue that transparency is needed, as in the case (...) of non-inferiority trials. The Consolidated Standards of Reporting Trials and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements should be revised accordingly. (shrink)

A key question for evidence-based medicine is how best to model the way in which EBM should “[integrate] individual clinical expertise and the best external evidence”. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems. For example, both the early and updated models of evidence-based clinical decisions presented in Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research and (...) clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making and practice to be in accordance with ‘science and proven experience’. In the paper we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. In addition the paper sketches the as yet unexplored historical background to EBM. (shrink)

In many clinical cases a dentist may feel certain when for example diagnosing, deciding on treatment, or assessing the prognosis - in other cases many dentists may feel a degree of doubt or uncertainty. This paper aims to explore the philosophical concept of uncertainty and its different dimensions, using the condition "persistent apical periodontitis associated with a previously root filled tooth" as an example. Acknowledging that uncertainty exists in any clinical situation can be perceived as uncomfortable, as some might regard (...) it as a weakness. While some types of uncertainty met in dental practice can be addressed and reduced, there are other types which are inevitable and must be accepted. To make sound decisions, it is pertinent that the dentist reflects on and values the consequences of uncertainty. In this paper, a conceptual model is presented by which the dentist can identify the type of uncertainty in a clinical case, making it possible to decide on a strategy on how to manage the uncertainty and its possible consequences, with the aim to support the dentist's care for their patients. The understanding that uncertainty exists and the ability to acknowledge and be comfortable with it when making decisions should be addressed throughout our professional career, and thus ought to be developed during undergraduate education. Some suggestions on how teachers could target this are given in the paper. (shrink)

The articles included in this thesis centre on what can be called the normative basis of risk analysis. Since risk analyses are decision procedures, they should adhere to norms of rational decision-making, and this they do. Most risk analysis schemes are built on a notion of the decision theoretic maxim that the goal of every decision is to maximize expected utility. However, for some thirty years now this maxim has been called into question. The idea is not that it is (...) unreasonable in itself, but that the theoretical construct of which it is a consequence is in some way inappropriate. Idealizations of the theories are criticized for being too excessive. They do not properly cover cases where the decision maker has poor or, as it were, imprecise knowledge. These are situations where risks are not only about the consequences of the decision but also there are risks with the knowledge itself, epistemic risks. If it is important for a normative decision theory to be not only ideal as a theoretical construct, but to have, in addition, a prescriptive purpose, that theory should also be applicable to actual decision makers and to somehow deal with epistemic risks. The first two papers are about what kinds of decision theory there are, and how best to construe them. The first describes the differences between normative, descriptive and prescriptive decision theories. The second asks whether there is anything intrinsic to the theory that makes it normative or descriptive. Paper 3 asks on what grounds risk assessment is required to be separated from risk management in the risk analysis process. It is argued that the separation is there to ensure that epistemic values are held apart from non-epistemic values. The paper ends by arguing that, in efforts to improve risk management decision-making, it is more important to be explicit about scientific uncertainty than it is to separate sets of values. Paper 4 argues for a more complete decision-theoretic basis for risk analysis. The contrast here is with the bifurcated process of maximizing expected utility when sufficient knowledge is available and using the precautionary principle in cases where knowledge is more limited. Paper 5 investigates the notion of epistemic risk in detail. (shrink)

The problem addressed in this text is the problem of identifying conditions according to which it is possible to distinguish between a descriptive theory and a normative theory. What makes a descriptive theory descriptive and a normative theory normative? Focus is on subjective expected utility theories where it seems open to debate whether the appropriate use is normative or descriptive. My discussion, which takes arguments by Isaac Levi and Hugh Mellor as a point of departure, is mostly negative, showing that (...) there are no obvious distinguishing features of theories qua theories. Rather the theories can be used normatively or descriptively without making them theories of the one kind or the other. I also point to situations in prescriptive decision analysis where one should be observant of in what way theories are used. (shrink)