Immortal Life

Today, we talked about informed consent, bodies as property, and education in the context of media and medical decision making, springboarding from our reading of the book _The Immortal Life of Henrietta Lacks_ by Rebecca Skloot.

I heard the word “rational” decision making being thrown around a lot. What constitutes a rational decision? Can decisions be rational? How so? What do you mean when you use the term? Is rational the same thing as informed?

8 comments:

  1. A rational decision in the context of taking informed consent is one that makes the best of present opportunities. A lot of interesting thoughts were presented during today’s discussion that took into account the fact that even though we have heavily criticized the decisions of Henrietta’s doctors to use her cells for research, we do so in the context of today’s day and age and often fail to take into account the circumstances and socioeconomic disparity during that period which heavily influenced not only medical decisions in general but many different facets of society and life. If Henrietta’s cells had failed to grow in the lab, we wouldn’t be asking a lot of the questions we are asking.
    My point being that what may be considered a rational request to participate in say a stem cell study is influenced by a number of factors such as the socioeconomic background of the patient, the educational qualifications of the patient and the state of medical research. Henrietta’s case was one situation where a supposedly “irrational” request resulted in wonderful outcomes for the research community. Would we feel more comfortable about the fact that say Henrietta’s cells had not been collected because she was informed and declined consent to donate her cells to research, we may have experienced a major setback in cancer research, which could impact possibly the advent of novel therapeutic outcomes?
    I think that in Henrietta’s case, the consent process was more rational and less informed. It was rational to save discarded tissue for research. Today the consent process is a lot more closely regulated in general, however in the 50’s and 60’s it wasn’t. It would be a violation of basic human rights if doctors had knowingly ignored the consent process if one was already in place, but there wasn’t, and hence the question is, who is actually to blame?

  2. Rational is defined more along the lines of logical thinking, which is closely associated with analyzing all possible outcomes and choosing which one is best. What I liked about today’s discussion were the points about making “irrational” decisions. I think in cases like Henrietta’s, as well as in situations like organ donations, it’s important to remember that sometimes people are going to make irrational decisions based on emotions regardless of their education status. So when Henrietta’s husband initially refused to have her body autopsied, the doctors and researchers saw it as an irrational decision he was making because of his lack of education. In reality, he could have just been upset that his wife had died and did not have the time to really think and process his emotions properly before making his initial decision.
    When thinking in the context of informed consent – it’s important to use language that is easily understood by a lower education level. However, even if someone understands the rationale behind what would be the rational decision, that does not mean their emotions won’t play into them making the irrational choice. Doctors and researchers need to respect family members making these irrational choices, especially since it’s emotions and making irrational choices that really tap into humanity. If we as humans always made rational choices, we would be closer to robots than people.

  3. A rational decision is one that follows after a person has weighed all the possibilities, understood the pros and cons of each, and then chooses the one that he/she believes is best for his/her specific situation. We assume this decision will maximize benefit while minimizing dentriment to those involved. Generally, we also assume that the person is following a logical flow and that a similar decision would be reached by other people in the same situation.

    However, this generalization is flawed in that most people use a combination of logic, emotion, educational background, historical knowledge (i.e. what they know of the outcomes of similar situations from the past), philosophy/beliefs/moral code, and socioeconomic status to process information and to make decisions. A robot or a psychopath are the only ones capable of making purely rational decisions as kishgresh alluded to in the previous post.

    Therefore, what we really mean by the term “rational decision” is that we can follow the person’s logical flow of thought (influenced by all the factors listed above) that led them to the final decision and we understand making that decision (even if we would have made a different decision in a similar situation based on our own different set of the factors listed above).

    A rational decision and an informed decision share similarities but are not ultimately the same thing. We defined a rational decision above as the term is generally used and that such a decision is logical but influenced by many factors. Both a rational decision and an informed decision may have a logical flow and both are influenced by the above factors. The key difference is that an informed decision refers to the information the person who is making the decision has available, not to how the person is processing the decision in his/her head.

    An informed decision means that the person making the decision understands all the possible options, the benefits and risks of each decision, and is satisfied with the extent of his/her knowledge. All the information they desire (ideally as complete information as possible) is before them and they feel ready to make the decision. They are many ways to inform someone to help them in making a decision. Some of the options include written information, oral discussion, pointing them to solid resources, and allowing them to talk to people who have gone through similar situations. Often, it is wise to provide information through multiple of these avenues and to reiterate the information multiple times to try to get the best understanding possible.

    It is the clinician’s job (along with a patient advocate as needed) to provide all the options, the pros and cons of each, and to satisfy the client/patient’s knowledge until the client/patient understands to the extent that he/she wants to understand and feels comfortable making the decision. It is not the clinician’s job to make the decision for the client/patient (even if asked) as it is important for the client/patient to own that decision as he/she will be the one living with the consequences.

