Defense Date

Fall 10-12-2017

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Health Care Ethics

School

McAnulty College and Graduate School of Liberal Arts

Committee Chair

Henk ten Have

Committee Member

Gerard Magill

Committee Member

Joris Gilen

Committee Member

James Swindal

Keywords

bioethics, decision-making, critical care, end-of-life, intuition, deliberation, nudges, persuasion, uncertainty

Abstract

The theory of decision-making as it applies to bioethics and healthcare assumes a rational decision maker: someone who knows all his alternatives, has clear preferences, can rank and weigh risks and benefits of an intervention, and always acts in his own best interests. However, the growing body of research from the field of decision science shows that, in reality, such a purely rational decision maker does not exist. Instead, patients are rational within personal or environmental constraints such as uncertainty or ambiguity in which non-rational approaches such as emotion and intuition are instrumental. This issue is particularly important in critical care. To ensure that patients receive the end-of-life care that they want, especially considering the increase in futile care, proper risk communication is necessary. While the move from paternalism to the current emphasis on patient empowerment and shared decision-making means that patients and surrogates want comprehensive and understandable information about their conditions and treatment in order to participate fully in decisions about their care, emotions complicate this decision-making. Though there is a great deal of empirical research on emotions and risk perception, there is a lack of philosophical research on this topic, especially when it comes to futility considerations in critical care. This research asserts that emotions should be considered a necessary component of ethical assessment of risk and communication about risk, especially in the field of critical care. It explores the existing literature on how people employ emotions and deliberation in their decision-making, and it questions the existing bias among normative scholars that decisions resulting from deliberation are inherently better or superior to those grounded in intuition. Furthermore, this research attempts to determine the value of autonomy in designing health policies grounded in behavioral economics. While providers want patients to make decisions that promote their own interests, this task is rarely achieved when patients are left alone to make important decisions. This research questions whether providers should let their patients make decisions that divert them from their own health goals or intervene by actively directing patients toward choices that are most likely to promote their goals.

Language

English

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