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Showing papers on "Rationality published in 2008"


Journal ArticleDOI
TL;DR: This paper argued that contemporary tendencies to economize public domains and methods of government also produce tendencies to moralize markets in general and business enterprises in particular, and that the moralization of markets further sustains, rather than undermines, neo-liberal governmentalities and vision of civil society, citizenship and responsible social action.
Abstract: This article explores emerging discursive formations concerning the relationship of business and morality. It suggests that contemporary tendencies to economize public domains and methods of government also dialectically produce tendencies to moralize markets in general and business enterprises in particular. The article invokes the concept of ‘responsibilization’ as means of accounting for the epistemological and practical consequences of such processes. Looking at the underlying ‘market rationality’ of governance, and critically examining the notion of ‘corporate social responsibility’, it concludes that the moralization of markets further sustains, rather than undermining, neo-liberal governmentalities and neo-liberal visions of civil society, citizenship and responsible social action.

764 citations


Journal ArticleDOI
TL;DR: In this paper, the authors highlight how popular understandings of neoinstitutionalism as a theory of isomorphism need to be revised as institutionalists have shifted attention towards the study of organizational heterogeneity.
Abstract: In this paper, I highlight how popular understandings of neoinstitutionalism as a theory of isomorphism need to be revised as institutionalists have shifted attention towards the study of organizational heterogeneity. As part of this shift, old emphases on arational mimicry and stability have been replaced with new emphases on institutional rationality and ongoing struggle and change. I discuss these new directions and the implications for the study of accounting practice. I argue that given recent efforts by institutionalists to account for actors and practice diversity, there is an important opportunity for dialogue with practice theorists, such as those drawing on Actor Network Theory, and the creation of a more comprehensive approach to the study of practice that attends to both institutional and micro-processual dynamics.

621 citations


Journal ArticleDOI
TL;DR: In this paper, Adler explores the theoretical implications of the logic of practicality in world politics and develops a theory of practice of security communities arguing that peace exists in and through practice when security officials' practical sense makes diplomacy the self-evident way to solving interstate disputes.
Abstract: This article explores the theoretical implications of the logic of practicality in world politics In social and political life, many practices do not primarily derive from instrumental rationality (logic of consequences), norm-following (logic of appropriateness), or communicative action (logic of arguing) These three logics of social action suffer from a representational bias in that they focus on what agents think about instead of what they think from According to the logic of practicality, practices are the result of inarticulate know-how that makes what is to be done self-evident or commonsensical Insights from philosophy, psychology, and sociology provide empirical and theoretical support for this view Though complementary with other logics of social action, the logic of practicality is ontologically prior because it is located at the intersection of structure and agency Building on Bourdieu, this article develops a theory of practice of security communities arguing that peace exists in and through practice when security officials' practical sense makes diplomacy the self-evident way to solving interstate disputes The article concludes on the methodological quandaries raised by the logic of practicality in world politics For helpful comments on earlier versions of this article, many thanks to Emanuel Adler, Janice Bially Mattern, Raymond Duvall, Stefano Guzzini, Jef Huysmans, Markus Kornprobst, Jennifer Mitzen, Iver Neumann, Daniel Nexon, David Welch, Alexander Wendt, and Michael Williams, as well as the journal's reviewers

499 citations


Journal ArticleDOI
TL;DR: The theoretical and practical implications of incorporating behavioral and cognitive factors into models of operations management and suggest fruitful avenues for research in behavioral operations are explored.
Abstract: Human beings are critical to the functioning of the vast majority of operating systems, influencing both the way these systems work and how they perform. Yet most formal analytical models of operations assume that the people who participate in operating systems are fully rational or at least can be induced to behave rationally. Many other disciplines, including economics, finance, and marketing, have successfully incorporated departures from this rationality assumption into their models and theories. In this paper, we argue that operations management scholars should do the same. We explore the theoretical and practical implications of incorporating behavioral and cognitive factors into models of operations management and suggest fruitful avenues for research in behavioral operations.

