Should Informed Consent be based on rational beliefs? A Critique:
Julian Savulsecu and Richard W Momeyer argue, “being autonomous requires … a person [to] hold rational beliefs” (Savulsecu & Momeyer 282). They make an important distinction between rational beliefs and rational choice. Rational beliefs is the knowledge of the situation regarding its accurately and validity. Rational choice is how a person acts upon the beliefs that they have. When specifically applying this to the medical world, Savulsecu and Momeyer believe that it is not enough to simply provide information to the patients; rather, the physicians should help their patients with more rational thinking and deliberations.
Overall, I do not agree with Savulsecu’s and Momeyer’s argument of rational beliefs. Autonomy does not, and should not, correlate with a persons belief – knowledge – or the rationality of choice behind it. Autonomy is very basic. It is the right or condition of self-government I would argue that a person’s autonomy should be based off the action a person takes. Being autonomous is an action – similar to the action of jumping. If you meet a set of criteria that distinguishes an action form others, then I believe that you have preformed that action. If both feet come off the ground and I elevate my body, then I have jumped. In the case of autonomy, a person would preform a self-governing action. Performing this action does not require extensive knowledge on a situation, only the person’s opinion at that moment of time, and the action itself. When the action is complete, the person has preformed acted autonomously and therefore responsible for the outcomes of their actions.
Rationality and true/false beliefs do not hold much weight when deciding whether a person is/was autonomous. Acting rationally upon true beliefs may lead to a better consequence, however the quality of the consequence should not dictate whether or not it was an autonomous decision. Take the Jehovah Witness case for an example. The doctor actions to transfuse or not, regardless of the information he knew, would be his decision and his decision alone. When a willing, conscious effort is made to preform a task, that action is autonomous; and therefore, in that moment, the performer of such action has autonomy.
I agree with the end result and the change they want. I do believe that doctors should be made to give a more conscious effort to teach and educate their patients. Not only does this help the doctor feel more at ease when making decisions mid-surgery, but also creates a more trusting relationship between the doctor and patient. None the less, I would like to stress being autonomous has more to do with the action than the belief or choice behind the action.
Alex Liu
Citations:
Savulescu, J., and R. W. Momeyer. “Should informed consent be based on rational beliefs?” Journal of Medical Ethics 23.5 (1997): 282-88. Web.
Alex, while I do understand your point, I also disagree with your point.
Autonomy is the ability to make a choice and being able to act on that choice and sometimes our choices are based on our beliefs. The decisions and choices can sometimes stem from something.
The transfusion case dealt with religion as a factor for decision-making. Jehovah Witnesses do not believe in transfusion. Their practice of autonomy comes from a belief that they hold.
Hi Sandra,
I have used the word “belief” very loosely in my critique above. When I read the original article, true/false beliefs seemed to be equivalent to true/false knowledge. That being said, I would agree that all our actions are based off of our beliefs. My argument would say that, although you have certain beliefs, you still consciously choose an action to take and are able to act on that choice. In a simple example of eating an apple. A person does not know if the apple is rotten or not, but they think it is a fresh apple. They take a bite an realize it had a worm in it. In this case, the apple was fresh but also had a worm in it. The knowledge they had of the apple was false, but they none-the-less had a choice to eat the apple (this is the autonomy I am referring to) and the ability to act on that choice. The result was not good, but they were still acting autonomously.
In the case of the Jehovah Witness, I wrote the Doctor was practicing the action of autonomy. The patient, however, was not. She was unable to make a conscious choice; and therefore, she was also unable to act upon it. (This line of thinking can be taken in many ways– the unknowing argument, the fact she could not speak for herself, religion would be speaking on her behalf… etc).
I hope this clears some things up!
Alex
Perhaps allowing complete patient autonomy decreases the paternalistic aspect of medical care, thus decreasing the physician’s influence over making decisions on the behalf of the patient. I’d argue that any physician automatically assumes their decision making ability regarding medical choices to be superior to the patient, whether from schooling or experience in treating a particular disease. However, while a physician may feel that their opinion is more informed than the patient, the need for autonomy counteracts the physician’s purported sense of judgmental superiority.
However, this does not mean that physicians shouldn’t use their knowledge and experience to frame their advice in a manner that will lead a patient to agree with them. I agree with your statement that doctors should educate their patients. In fact, I’d argue that doing so is one of the most important aspects of patient autonomy. As long as the physician is honest and acting in the interest of the patient, their judgment should be used to help guide the patient towards the safest and healthiest choice.
Hi Alex!
I think I am still confused about your stance on the issue. If I understand correctly, you believe that patient autonomy should be held above all other principles (beneficence, nonmaleficience, etc.) that a physician may instead be advocating for regardless of whether or not the patient’s choice is founded in rationality? I agree that patient autonomy is of the utmost importance; however if a patient holds a false belief, compromising their rationality , I think it is the duty of the physician to inform the patient of the discrepancy. Beauchamp and Childress argued that “as long as this patient continues to hold a false belief that is material to her decision, her refusal is not an informed refusal” in response to the case of a woman who refused a potential life-saving procedure because she simply did not believe that she had the condition she did in fact have (Beauchamp & Childress, 136). It is one thing if a physician and patient disagree on how to handle a situation if both sides are founded in reality; however if it becomes clear the patient is acting irrationally or does not comprehend the situation accurately, I believe the physician has a right to the patient to do his/her best to inform the patient of the actual facts and try to deconstruct irrational ideas.
I think the main issue in this type of situation is how exactly to define irrational. I know the article claims irrationality on the grounds of: “(1) ignorance, (2) not caring enough about rational deliberation and (3) making mistakes in deliberation”, but I disagree with some of their examples to support these broader categories (Savulescu & Momeyer 282). I agree that ignorance is grounds for irrationality and that the physician should step in and try to provide a more clear understanding to the patient. However, in the case of the Jehovah’s Witnesses, although their position on blood transfusions may seem irrational to most, I do not think the physician can argue that the patient is irrational. The physician can provide his/her best medical opinion and tell the patient why they believe they should go through with the blood transfusion, but at the end of the day I think that challenging religious beliefs on the premise of irrationality is a very slippery slope. To some extent, one could argue that the belief in any religion or higher being is irrational, yet many people, myself included, believe in religion and a higher being anyway. Are any decisions I make keeping a higher power in mind irrational?
I know I strayed a bit from your original point, but I think this is a really interesting and controversial topic! Overall my opinion is that the rationality of the patient’s opinion is important and should be used as a basis for consent in order to ensure that the patient is competent enough to make an autonomous choice.
Citations:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print
Savulescu, J., and R. W. Momeyer. “Should informed consent be based on rational beliefs?” Journal of Medical Ethics 23.5 (1997): 282-88. Web
Hi Alex, I thought your post was very interesting. I had a few comments on it. I actually believe that autonomy does require rational beliefs, because our self-government is affected by our beliefs and our knowledge. You used an example of jumping and how once we decided to pick our feet off of the ground we jumped, but the process prior to the jumping and the manner we arrived at jumping is affected by our decision. I can choose to run and then jump, someone can choose to do something else prior to jumping, but at the end of the day our decision to jump was affected by our beliefs. I think our self governance has everything to do with our rational beliefs. Interesting post though!