Book contents
- Frontmatter
- Contents
- Preface
- Introduction
- I OVERVIEW PAPER
- II CONCEPTIONS OF CHOICE
- III BELIEFS AND JUDGMENTS ABOUT UNCERTAINTIES
- IV VALUES AND UTILITIES
- V AREAS OF APPLICATION
- 22 BEHAVIOR UNDER UNCERTAINTY AND ITS IMPLICATIONS FOR POLICY
- 23 THE RELEVANCE OF QUASI RATIONALITY IN COMPETITIVE MARKETS
- 24 HOW SENIOR MANAGERS THINK
- 25 PROBLEMS IN PRODUCING USABLE KNOWLEDGE FOR IMPLEMENTING LIBERATING ALTERNATIVES
- 26 ON THE FRAMING OF MEDICAL DECISIONS
- 27 WHETHER OR NOT TO ADMINISTER AMPHOTERICIN TO AN IMMUNOSUPPRESSED PATIENT WITH HEMATOLOGIC MALIGNANCY AND UNDIAGNOSED FEVER
- 28 THE EFFECT OF PRIVATE ATTITUDES ON PUBLIC POLICY: PRENATAL SCREENING FOR NEURAL TUBE DEFECTS AS APROTOTYPE
- 29 DISCUSSION AGENDA FOR THE SESSION ON MEDICAL DECISION MAKING and MINUTES OF A GROUP DISCUSSION ON CLINICAL DECISION MAKING
- Index
29 - DISCUSSION AGENDA FOR THE SESSION ON MEDICAL DECISION MAKING and MINUTES OF A GROUP DISCUSSION ON CLINICAL DECISION MAKING
Published online by Cambridge University Press: 01 March 2011
- Frontmatter
- Contents
- Preface
- Introduction
- I OVERVIEW PAPER
- II CONCEPTIONS OF CHOICE
- III BELIEFS AND JUDGMENTS ABOUT UNCERTAINTIES
- IV VALUES AND UTILITIES
- V AREAS OF APPLICATION
- 22 BEHAVIOR UNDER UNCERTAINTY AND ITS IMPLICATIONS FOR POLICY
- 23 THE RELEVANCE OF QUASI RATIONALITY IN COMPETITIVE MARKETS
- 24 HOW SENIOR MANAGERS THINK
- 25 PROBLEMS IN PRODUCING USABLE KNOWLEDGE FOR IMPLEMENTING LIBERATING ALTERNATIVES
- 26 ON THE FRAMING OF MEDICAL DECISIONS
- 27 WHETHER OR NOT TO ADMINISTER AMPHOTERICIN TO AN IMMUNOSUPPRESSED PATIENT WITH HEMATOLOGIC MALIGNANCY AND UNDIAGNOSED FEVER
- 28 THE EFFECT OF PRIVATE ATTITUDES ON PUBLIC POLICY: PRENATAL SCREENING FOR NEURAL TUBE DEFECTS AS APROTOTYPE
- 29 DISCUSSION AGENDA FOR THE SESSION ON MEDICAL DECISION MAKING and MINUTES OF A GROUP DISCUSSION ON CLINICAL DECISION MAKING
- Index
Summary
DISCUSSION OUTLINE: DESCRIPTIVE/PRESCRIPTIVE/NORMATIVE INTERACTIONS IN MEDICAL DECISION MAKING
Issues relating to values and preferences
Valued consequences that are typically reflected in formal models of medical decision making include the following:
survival (length of life)
quality of life
symptoms
physical function
social function
Are preferences regarding these attributes fixed or labile? How do they change with age, physical status, mental status, interactions with physicians? Prescriptively or normatively, how does one deal with the existence of “multiple selves”? Is the prescriptive solution more complicated than just trying to assess the uncertainty about future preferences, and then take expectations across all possible future utility functions? If perfectly or imperfectly knowable, should future preferences substitute for present preferences in decisions with future consequences?
Examples: labor and anesthesia (Christensen–Szalanski)
smoking and addictive behaviors
myopia, ignorance, or uncertainty about old age
euthanasia (Schelling)
Are some preference functions normatively “better” than others? When is it appropriate for the physician to intervene to try to change patients' preferences?
What are the ethical implications for informed consent?
Example: a couple's desire to have a baby at home, under the care of a midwife
Issues in assessing utilities for health outcomes: Assuming that preferences are stable and measurable, what is the best way to measure them? While proper von Neumann–Morgenstern utility functions may be the prescriptive goal, are there other means to that end that are more reliable or acceptable than using lottery techniques, e.g., category scaling, magnitude estimation? […]
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- Information
- Decision MakingDescriptive, Normative, and Prescriptive Interactions, pp. 599 - 612Publisher: Cambridge University PressPrint publication year: 1988