474 citations


Book
21 Aug 2008
TL;DR: Lupia, McCubbins and Popkin this article proposed a theory of motivated political reasoning, based on a fixed choice theory of political reasoning with respect to the role of public mood in political reasoning.
Abstract: 1. Beyond rationality: reason and the study of politics Arthur Lupia, Mathew D. McCubbins and Samuel L. Popkin Part I. External Elements of Reason: 2. Shared mental models: ideologies and institutions Arthur T. Denzau and Douglass C. North 3. The institutional foundations of political competence: how citizens learn what they need to know Arthur Lupia and Mathew D. McCubbins 4. Taking sides: a fixed choice theory of political reasoning Paul Sniderman 5. How people reason about ethics Norman Frohlich and Joe Oppenheimer 6. Who says what? Source credibility as a mediator of campaign advertising Shanto Iyengar and Nicholas A. Valentino 7. Affect as information: the role of public mood in political reasoning Wendy M. Rahn Part II. Internal Elements of Reason: 8. Reconsidering the rational public: cognition, heuristics, and mass opinion James H. Kuklinski and Paul J. Quirk 9. Three steps toward a theory of motivated political reasoning Milton Lodge and Charles Taber 10. Knowledge, trust, and international reasoning Samuel L. Popkin and Michael A. Dimock 11. Coping with tradeoffs: psychological constraints and political implications Philip E. Tetlock 12. Backstage cognition in reason and choice Mark Turner 13. Constructing a theory of reasoning: choice, constraints, and context Arthur Lupia, Mathew D. McCubbins and Samuel L. Popkin.

435 citations


Book
01 Jan 2008
TL;DR: Bounded and Rational: A Manual for Building Cognitive Theories of Rationality as discussed by the authors The Evolution of Statistical Thinking: From Innumeracy to Insight Theory Defeated: From Inception to Insight.
Abstract: Preface 1 Bounded and Rational 2 Fast and Frugal heuristics 3 Rules of Thumb in Animals and Humans 4 I Think, Therefore I Err 5 Striking a Blow for Sanity in Theories of Rationality 6 Out of the Frying Pan Into the Fire 7 What's in a Sample? A Manual for Building Cognitive Theories 8 "A 30% Chance of Rain Tomorrow" 9 Simple Tools for Understanding Risks: From Innumeracy to Insight 10 The Evolution of Statistical Thinking 11 Mindless Statistics 12 Children Can Solve Bayesian Problems 13 In the year 2054" Innumeracy Defeated References Subject Index Name index

425 citations


Journal ArticleDOI
TL;DR: Results suggest that whereas the popular characterization of conflict detection as an actively experienced struggle can be questioned there is nevertheless evidence for Sloman's and Epstein's basic claim about the flawless operation of the monitoring.

346 citations


Book
05 Jun 2008
TL;DR: The main argument of as mentioned in this paper is the ordering principle and the independence principle, and the main argument is based on a critique of the pragmatic arguments and the feasibility of resolute choice.
Abstract: 1. Introduction and sketch of the main argument 2. The ordering principle 3. The independence principle 4. The problem of justification 5. Pragmatic arguments 6. Dynamic choice problems 7. Rationality conditions on dynamic choice 8. Consequentialist constructions 9. Rethinking the problem of dynamic consistency 10. A critique of the pragmatic arguments 11. Formalizing the pragmatic arguments 12. The feasibility of resolute choice 13. Connections 14. Conclusions Postscript: projections.

269 citations


Journal ArticleDOI
TL;DR: The so-called strategy as practice approach has claimed to integrate earlier epistemologically and ontologically more reflexive positions into a new orthodoxy as discussed by the authors, and is clearly to be understood as a systematic critique of orthodox, hegemonic, and mainly North American or North American-inspired, strategy research.
Abstract: Strategy is supposed to lead an organization through changes and shifts to secure its future growth and sustainable success, and it has become the master concept with which to address CEOs of contemporary organizations and their senior managers. Its talismanic importance can hardly be overstated. Thus, strategic management is increasingly understood as the task of the top management team. While seminal works on strategy bear the imprint of modernist rationality (Ansoff, 1965; Porter, 1980), there have been numerous contributions to the strategy literature that can be characterized as more reflexive and critical (e.g. Clegg et al., 2004). More expressly sociological in nature, they have placed emphasis on, inter alia, how power and politics shape the strategies that emerge (Mintzberg, 1987; Pettigrew, 1985); the strategic choices made (Child, 1972); the language games that constitute strategy (Barry and Elmes, 1997); as well as how strategy is best understood through interpretative approaches (Schwenk, 1989), structuration theory (Whittington, 1992) or epistemology (Knights and Morgan, 1991). Such works set out an alternative to the neat assumptions of ubiquitous rationality underpinning orthodox strategy. Most recently, the so-called strategy as practice approach has claimed to integrate earlier epistemologically and ontologically more reflexive positions into a new orthodoxy. The new approach is one that is very much couched in European characters ( Jarzabkowski, 2003, 2004; Samra-Fredericks, 2003; Whittington, 1996, 2002, 2003, 2004), and is clearly to be understood as a systematic critique of orthodox, hegemonic, and mainly North American, or North American-inspired, strategy research. In this essay, we seek to advance the current debate in the field of strategy in several respects: first, we discuss the intellectual genesis of the strategy as practice STRATEGIC ORGANIZATION Vol 6(1): 83–99 DOI: 10.1177/1476127007087154 Copyright ©2008 Sage Publications (Los Angeles, London, New Delhi and Singapore) http://so.sagepub.com

