Recent insights into decision-making and their implications for informed consent

2018 ◽  
Vol 44 (11) ◽  
pp. 734-738 ◽  
Author(s):  
Irene M L Vos ◽  
Maartje H N Schermer ◽  
Ineke L L E Bolt
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Rational Choice ◽  
Medical Practice ◽  
Real World ◽  
Ethical Principle ◽  
Traditional Theory ◽  
Choice Behaviour ◽  
Autonomous Decision ◽  
Behavioural Sciences

Research from behavioural sciences shows that people reach decisions in a much less rational and well-considered way than was often assumed. The doctrine of informed consent, which is an important ethical principle and legal requirement in medical practice, is being challenged by these insights into decision-making and real-world choice behaviour. This article discusses the implications of recent insights of research on decision-making behaviour for the informed consent doctrine. It concludes that there is a significant tension between the often non-rational choice behaviour and the traditional theory of informed consent. Responsible ways of dealing with or solving these problems are considered. To this end, patient decisions aids (PDAs) are discussed as suitable interventions to support autonomous decision-making. However, current PDAs demand certain improvements in order to protect and promote autonomous decision-making. Based on a conception of autonomy, we will argue which type of improvements are needed.

Loss of Possession: Concussions, Informed Consent, and Autonomy

2014 ◽  
Vol 42 (3) ◽  
pp. 334-343 ◽  
Author(s):  
Richard Robeson ◽  
Nancy M. P. King
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Fiduciary Duty ◽  
Decision Making Process ◽  
Informed Decision Making ◽  
Research Subjects ◽  
Autonomous Decision ◽  
Duty To Inform ◽  
Fundamental Shift ◽  
Original Concept

The principle of informed consent is so firmly established in bioethics and biomedicine that the term was soon bowdlerized in common practice, such that engaging in the informed decision-making process with patients or research subjects is now often called “consenting” them. This evolution, from the original concept to the rather questionable coinage that makes consent a verb, reveals not only a loss of rhetorical precision but also a fundamental shift in the potential meaning, value, and implementation of the informed consent process. Too often, the sharing of information has been replaced by the mere acquisition of agreement with the authority ostensibly offering a choice.Scholars of informed consent agree that its salience and its legitimacy derive from a fiduciary duty to inform, in order to respect, protect, and promote autonomous decision making by those to whom the duty is owed.

scholarly journals Decision-Making Experiments and Real-World Choice Behaviour

1984 ◽  
Vol 66 (1) ◽  
pp. 39 ◽  
Author(s):  
Harry Timmermans ◽  
Rob Van Der Heyden ◽  
Hans Westerveld
Keyword(s):  
Decision Making ◽  
Real World ◽  
Choice Behaviour

Universalism in Experimental Committees

1982 ◽  
Vol 76 (3) ◽  
pp. 561-574 ◽  
Author(s):  
Gary J. Miller ◽  
Joe A. Oppenheimer
Keyword(s):  
Decision Making ◽  
Experimental Design ◽  
Rational Choice ◽  
Real World ◽  
Coalition Formation ◽  
Winning Coalition ◽  
Committee Decision Making ◽  
Expected Benefits ◽  
High Level ◽  
Rational Choice Theories

Most rational choice theories of committee decision making predict a process of competitive coalition formation leading to a minimum winning coalition. Committee experiments reported to date tend to support these theories. However, both theories and committee experiments are contradicted by the evidence of real-world legislatures making distributive decisions; these decisions are characterized by coalitions of the whole providing virtually all members with a share of distributive benefits. The results in this article help to resolve this contradiction by showing that if the committee experimental design includes a universalistic alternative which provides a high level of expected benefits for committee members, it will be selected. Competitive coalition formation occurs in experimental settings which do not include such an alternative. The results call into question the generality of ordinalist theories of competitive coalition formation.

scholarly journals Decision-Making Experiments and Real-World Choice Behaviour

1984 ◽  
Vol 66 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Harry Timmermans ◽  
Rob Van Der Heyden ◽  
Hans Westerveld
Keyword(s):  
Decision Making ◽  
Real World ◽  
Choice Behaviour

scholarly journals Autonomy Challenges in Epigenetic Risk-Stratified Cancer Screening: How Can Patient Decision Aids Support Informed Consent?

