An Outcomes Model of Medical Decision Making
Theoretical Medicine. 1991 Dec; 12(4): 325-343.
In the traditional 'fix-it' model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.
Advance Directives; Allowing to Die; Alternatives; Autonomy; Chronically Ill; Competence; Cultural Pluralism; Consent; Decision Making; Diagnosis; Disclosure; Ethical Analysis; Family Members; Goals; Health; Health Care; Health Personnel; Informed Consent; Life; Life Extension; Medicine; Metaphor; Normality; Patient Care; Patient Compliance; Patients; Persistent Vegetative State; Physician Patient Relationship; Physician's Role; Preventive Medicine; Prognosis; Prolongation of Life; Quality of Life; Surgery; Third Party Consent; Treatment Refusal; Value of Life; Values;
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Lynn, Joanne; DeGrazia, David (1991-12)In the traditional 'fix-it' model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available ...
Teno, Joan M.; Fisher, Elliot; Hamel, Mary Beth; Wu, Albert W.; Murphy, Donald J.; Wenger, Neil S.; Lynn, Joanne; Harrell, Frank E., Jr. (2000-05)