242 citations


Journal ArticleDOI
Gavin Cassar1
TL;DR: In this paper, the rationality of the expectations of self-employed individuals was examined and substantial over-optimism in their expectations was found in that they overestimate the probability that their nascent activity will result in an operating venture.
Abstract: This research examines the rationality of the expectations of nascent entrepreneurs. Consistent with conjectures regarding entry into self-employment, I find substantial over-optimism in nascent entrepreneurs' expectations in that they overestimate the probability that their nascent activity will result in an operating venture. Further, for those ventures that achieve operation, individuals overestimate the expected future sales and employment. To explain cross-sectional variations in over-optimism, I posit that those individuals who adopt an inside view to forecasting, through the use of plans and financial projections, will exhibit greater ex-ante bias in their expectations. Consistent with inside view adoption causing over-optimism in expectations, I find that the preparation of projected financial statements results in more overly-optimistic venture sale forecasts.

220 citations


Journal ArticleDOI
TL;DR: This paper showed that existing rationality tests are not robust to even small deviations from symmetric loss and hence have little ability to tell whether the forecaster is irrational or the loss function is asymmetric.
Abstract: Empirical studies using survey data on expectations have frequently observed that forecasts are biased and have concluded that agents are not rational. We establish that existing rationality tests are not robust to even small deviations from symmetric loss and hence have little ability to tell whether the forecaster is irrational or the loss function is asymmetric. We quantify the exact trade-off between forecast inefficiency and asymmetric loss leading to identical outcomes of standard rationality tests and explore new and more general methods for testing forecast rationality jointly with flexible families of loss functions that embed quadratic loss as a special case. An empirical application to survey data on forecasts of nominal output growth demonstrates the empirical significance of our results and finds that rejections of rationality may largely have been driven by the assumption of symmetric loss.

Journal ArticleDOI
John Tribe1
TL;DR: In this paper, a research and practice gap is identified demonstrating tourism to be insufficiently critical business, and the limited extent of critical tourism research is established, concluding that tourism should be a critical business and offers pointers for such an agenda.
Abstract: A research and practice gap is identified demonstrating tourism to be an insufficiently critical business. Initially the idea of critical tourism is addressed in two ways. First, an array of meanings is exposed from which the idea of critical theory is developed. Next, discussion turns to how critical approaches can contribute to good management and governance of tourism by providing understandings that technical rationality can overlook. Finally, the limited extent of critical tourism research is established. The article concludes that tourism should be a critical business and offers pointers for such an agenda. For although positivist research informed by technical rationality is crucial to the better operational management of tourism, critical research is essential for setting an agenda for ethical management, governance and coexistence with the wider world. Indeed it is critical to deep, long-term sustainability and even the survival of tourism.

Journal ArticleDOI
TL;DR: In this paper, the authors formulate conditions of rationality and mth-order assumption of rationality (RmAR) and rationality and common assumption of RCAR (RCAR), and show that RCAR is characterized by a solution concept we call a self-admissible set.
Abstract: Suppose that each player in a game is rational, each player thinks the other players are rational, and so on. Also, suppose that rationality is taken to incorporate an admissibility requirement-that is, the avoidance of weakly dominated strategies. Which strategies can be played? We provide an epistemic framework in which to address this question. Specifically, we formulate conditions of rationality and mth-order assumption of rationality (RmAR) and rationality and common assumption of rationality (RCAR). We show that (i) RCAR is characterized by a solution concept we call a "self-admissible set"; (ii) in a "complete" type structure, RmAR is characterized by the set of strategies that survive m + 1 rounds of elimination of inadmissible strategies; (iii) under certain conditions, RCAR is impossible in a complete structure.

