Monday, January 19, 2009
The Relativity of Values: Health and Life
While reading the first paragraph of the author Alan Goldman's article on Relativity of Values: Health and Life, the questions that came to mind is, how do we know a person is actually acting irrationally or inconsistently when it comes to their own long range preferences? At what point is it ok to have paternalistic interference be justified? Of course, the people who actually know the person really well, (family members and close friends), can tell if something is not in sync with the decisions this person decides to make. But what about this person changing their mind that seems logical to them about how they want their health handled? And what if even close family and friends think this is irrational thinking, when in fact, this is the way the patient wants it? What if this person made statements their whole lives mentioning that no matter what happens to them, they wish to be hooked up to a ventilator and have their life prolonged as much as possible, in hopes of a miracle, and then when the time comes when they are in the hospital, fully aware of what is going on, decide to not be attached to any medical equipment to prolong their life knowing their life is going downhill and the pain they are in, to be let go naturally and let nature run it's course? Would this decision be irrational, or would it be just the patient changing his mind while going through these hardships?
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ReplyDelete"Would this decision be irrational, or would it be just the patient changing his mind while going through these hardships?"
ReplyDeleteWe would have to look at what caused the change of the patient's mind. If it were solely the fear and depression engendered by her illness that changed her mind, than that is irrational.
There is a possibility, however, that the change of the patient's mind is the result of a genuine change in her value system ("value-ordering", as Goldman would call it), in which case we would not deem that change irrational.
Attempting to determine the cause of a patients "irrational thinking", whether it be from a change in his or her individual value system or just out of fear, seems rather unnecessary. As mentioned under the section of "Paradigm Cases" in Alan Goldman's piece, we need to understand that though our individual actions may not be truly "voluntary" with justified paternalism, we should have faith in our doctors who are definitely more knowledgeable about our condition. Goldman makes the point that there is a reason why physicians must be licensed and that these kind of controls are what keep us from being treated by quacks.
ReplyDeleteI do believe that it is important for patients to have freedom of choice in their treatment options; however I believe that doctors, more often than not, know what is in the best interest of each individual patient.
How would one even be able to objectively determine whether a patient's thinking is "irrational thinking" or a change in their belief system during times of hardship? furthermore, I do not believe that a doctor has the expertise to psychologically determine their patient's frame of mind at a particular point and the patient's opinion is not objective by nature.
ReplyDelete"furthermore, I do not believe that a doctor has the expertise to psychologically determine their patient's frame of mind at a particular point and the patient's opinion is not objective by nature."
ReplyDeleteIn some cases I do believe that this is true, but I do know from personal experience that a doctor can often determine a patient's frame of mind provided that it is a result of a given condition. Some conditions can cause delirium during its progression and doctors know to anticipate this change in the psychological state of their patient. At times like these, I definitely feel a need for justified paternalism because a patient can not rationally make decisions regarding their treatment.