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Science and Problem Solving Techniques

Writing Project

Making Decisions: A Practical Model

Edward Hundert, a psychiatrist, wrote an article* designed to assist physicians in making life and death decisions involving patients. Hundert describes a practical model for complex problems: He believes that each new dilemma represents a set of conflicting values. Making a list of these relevant values helps clarify what is important. Utilizing a scale which attempts to equate values, a decision can be made as to whether one side has more "weight" than the other. An example follows:

Problem: A psychiatrist must decide if a patient is mentally ill enough to require commitment to a psychiatric hospital. The moral principles involved are part of a physician's code of conduct stating that: the primary duty of a physician is to benefit the patient; to enable patients to be self-determining agents; to do no harm. A potential list of conflicting values follows:

To Commit against the patient's will versus to Not Commit the patient:

Concern for the patient's welfare and safety versus patient's right to individual liberty

Need to relieve patient's suffering versus patient's right to privacy

Concern for safety of others who may beaffected by patient versus modesty concerning one's own who may be affected by actions i.e. suicide or homicide

In the final analysis, the physician, guided by a code for ethical behavior, decides while being consistent with his/her own principles and perspective which course of action would be most appropriate. Should the patient remain free and subsequently commit suicide, this result might modify the physician's confidence in predicting a patient's future behavior and may change the priority given to that particular belief. Such experiences may change the physician's future actions, but not necessarily alter the fundamental principles involved.


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