Journal ArticleDOI
TL;DR: The authors categorize studies of the relationship between science and religion into three groups: the symbolic epistemological conflict studies, the symbolic directional influence studies, and the social-institutional studies.
Abstract: Studies of the relationship between religion and science have traditionally assumed that any conflict that exists is based on epistemology. This assumption is built into the history of Western academic thought, the founding of sociology itself, as well as the common definitions of religion used by social scientists. This assumption has hindered the examination of the relationship between religion and science. We categorize studies of the relationship between science and religion into three groups: the symbolic epistemological conflict studies, the symbolic directional influence studies, and the social-institutional studies. We find that the social-institutional studies, which most closely examine actual public conflicts, do not presume that the conflict is over epistemological claims and offer a more general and fruitful approach to examining the relationship between religion and science.

Journal ArticleDOI
TL;DR: The authors argue that policy outputs are neither exclusively rational nor solely a function of institutional design; rather they depend heavily on a complex interaction between problems, solutions, and politics during fleeting open windows of opportunity.
Abstract: Amending rational institutionalist accounts of EU policy, I use the multiple streams perspective and examples from several policy sectors to explore the impact of two elements of policy choice: policy windows and the dynamics of coupling. I argue that policy outputs are neither exclusively rational nor solely a function of institutional design; rather they depend heavily on a complex interaction between problems, solutions, and politics during fleeting open windows of opportunity. Policy windows pose limitations to rational policy-making by framing the context within which choice is made, while the notion of coupling stresses the impact of entrepreneurial politics and strategies in EU policy-making. The analysis illuminates the limitations of rationality in explaining policy choice, the role of political power in the absence of institutional hierarchies, and the impact of ideas, institutions, and entrepreneurs in the EU policy process.

Journal ArticleDOI
TL;DR: It is argued that health care is well overdue for a re-defining of what policy-making is, and future research into health care policy- making needs to move beyond the study of ‘getting evidence into practice’ and address the language, arguments and discourse through which policy is constructed and enacted.
Abstract: Critiques of the 'naive rationalist' model of policy-making abound in the sociological and political science literature. Yet academic debate on health care policy-making continues to be couched in the dominant discourse of evidence-based medicine, whose underlying assumptions - that policies are driven by facts rather than values and these can be clearly separated; that 'evidence' is context-free, can be objectively weighed up and placed unproblematically in a 'hierarchy'; and that policy-making is essentially an exercise in decision science - have constrained both thinking and practice. In this paper, drawing on theoretical work from political science and philosophy, and innovative empirical work in the health care sector, we argue that health care is well overdue for a re-defining of what policy-making is.Policy-making is the formal struggle over ideas and values, played out by the rhetorical use of language and the enactment of social situations. While the selection, evaluation and implementation of research evidence are important in the policy-making process, they do not equate to that process. The study of argument in the construction of policy has the potential to illuminate dimensions of the process that are systematically occluded when policy-making is studied through a naive rationalist lens. In particular, a rhetorical perspective highlights the struggle over ideas, the 'naming and framing' of policy problems, the centrality of audience and the rhetorical use of language in discussion to increase the audience's adherence to particular framings and proposals. Rhetorical theory requires us to redefine what counts as 'rationality' - which must extend from what is provably true (by logic) and probably true (by Bayesian reasoning) to embrace, in addition, that which is plausibly true (i.e. can convince a reasonable audience).Future research into health care policy-making needs to move beyond the study of 'getting evidence into practice' and address the language, arguments and discourse through which policy is constructed and enacted.

Book
01 Jan 2008
TL;DR: In this paper, the authors discuss the dance of change and the music and its features in order to order order in the city of Boston, Massachusetts, USA and discuss the contribution of structure, content, and focus to ordering.
Abstract: I Theorizing 1 Rationalities 2 The Dance of Change3 The Music and Its Features4 Technology's Ways: Imaginative Variations II Case Studies Overview of the Case Studies 5 Western City and Police 6 Metropolitan Washington and Police7 Boston and Police III Appraising 8 Contributions of Structure, Content and Focus to Ordering9 Seeing and Saying in the Boston CAM10 Generalization Epilogue Appendix A: Data and Methods Appendix B: Professional "Faery Tales" and Serious Organizational Ethnography Compared NotesReferencesIndexAbout the Author


