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for surrogate decision making that is assisted by a preference predictor which sug-
gests decisions based on factors such as age, gender, race and also most recent de-
cisions [10]. The advantage is to have a broader basis for the decision by referring
to different types of data. One disadvantage may be seen in the categorization of
decisions along age, gender or race. Though there are statistical similarities the idea
of individualized decisions that is strengthened by the idea of autonomy seems to
be reduced. A preference predictor thus can be seen as helpful in situations where
there is not enough knowledge about a patient and family or friends who might tell
more about the patient are not available.
While in some situations the integration of patients' wishes is not wanted by pa-
tients or patients are incapacitated there are also situations in medical decision mak-
ing where a patient wishes for a special treatment while medical indication points
into another direction. Alt-Epping and Nauck discuss the role and significance of
positive wishes for therapy by patients in clinical decisions on therapy. While the
usual situation in clinical decision making is a therapeutic decision of a doctor based
on an indication and an agreement to this therapy in the form of an informed consent
by a patient this model mainly supports the right of a patient to refuse a treatment.
This right is broadly discussed, legally secured and usually accepted by doctors but
what about a situation where a patient wishes for a special treatment? Alt-Apping
and Nauck discuss an example of divergent perspectives on risk and chances of a
cancer treatment by doctor and patient and analyse different options how to inte-
grate a patient's wish into medical decision making. The authors stress the point
that even principles like beneficience and non-maleficience rely on subjective mea-
sures or criteria such as the individual therapeutic aim of a patient (or a doctor) [1,
p. 21]. Terms like life quality, compliance, chances or risk show how the evalua-
tion of the outcome of a treatment is based on subjective factors that may vary from
patient to patient but also from doctor to doctor. While some patients and doctors
may think that a 23% chance of curing is a good chance other patients might want
to avoid side effects with regard to higher life quality instead. Empirical evidence
shows that the assessment not only varies between patients but that patients change
their mind during treatment as well [5]. The authors conclude that by taking the
personal risk assessment of a patient seriously and thus understanding his or her
approach to a special therapy can lead to a re-evaluation of the medical indication.
The three different examples of patients show how different patients want to get
involved within medical decision making. All three lead to different decision sit-
uations and different forms of communication. Processing medical information is
only one part of this decision making process that needs to be adapted to a patient's
individual needs for information and involvement.
5.6
Conclusion
Decision making processes in medicine are a shared process between doctors and
patients. Due to reasons of responsibility the participants cannot easily be replaced
by machines, algorithms or even proxies. The question of trust and responsibility