  4. I think that jmcary brings up a very good point in the last paragraph. Informed consent is easily defined, either a patient is given all the available information, or they are not. The decision-making is totally left up to the patient, whether the decision appears to be rational or not from the point of view of outsiders. The term “rational” is not consistent because the reasons and logic of individuals varies. Therefore, what is “rational” to one individual may be “irrational” to someone else. As it has been stated, a rational decision involves weighing up pros and cons as well as considering all eventualities. How an individual considers information in order to make a rational decision is dependent on their socioeconomic background, religious beliefs and previous experiences. As a result, it is impossible for a clinician, researcher or entity to say they are guiding an individual toward a rational decision because that would suggest that they have used their own views to influence the views of the patient or subject.

    In contrast, an informed decision is more simplistic and does not contain the element of bias that a rational decision may have. Information comes as an objective unit without preconception on how to think about it. Consider the scenario that your loved one is brain dead and on life support. You are trying to decide if you should turn off the life support or not. The information you are given is that there is a 20% chance they will come off life support and if so they will have severe brain damage. Right now, you can make an informed decision; you put all of your beliefs and values into making a decision that is rational to you. In contrast, if the doctor or wider society believes that it is wrong to turn off life support but you want to, all of a sudden your decision is viewed as irrational. This is the crux of why as healthcare professionals we have to give the information cut and dry. It is our patients’ decision and we should not judge them by labeling their decision as rational or irrational.

  5. During medical proceedings, a patient’s doctor will be the one to decide whether the patient is rational or irrational. As an irrational person will no longer be seen as capable of making decisions for themselves, a doctor may call upon a family member to make decisions. For one working in the medical field, their definition of rationality will differ, as modern requests from patients become strange. Today, doctors may be asked to perform plastic surgeries different from the norm, such as a patients wish for a doughnut to be formed on their forehead (this is something that actually happened), and it is up to a doctor to decide in the rationality of the request. An even more controversial request, that is true to this day, is a request from parents to keep from vaccinating their children. A doctor is faced with knowing that the child would be at risks for multiple diseases, as well as the child infecting others. While a doctor is not allowed to deny the request, the decision of rationality is there.

  6. When talking about “rational,” it often refers to weigh the potential risk and potential benefit – the instrumental reason which proceed the goal with organizing available sources and counting the cost-benefits without considering emotional perspectives. In this sense, a person cannot make a decision without being fully informed because if he/she doesn’t have all information, there is no way to count the cost and benefits. However, this concept ignore the actual situation, that people have their emotions, especially when facing serious medical decisions. Hope, and love play important parts in making medical decisions. This doesn’t mean that they are not rational; they may be value rational, which choose all available to get to their goals without considering cost-benefits. Of course they want to succeed, but the practices are important than the ends for them. Being fully informed will help them to make a better decision, but if they may make their decisions based on their values which may against the information. For example, regardless of price, a person with instrumental reason may refuse to take anti-aging stem cell therapy because it may not be effective, but a person with value reason may take this treatment even though he/she knows the therapy may not work perfectly, because he/she values the hope of being young much more than the potential lost. They are both rational but with different concerns.

  7. A “rational” decision is based on logical, reasoned consideration of the factors relating to your decision (although a rational decision is not necessarily the same thing as a reasonable decision). Decisions can be rational if the person making the decision reasons through the possible consequences and driving forces for the conclusion (i.e., for a decision to be rational, the person cannot make the decision based purely on emotion–logic must be used to sort through the pros and cons of the choice). In the context of medical research, a rational decision considers the potential benefits of the choice and the rules governing the decision. However, a rational decision is not necessarily an ethical decision. For example, the doctor working with Henrietta Lacks made an ostensibly rational decision to take her cells without her consent. No rules forbade it, taking samples without consent was common practice at the time, and there was a great potential for benefit to science and medicine. However, whether taking Henrietta’s cells without consent was ethical is questionable. Also, a rational decision may or may not be informed. “Informed” implies that the person has been given necessary information relating to the choice under consideration. If a person is not adequately informed, they may make a decision that is rational but not the best decision under the circumstances. For example, Henrietta’s family agreed to give blood samples because they believed they were being tested for cancer. Their decision was rational considering the information they were given, but not informed since they were not told the real motivation for the blood samples.

  8. I do not believe that any decision can be purely rational. Rational has two definitions that I think get conflated/confounded a lot of the time. The first is “based on facts or reason and not on emotions or feelings,” and the second is “having the ability to reason or think about things clearly.” And of course, these are descriptive definitions, not prescriptive, so this is merely how the word IS used, not necessarily how it OUGHT to be used. However, sometimes we think that the “ability to think about things clearly” is the same as being “based on facts… and not emotions,” as though we could ever separate our thoughts from our desires.

    The second definition is the one that I believe we need to use when speaking of informed consent, because the first imparts far too much responsibility for “factual” knowledge upon the patient. There needs to be a burden of a participatory exchange of information on the part of the researcher/clinician, and a burden of clear thought on the patient. This is where issues of competence come up. We must not simply judge rationality by the use of facts, figures or information, but rather the ability to consider consequences, judge risk, and on clear thought. If we merely judge rationality on the use of information, then no one can be truly rational, for in order to do so, one must have all possible information.

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