Journal ArticleDOI
TL;DR: In this article, the authors argue that the comparative subfield still needs to reckon with the noninstrumental aspect of religious behavior, the power of religion as an independent variable, and the differential appeal, persuasiveness, and political salience of religious ideas over time.
Abstract: Studies of religion and politics have begun to force their way into the mainstream of the discipline thanks to their increasing methodological sophistication and theoretical ambition in addition to the push of real-world events. In comparative politics, puzzle-driven structured comparison has yielded new insights into the rationality of religious behavior, the weight of path dependence in shaping religious values, and the play of socioeconomic factors in shaping religion's vitality. In international relations, recognition of the importance of religious identities and values in the play of international affairs has spelled an advance over realist caricatures that long discounted ideas as epiphenomenal and focused on the quest for wealth and power as the sole driver of international politics. But notable lacunae remain. The comparative subfield still needs to reckon with the noninstrumental aspect of religious behavior, the power of religion as an independent variable, and the differential appeal, persuasiveness, and political salience of religious ideas over time. The IR subfield must move beyond “paradigm wars” focused on whether religion matters in international politics in favor of more empirically grounded, structured comparison to illuminate when and why religion matters in international affairs.


Book ChapterDOI
TL;DR: In this paper, evolutionary psychology and cognitive neurosciences may be able to reconcile the EMH with behavioural anomalies, which is the most enduring critique from psychologists and behavioural economists who argue that EMH is based on counterfactual assumptions regarding human behaviour, that is, rationality.
Abstract: The efficient markets hypothesis (EMH) maintains that market prices fully reflect all available information. Developed independently by Paul A. Samuelson and Eugene F. Fama in the 1960s, this idea has been applied extensively to theoretical models and empirical studies of financial securities prices, generating considerable controversy as well as fundamental insights into the price-discovery process. The most enduring critique comes from psychologists and behavioural economists who argue that the EMH is based on counterfactual assumptions regarding human behaviour, that is, rationality. Recent advances in evolutionary psychology and the cognitive neurosciences may be able to reconcile the EMH with behavioural anomalies.

Book
15 Sep 2008
TL;DR: The role of amour pre in forming rational subjects is discussed in this article, where the authors define the nature of human nature and the dangers of Amour pre and the role of love pre in formulating rational subjects.
Abstract: I. DEFINING HUMAN NATURE 1. The Nature of Amour Propre II. DIAGNOSIS 2. The Dangers of Amour Propre 3. The Varieties of Inflamed Amour Propre 4. Why Is Inflamed Amour Propre So Common? III. PRESCRIPTION 5. Social and Domestic Remedies IV. CURING THE MALADY WITH ITS OWN RESOURCES 6. The Standpoint of Reason 7. The Role of Amour Propre in Forming Rational Subjects

Journal ArticleDOI
TL;DR: In this paper, the authors examine the effect of money illusion and anchoring on the adjustment of nominal prices after an anticipated monetary shock and find that the adjustment difference is driven by price expectations, which are very flexible and forward-looking under substitutability but adaptive and sticky under complementarity.
Abstract: Much evidence suggests that people are heterogeneous with regard to their abilities to make rational, forward-looking decisions. This raises the question as to when the rational types are decisive for aggregate outcomes and when the boundedly rational types shape aggregate results. We examine this question in the context of a long-standing and important economic problem: the adjustment of nominal prices after an anticipated monetary shock. Our experiments suggest that two types of bounded rationality— money illusion and anchoring—are important behavioral forces behind nominal inertia. However, depending on the strategic environment, bounded rationality has vastly different effects on aggregate price adjustment. If agents’ actions are strategic substitutes, adjustment to the new equilibrium is extremely quick, whereas under strategic complementarity, adjustment is both very slow and associated with relatively large real effects. This adjustment difference is driven by price expectations, which are very flexible and forward-looking under substitutability but adaptive and sticky under complementarity. Moreover, subjects’ expectations are also considerably more rational under substitutability.

Journal ArticleDOI
TL;DR: The authors develops a biopolitics of neoliberalism, exploring how it uses market values as a template for realigning corporate power and the state, but also how it produces modes of consent vital to the construction of a neoliberal subject and a more ruthless politics of disposability.
Abstract: Under the current reign of neoliberalism, the US has entered a New Gilded Age, more savage and anti-democratic than its predecessor. The current form of market fundamentalism demands a new set of conceptual and analytical tools that engage neoliberalism not only through an economic optic but also as a mode of rationality, governmentality, and public pedagogy. The essay develops a biopolitics of neoliberalism, exploring how it uses market values as a template for realigning corporate power and the state, but also how it produces modes of consent vital to the construction of a neoliberal subject and a more ruthless politics of disposability. Within this new form of neoliberal rationality and biopolitics – a political system actively involved in the management of the politics of life and death – new modes of individual and collective suffering emerge around the modalities and intersection of race and class.

