Design teams commonly need to explain the rationale or logic behind how they frame design challenges and develop a particular design concept and not others. This paper explores the use of Design Logic Visualizations (DLV) as a boundary object to enhance understanding and communication in convergent interdisciplinary engineering design environments. We developed the DLV as a new design tool, building upon existing design process visualizations like design signatures, and provide a case study from our NASA team. We then use a reflection-based autoethnographic and collaborative inquiry approach to reflect on how the DLVs influenced our team, our process, and our decision-making. The findings suggest DLVs can serve as a succinct storytelling tool, support shared understanding across disciplines and levels of leadership, and, ultimately, influence design outcomes.

Pharmacological cognitive enhancement (PCE) refers to the use of pharmaceuticals to improve cognitive function when that use is not intended to prevent or treat disease. Those who favour a liberal approach to PCE trust users to make informed decisions about whether enhancing is in their best interest. The author argues that making informed decisions about PCE requires a nuanced risk-benefit analysis that is not accessible to many users. Presently, the PCE use of prescription medications such as methylphenidate and modafinil is widespread but most commonly happens without medical supervision. Direct and indirect barriers generate a situation where the risks and benefits of PCE are inequitably distributed; as a result, PCE is sometimes not in the user’s best interest. This is likely to also be the case for future pharmaceuticals. As a result, even if PCE pharmaceuticals were equitably distributed, its associated risks and benefits would not be. The article concludes with a discussion of the prospects of the clinical consultation on one hand, and e-health solutions on the other, in ameliorating the situation, arguing for cautious optimism.

Disorders of consciousness (DOC) continue to profoundly challenge both families and medical professionals. Once a brain-injured patient has been stabilized, questions turn to the prospect of recovery. However, what “recovery” means in the context of patients with prolonged DOC is not always clear. Failure to recognize potential differences of interpretation—and the assumptions about the relationship between health and well-being that underlie these differences—can inhibit communication between surrogate decisionmakers and a patient’s clinical team, and make it difficult to establish the goals of care. The authors examine the relationship between health and well-being as it pertains to patients with prolonged DOC. They argue that changes in awareness or other function should not be equated to changes in well-being, in the absence of a clear understanding of the constituents of well-being for that particular patient. The authors further maintain that a comprehensive conception of recovery for patients with prolonged DOC should incorporate aspects of both experienced well-being and evaluative well-being.

Patients with amyotrophic lateral sclerosis (ALS) face many difficult, timing-sensitive decisions over the course of their illness, weighing present versus future harms and benefits. Supplemented by interviews with people with ALS, we argue for a relational approach to understanding these decisions and their effects on identity. We highlight two critical aspects of the patient–caregiver relationship: (1) the extent to which each may rely on the other leaves their wellbeing intimately intertwined and (2) patients often require others to help with the imaginative task of considering possible futures for each therapeutic option. We show why family involvement in decisionmaking practices can be so critical, and shed light on the ways intimate others help preserve and protect people’s identities amidst the destabilizing uncertainty illness and treatment can bring.

The “Ashley treatment” has provoked much debate and remains ethically controversial. Given that more children are being referred for such treatment, there remains a need to provide advice to clinicians and ethics committees regarding how to respond to such requests. This article contends that there is one particularly important gap in the existing literature about growth attenuation therapy (GAT) (one aspect of the Ashley treatment): the views of parents of children with profound cognitive impairment (PCI) remain significantly underrepresented. The article attempts to redress this balance by analyzing published accounts both from parents of children who have received GAT and from parents who oppose treatment. Using these accounts, important points are illuminated regarding how parents characterize benefits and harms, and their responsibilities as surrogate decisionmakers. This analysis could contribute to decisionmaking about future requests for GAT and might also have wider relevance to healthcare decisionmaking for children with PCI.

Fisheries management in the future will require that biological assessments be combined appropriately with operational, social, and economic considerations toward effective management of complex fisheries systems. This is not currently being done in fisheries management because of: (i) the lack of a conceptual and organizational framework for integrated and participatory decision making, and (ii) the lack of more appropriate methodologies for dealing with diverse sources of information, interdisciplinary objectives, and the inherent uncertainty of these systems. An integration of traditional "fisheries science" with other aspects of "fisheries management" and the field of "management science" in a new discipline of "Fisheries Management Science" is proposed. FMS is defined as "the rigorous application of the scientific method of problem solving in the development of strategic alternatives and their evaluation on the basis of objectives that integrate biological, economic, social, and operational factors into management decision making". Management science or operational research provides guidance in methodologies for complex decision making and problem resolution. A multidisciplinary decision framework is proposed involving the following key steps: (1) specification of quantifiable objectives and constraints; (2) modelling of the expected multicriteria performance of a range of proposed management decisions; (3) risk assessment through descriptions of the expected variability in performance measures; (4) risk management through analytical evaluation of risk and ranking of alternate solutions; and (5) continuous monitoring and improvement of past decisions including deviations from expected performance and corresponding adjustment of future alternatives toward achieving strategic objectives.