An economic theory of patient decision-making

Abstract

Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity--finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the 'unreasonable' attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making.

Preference for One or Two Hearing Aids Among Adult Patients

“…In dealing with this kind of quandary, it is helpful to consider some theory about patient decision-making and compliance with treatment recommendations. Stewart and DeMarco (2006) presented a compelling theoretical approach to this topic that makes several important points: (1) Fully informed rational patients will attempt to maximize the net benefit of treatments. (2) Net benefit is the difference between treatment benefits (such as decrease in symptoms of hearing loss) and treatment burdens (such as money, aggravation, stigma, and discomfort of using hearing aids).…”

Patient Decision Making Among Older Individuals With Cancer

“…Instead, there were a number of clear dichotomies among the key characteristics attributed to this concept. Authors described patient decision making as a discrete, momentary event (Matteson & Hawkins, 1990;Noone, 2002;Redelmeier et al, 1993) Noone; Ratliff et al, 1999;Redelmeier et al, 1993;Stewart & DeMarco) and as irrational (Redelmeier et al) or automatic/naturalistic (Broadstock & Michie, 2000;Broom, 2009;Mykhalovskiy). The divergence among these characteristics reflected fundamental differences in the implicit assumptions underlying conceptualizations of patient decision making.…”

Patients as Rational Traders: Response to Stewart and DeMarco

“…With their economic theory of patient decisionmaking [1], Stewart and DeMarco aim to broaden the interdisciplinary nature of clinical bioethics. Ironic, and a pity, then, that the theory suffers from just that deficiency they seek to redress.…”