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and rule table entries.” (ibd., p. 952). Statistically speaking this might not make
any difference with regard to the quality of medical care. But with regard to trust
it makes a difference whether the decision was made by an algorithm or a machine
or whether it was made by a person. From the perspective of a patient, in a situ-
ation of vulnerability such as being ill decisions need to be trustworthy and there
needs to be an instance that can be held responsible in case the decision was wrong.
Usually it is difficult for patients to ascribe trust and responsibility to a machine but
they would rather have a person like a doctor in between them and the algorithm.
Thus the doctor would have the responsibility to guarantee the trustworthiness of
the machine. If the doctor trusts the results then the patients can trust them as well
because they trust the doctor. Thus the algorithm might support decision making
processes on the level of processing information, but it cannot help with questions
of responsibility of a doctor. The doctor and his or her diagnostic evaluation remain
on pillar of informed consent.
Turning to the second pillar, the consent of patients, the picture gets even more
complicated. For example there is an ongoing debate on how much information a
patient should be given and to what he or she should give consent. Should the patient
learn about different options and weigh them for him- or herself? Or is this a task of
the doctor? Schwab discusses this problem with regard to risk-benefit assessment
and asks in how far risk assessment and the possibility of failure of a treatment
should be communicated openly to the patient. He argues for epistemic humility
and that the patient should not only give his or her consent to a treatment but also to
the risk-benefit ratio that comes along with it [12]. Following Schwab's idea would
mean to communicate much more information to the patient. The evaluation of
different therapeutic options would be a shared process between doctor and patient.
When patients are asked about participating in shared decision making processes
with doctors and how much they want to be involved we see a different picture.
Chung et al. asked patients at a general internal medical service in Chicago about
their preference in decision making processes and gave them different ways of dis-
tributing responsibility within a decision as options. The empirical research shows
that although most patients want to be asked their opinion (87% strongly agree) and
want to be involved there is also a strong tendency to delegate the last decision about
medical care to the doctor (34% strongly agree, 33% agree) [6]. So many but not all
patients do not wish to decide about the therapy. They want to be involved but not
fully responsible. In order to structure a decision making process a doctor needs to
know in how far a patient wants to be involved in the process.
But the ability as well as the will to decide for oneself varies with the degree of
illness. Strengthening the autonomy of a patient is the aim of various tools such as
advance directives and living wills for cases when a patient cannot decide anymore.
But still many situations occur where patients do not have a document transport-
ing their wishes. Rid and Wendler therefore ask for alternatives in decision mak-
ing processes when informed consent cannot be gained. They especially focus on
Alzheimer patients who are incapacitated and cannot make decisions. They suggest
integrating the patient's wishes into decision making processes as far as possible
even when a patient cannot communicate his or her wishes anymore. They argue
