The old days of medical paternalism are gone. Today we have shared decision-making, in which doctors describe treatment options and patients choose the one they prefer.
It sounds simple, but it’s not. I learned this when I had to decide whether to have a feeding tube during cancer treatment. Doctors explained the tube’s benefits and risks, then left it to me to decide. I said no. I had my reasons — I didn’t want a foreign object in my body or an overnight stay in the hospital. I wanted to prove that I was tough enough to get through treatment without extra help.
But this was a bad decision. As time passed, I became too weak to continue daily radiation sessions. People kept trying to get me to change my mind, and finally a nurse succeeded. Consenting to the tube was the right thing to do, but it took a lot of persuasion for me to accept that.
Argument is a legitimate part of shared decision-making, but not everyone understands this. Some clinicians think that respect for autonomy means they should never disagree with a patient. Some think that it would be cruel to question what a seriously ill person says she wants. Some don’t want to devote time to the hard conversations that produce good decisions.
Patients avoid arguments, too. Many are too intimidated to take issue with anything a doctor says. But doctors aren’t always right, and patients who are afraid to argue can pay the price. A friend had his cancer properly diagnosed only after he challenged his doctors’ opinions about what was wrong.
In everyday life, arguments with family and friends help us think through the consequences of our choices and sometimes change our minds. Patients and doctors should do the same for one another.
St. Louis, Aug. 21, 2012
The writer is a professor of law and medical humanities at Washington University and the editor of “Malignant: Medical Ethicists Confront Cancer.”