Tag Archives: Decision-making

Medical Decision-Making: An Evaluation of Three Models

Esther Warshauer-Baker, Dartmouth College

There are several models for medical decision-making within the doctor-patient relationship, and this paper discusses three of these models: paternalism, informed decision-making, and shared decision-making. I describe each model and give arguments for the plausibility of each. I conclude that each is problematic. Paternalism, the traditional model, is problematic because it relies on a false ideal of medical certainty, and it devalues patient autonomy. This becomes apparent when one examines medical decisions involved in prostate cancer diagnosis and treatment. Informed decision-making, while possessing the merit of valuing patient autonomy, is also flawed, because it limits the roll of the doctor to a technician and information source, and it calls for an impossible bifurcation between information and values. Shared decision-making is the ideal model for most medical decisions, especially those involving a great deal of medical uncertainty. However, by examining the problem of doctors providing antibiotics to patients who do not have bacterial infections, it becomes clear that shared decision-making is not always appropriate. Doctors may have non-medical incentives to prefer what patients prefer. Indeed, to develop a non-problematic model for medical decision-making, we must take into account the societal and structural context within which medical decisions take place

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Weird Science: Testing Moral Claims

Lee Peck, Ohio University

Are there facts about how we should act? Can we test moral claims just as scientists test whether there is truth to a theory? Gilbert Harman believes there is “a real problem of testability in ethics, a problem that can be formulated without making mistakes about testability in science” (1986). Moral facts have no explanatory role, he says, and therefore ethics is immune from observational testing.

The Cornell realists have another view, however. The Cornell realist, Blackburn (1998) explains, “thinks we can identify the ‘truth-makers’ for our ethical thoughts, identifying what properties of things make them true, rather as the scientist identifies the property of stuff that identifies water or gold” (pp. 88-89).

In this paper, Harman’s and Sturgeon’s conflicting views will be presented. I argue Harman’s argument is the more feasible, but that Harman can make his argument stronger by presenting additional differences between the methodologies of ethical decision-making and scientific research.

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