Journal ArticleDOI
Andy Egan1
TL;DR: In this paper, the authors argue that humans have a number of distinct, compartmentalized systems of belief, different ones of which drive different aspects of our behavior in different contexts.
Abstract: On many of the idealized models of human cognition and behavior in use by philosophers, agents are represented as having a single corpus of beliefs which (a) is consistent and deductively closed, and (b) guides all of their (rational, deliberate, intentional) actions all the time. In graded-belief frameworks, agents are represented as having a single, coherent distribution of credences, which guides all of their (rational, deliberate, intentional) actions all of the time. It’s clear that actual human beings don’t live up to this idealization. The systems of belief that we in fact have are fragmented. Rather than having a single system of beliefs that guides all of our behavior all of the time, we have a number of distinct, compartmentalized systems of belief, different ones of which drive different aspects of our behavior in different contexts. It’s tempting to think that, while of course people are fragmented, it would be better (from the perspective of rationality) if they weren’t, and the only reason why our fragmentation is excusable is that we have limited cognitive resources, which prevents us from holding too much information before our minds at a time. Give us enough additional processing capacity, and there’d be no justification for any continued fragmentation. I argue that this is not so. There are good reasons to be fragmented rather than unified, independent of the limitations on our available processing power. In particular, there are ways our belief-forming mechanisms—including our perceptual systems—could be constructed that would make it better to be fragmented than to be unified. And there are reasons to think that some of our belief-forming mechanisms really are constructed that way.

Journal ArticleDOI
TL;DR: It is suggested that team reasoning predicts strategy choices more powerfully than orthodox game theory in some games, although individually rational players should choose equilibrium strategies.

Posted Content
TL;DR: In this article, the authors argue that norms established through the process of socialization, perhaps voluntarily accepted or affirmed, perhaps building on certain genetic predispositions, provide part of the framework within which individuals pursue their self interest.
Abstract: Norms established through the process of socialization, perhaps voluntarily accepted or affirmed, perhaps building on certain genetic predispositions, provide part of the framework within which individuals pursue their self interest. Intellectually defensible microeconomic analysis, in its competitive or game theoretic variant, can be undertaken only if this principle is recognized.

Journal ArticleDOI
TL;DR: In this paper, the authors highlight the implications of using bounded rationality models in environmental research in general and policymaking in particular, and highlight that the individual actors in many circumstances act within a bounded rationality framework, suggesting that predictions based on the conventional economic models would be less valid.

Book
21 Aug 2008
TL;DR: The essays in this volume offer a thorough discussion of the relationship between addiction and rationality, including contributions from philosophers, psychiatrists, neurobiologists, sociologists and economists as mentioned in this paper.
Abstract: The essays in this volume offer a thorough discussion of the relationship between addiction and rationality. This book-length treatment of the subject includes contributions from philosophers, psychiatrists, neurobiologists, sociologists and economists. Contrary to the widespread view that addicts are subject to overpowering and compulsive urges, the authors in this volume demonstrate that addicts are capable of making choices and responding to incentives. At the same time they disagree with Gary BeckerAs argument that addiction is the result of rational choice. The volume offers an exposition of the neurophysiology of addiction, a critical examination of the Becker theory of rational addiction, an argument for a Avisceral theory of addictionA, a discussion of compulsive gambling as a form of addiction, several discussions of George AinslieAs theory of hyperbolic discounting, analyses of social causes and policy implications, and an investigation of the problem of relapse

Journal ArticleDOI
Patrick Brown1
TL;DR: This paper analyses the approach taken by policy makers, arguing that it is based very much on an instrumental conception of trust, and a communicative understanding of trust is proposed as an alternative.
Abstract: Recent reforms within the UK National Health Service, particularly the introduction of clinical governance, have been enacted with the apparent aim of rebuilding patient trust. This paper analyses the approach taken by policy makers, arguing that it is based very much on an instrumental conception of trust. The assumptions and limitations of this model are discussed and in so doing, a communicative understanding of trust is proposed as an alternative. It is argued that the instrumental rationality and institutional focus inherent to instrumental trust neglect the importance of the communication between patient and medical professional and its affective dimensions. Communicative trust goes beyond a mere cognitive appreciation of the system and rather is dependent on the qualitative interaction at the access point, where the patient comes to believe that the communicative rationality of their best interests is mirrored by the professional's instrumental rationality. Whilst recent challenges to the confidence of patients in professionals and medical knowledge make some approximation of an ideal speech situation more imperative than previously, the application of an instrumental concept of trust in the NHS makes such interactions less likely, as well as facilitating a divergence between instrumental and communicative rationality in healthcare provision.