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5
Medical Ethics, Fuzzy Logic
and Shared Decision Making
Julia Inthorn
5.1
Introduction
Doctors especially those working in hospital surroundings characterize their every-
day life as a continuity of decisions. Even routine examinations and treatments
of patients who have a cold can be described as a succession of decisions starting
with the first questions the patient is asked, ruling out severe illnesses with similar
symptoms up to the medication chosen. Decisions have to be made on the use of di-
agnostic tools, the diagnosis itself as well as therapies. Decision-making processes
usually have to take place under time pressure which may result in stress. Adding
to the stress is the responsibility for a patient who is especially vulnerable in this
situation. Patients trust in a doctor's ability to make correct decisions based on the
latest standard of scientific knowledge. Various tools like guidelines and codes of
conduct have been established to support doctors in their decisions for the patient.
But not only the medical, knowledge-based side of decisions is complex. De-
cisions should be based on medical knowledge while at the same time normative
aspects like the respect for the autonomy of a patient should be taken into account.
This leads to complex decision making processes where descriptive as well as nor-
mative reasons can come together.
In his book
Handbook of Analytic Philosophy of Medicine
Sadegh-Zadeh
analyzes the dimensions and structure of medical knowledge and it's relation to
decision making processes in diagnosis and therapy. By integrating the notion of
fuzziness he can modify the notion of decision making processes in medical prac-
tice and describe decisions as based on fuzzy concepts. He shows the advantage
of fuzzy logic to deal with decisions in medicine, especially medical practice. [11]
His approach may lead to new ways of decisions better adapted to the structure of
medical knowledge than current guide lines and check lists in medicine.
He also discusses the normative dimension of decisions by reconstructing medi-
cine as a deontic discipline. The following chapter takes his thoughts on the norma-
tive dimension of decision making as a starting point. While Sadegh-Zadeh focuses
on the structure of medical knowledge as a whole this chapter wants to have a closer