2019 ◽  
Vol 9 (1) ◽  
pp. 14 ◽  
Author(s):  
Maaike Alblas ◽  
Maartje Schermer ◽  
Yvonne Vergouwe ◽  
Ineke Bolt
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Cancer Screening ◽  
Decision Aids ◽  
Treatment Options ◽  
Specific Context ◽  
Patient Decision Aids ◽  
Autonomous Decision ◽  
Patient Decision ◽  
Screening Strategies

Information of an individual's epigenome can be useful in cancer screening to enable personalised decision making on participation, treatment options and further screening strategies. However, adding this information might result in complex risk predictions on multiple diseases, unsolicited findings and information on (past) environmental exposure and behaviour. This complicates informed consent procedures and may impede autonomous decision-making. In this article we investigate and identify the specific features of epigenetic risk-stratified cancer screening that challenge the current informed consent doctrine. Subsequently we describe current and new informed consent models and the principle of respect for autonomy and argue for a specific informed consent model for epigenetic risk-stratified screening programmes. Next, we propose a framework that guides the development of Patient Decision Aids (PDAs) to support informed consent and promote autonomous choices in the specific context of epigenetic cancer screening programmes.

Physiological Modeling and Simulation—Validation, Credibility, and Application

2020 ◽  
Vol 22 (1) ◽  
pp. 185-206
Author(s):  
W. Andrew Pruett ◽  
John S. Clemmer ◽  
Robert L. Hester
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Real World ◽  
Scientific Community ◽  
Physiological Modeling ◽  
Critical Importance ◽  
Physiological Models ◽  
The Past ◽  
Simulation Validation ◽  
Physiological Research

In this review, we discuss the science of model validation as it applies to physiological modeling. There is widespread disagreement and ambiguity about what constitutes model validity. In areas in which models affect real-world decision-making, including within the clinic, in regulatory science, or in the design and engineering of novel therapeutics, this question is of critical importance. Without an answer, it impairs the usefulness of models and casts a shadow over model credibility in all domains. To address this question, we examine the use of nonmathematical models in physiological research, in medical practice, and in engineering to see how models in other domains are used and accepted. We reflect on historic physiological models and how they have been presented to the scientific community. Finally, we look at various validation frameworks that have been proposed as potential solutions during the past decade.

scholarly journals The Child’s Autonomy in Decision-making on Medical Treatment: Theoretical Considerations

2020 ◽  
Vol 29 ◽  
pp. 124-132
Author(s):  
Kristi Paron
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Informed Consent ◽  
United Nations ◽  
Medical Interventions ◽  
Rights Of The Child ◽  
Autonomous Decision ◽  
Health Care Practitioners ◽  
United Nations Convention ◽  
Theoretical Considerations

The article examines the theoretical and normative context of a child’s autonomous decision making in health care. Neither the United Nations Convention on the Rights of the Child nor the general comments of the Committee on the Rights of the Child state criteria for regarding a child to be competent for such decision-making. The key issue in the debate over children’s informed consent to medical interventions is that of competence. The author analyses competence through the lens of Archard’s division of rational autonomy into rationality, maturity, and independence. These three elements could guide health-care practitioners who need to assess the capacity of a child to consent.

Clinical Judgment Revisited

1999 ◽  
Vol 38 (04/05) ◽  
pp. 279-286 ◽  
Author(s):  
L. L. Weed
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Clinical Judgment ◽  
Medical Information ◽  
Patient Records ◽  
Practice Of Medicine ◽  
The Way

AbstractIt is widely recognised that accessing and processing medical information in libraries and patient records is a burden beyond the capacities of the physician’s unaided mind in the conditions of medical practice. Physicians are quite capable of tremendous intellectual feats but cannot possibly do it all. The way ahead requires the development of a framework in which the brilliant pieces of understanding are routinely assembled into a working unit of social machinery that is coherent and as error free as possible – a challenge in which we ourselves are among the working parts to be organized and brought under control.Such a framework of intellectual rigor and discipline in the practice of medicine can only be achieved if knowledge is embedded in tools; the system requiring the routine use of those tools in all decision making by both providers and patients.

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