Patients, doctors and risk attitudes
Patients, doctors and risk attitudes
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DOI：
10.1136/jme-2022-108665
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发表时间：
2023-03-10
影响因子：
4.1
通讯作者：
Makins，Nicholas
中科院分区：
文献类型：
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作者：
Makins，Nicholas
近年来，决策理论中一个活跃的辩论话题涉及我们对决策者所表现出的不同风险态度的理解。有充分的证据表明，规避风险和寻求风险的行为很普遍，而且越来越多的人认为，这种行为在理性上是允许的。在临床医学的背景下，这个问题是复杂的，因为医疗保健专业人员必须经常为病人的利益做出选择，但理性选择的规范通常是建立在决策者自己的愿望、信仰和行动的基础上的。医生和病人的同时出现提出了这样一个问题：谁的风险态度会影响手头的选择，以及当两者出现分歧时该怎么做。医生在治疗喜欢冒险的病人时必须做出冒险的选择吗？在为他人做选择时，他们是否应该普遍规避风险？在本文中，我将认为，医疗保健专业人员应该采取一种恭敬的方法，即病人的风险态度在医疗决策中至关重要。我将向大家展示，人们所熟知的关于医学的广泛反对家长式观点的论点，可以直接扩展到不仅包括患者对可能的健康状态的评估，还包括他们对风险的态度。然而，我也将表明，这种恭敬的观点需要进一步完善：必须考虑患者对其风险态度的高阶态度，以避免一些反例，并适应关于风险态度实际上是什么样的态度的不同观点。
A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are.