Patient Decision Making

Jeffrey K. Belkora

in Public Health

ISBN: 9780199756797
Published online March 2012 | | DOI:
Patient Decision Making


Patients historically deferred to physicians in a health crisis, even after Western civilization embraced individual autonomy and the right to self-determination in other, nonmedical areas of life. Physicians perpetuated this paternalism while embracing a principle of beneficence, meaning that they pledged to act in the interest of their patients. However, for patients, delegating decisions to physicians has always presented the agency problem: Those acting on your behalf may not act in your interest, even when they intend to. All people feel differently about the timing, likelihood, and value of different events or outcomes, and may act on these feelings and perceptions unconsciously. Some patient advocates have concluded that patients must assert their autonomy and behave as consumers. However, autonomy in a health crisis is a burdensome expectation because patients cannot make and implement most medical decisions alone. Therefore, many patient advocates, especially in the Western world, promote a model that frames patients as requiring assistance to exercise their legal right to autonomy or self-determination. At one extreme, patients may request or require so much assistance that they are essentially delegating the decision to a physician. This can look like old-style paternalism but differs in its starting point, as the patient, not the physician, is the ultimate decision maker. Others may require or request so little assistance that they are essentially deciding unilaterally. Most patients, especially in the West, place themselves in the middle of that spectrum, wishing to collaborate and share the decision making with their physicians. This has led to the emergence of a subfield within medical decision making focused on the provision of decision support to patients. Decision support promotes critical reflection within and between patients, their family or caregivers, and health care professionals. Critical reflection is a process in which people think, talk, and write about how to improve their situation. In a family health crisis, to engage in productive critical reflection, patients may need assistance formulating questions and absorbing, understanding, and acting on health-related information and advice. This annotated bibliography presents some key resources for learning about these dimensions of patient-oriented decision support. It focuses on prescriptive approaches to improving real-world decision making through critical reflection. This is in contrast to normative decision science, which outlines idealized forms of decision making, and descriptive decision science, which describes how human beings deviate from such norms.

Article.  7166 words. 

Subjects: Public Health and Epidemiology

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