Clinical decision making: from theory to practice. The individual vs society. Resolving the conflict

Dm, Eddy

doi:10.1001/jama.265.18.2399

Cited by 23 publications

(14 citation statements)

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“…Health futurist Russell Coile (1990) and others (Califano 1989(Califano , 1991Eddy 1991;Kitzhaber , 1991bZaldivar 1994;Clinton 1994) argue that change in the present health care system is inevitable. Coile (1990) believes that the future of medicine is evident in the observation of current events.…”

Section: Changing the Health Care Systemmentioning

confidence: 99%

Oregon Primary Care Physicians' Support for Health Care Reform

Baker¹

2000

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Section: Changing the Health Care Systemmentioning

confidence: 99%

Oregon Primary Care Physicians' Support for Health Care Reform

Baker¹

2000

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“…Thus, consumers are willing to purchase more health care than would otherwise be the case. In addition, as David Eddy has pointed out, 6,7 when a person consumes health services (as contrasted with when a decision is made to purchase insurance), she may be quite ill, with a very high perceived need for health care.…”

Section: The Healthcare Revolution: What Is Happening and Whymentioning

confidence: 99%

The Healthcare Revolution: Change and Impact on Geriatric Medicine

Pawlson¹

1995

J American Geriatrics Society

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“…In a series of articles in the early nineties, David Eddy argued that the increasing demand for health care could only be met equitably if individual patients made decisions on the cost-effectiveness of treatments [18][19][20]. Perceiving that once patients contracted a condition, they would have a compelling incentive to want all treatments for that condition funded, he advocated that a cross-section of people who were well but potentially at risk of conditions be convened and shown evidence of the health outcomes and cost burden of treatments as if those treatment would be paid for directly by themselves [20].…”

Section: Introductionmentioning

confidence: 99%

“…Perceiving that once patients contracted a condition, they would have a compelling incentive to want all treatments for that condition funded, he advocated that a cross-section of people who were well but potentially at risk of conditions be convened and shown evidence of the health outcomes and cost burden of treatments as if those treatment would be paid for directly by themselves [20]. In terms of managing demand, we would suggest that Eddy's proposition has value, however he also argues that 'in return for the benefit of sharing costs, individuals must also accept some responsibilities and limitations' [20, p. 239].…”

Section: Introductionmentioning

confidence: 99%

Advocating Mandatory Patient ‘Autonomy’ in Healthcare: Adverse Reactions and Side Effects

Davies

Elwyn

2007

Health Care Anal

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Promoting patient autonomy has become a key imperative in health service encounters. We will examine the potential negative effects of over-promoting patient autonomy and consider the impact on patient access, their experience and the provision of equitable services by focusing on an extreme manifestation of this trend, i.e. calls for patient involvement in health care decision making to be mandatory. Advocates of mandatory autonomy hold that patients have a duty to themselves, to society and to the medical system to make decisions on their health care independently. Models of mandatory autonomy may be contrasted to those of optional autonomy that seek to ascertain patients' decisional preferences and to understand wider limitations on their freedom to choose. Where choice as decisional responsibility becomes mandatory it ceases to promote agency and where autonomous choice is understood as an individualistic practice it will contribute to the cultural dominance of Western values. Moreover, taking a view that principlist ethics needs to take account of the social and cultural contexts of individual lives, we argue that if mandatory autonomy were to be over-emphasised as part of an ongoing move towards patient choice in UK National Health Service (NHS), educated and affluent people would be more able to exercise choices at the expense of people who are experienced in asserting preferences and who have the resources to make use of choices. We will argue that the promotion of autonomy needs to be tempered by steps to enable less powerful social, cultural and economic groups to contribute to decision making and to support individuals who may feel abandoned by having decisional responsibility transferred to them. Until constraints on individual choice can be understood and addressed, we advocate the model of optional autonomy used in shared decision making and make recommendations for practice, policy, education and research.

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Clinical decision making: from theory to practice. The individual vs society. Resolving the conflict

Cited by 23 publications

References 0 publications

Oregon Primary Care Physicians' Support for Health Care Reform

Oregon Primary Care Physicians' Support for Health Care Reform

The Healthcare Revolution: Change and Impact on Geriatric Medicine

Advocating Mandatory Patient ‘Autonomy’ in Healthcare: Adverse Reactions and Side Effects

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