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Article Evaluation

Article title: Decision Theory

Content Evaluation

The content on the Wikipedia page titled "Decision Theory" is entirely relevant to the topic of decision theory. There was nothing within this article that really distracted me. There is some information that seems out of date. The article drew some information from sources that are from the 1950s-60s, but given that other information on the page is from 2017, its possible that the older information is still standing and relevant. The article does not seem to be missing any information pertaining to the topic. One aspect that could be improved is its topic transitions which at times seem a little random. It could also add more information to the rest of the "Types of Decisions" section.

Tone Evaluation

Overall, the tone of the article seems neutral, with no wording favoring any of the theories that were discussed. Therefore, there does not seem to be any heavy bias towards any positions in this article. The ideas represented are the ones that the article are supposed to cover. There is one instance however, in the "Types of Decisions" section which may be over-representing one of the types titled "Choices Under Uncertainty" over the others mentioned which contain much less information. Besides that, the rest of the ideas are pretty evenly distributed.

Source Evaluation

After reviewing a few of the sources, the information used for the article does appear to be accurate and generally reliable. The claims made by the article are in alignment with those of the sources it draws its information from.

Talk Section

A majority of the topics on the talk section are discussions relating to the distinctions between some theories as well as their groupings within the article presentation. It is rated C-class and is of interest to 7 Wikiprojects

Autonomy Page

Medical Section

In a medical context, respect for a patient's personal autonomy is considered one of many fundamental ethical principles in medicine. Autonomy can be defined as the ability of the person to make his or her own decisions. This faith in autonomy is the central premise of the concept of informed consent and shared decision making. This idea, while considered essential to today's practice of medicine, was developed in the last 50 years. According to Tom Beauchamp and James Childress (in Principles of Biomedical Ethics), the Nuremberg trials detailed accounts of horrifyingly exploitative medical "experiments" which violated the subjects' physical integrity and personal autonomy. These incidences prompted calls for safeguards in medical research, such as the Nuremberg Code which stressed the importance of voluntary participation in medical research. It is believed that the Nuremberg Code served as the premise for many current documents regarding research ethics.

Respect for autonomy became incorporated in health care and patients could be allowed to make personal decisions about the health care services that they receive. Notably, autonomy has several aspects as well as challenges that affect health care operations. The manner in which a patient is handled may undermine or support the autonomy of a patient and for this reason, the way a patient is communicated to becomes very crucial. A good relationship between a patient and a health care practitioner needs to be well defined to ensure that autonomy of a patient is respected. Just like in any other life situation, a patient would not like to be under the control of another person. The move to emphasize respect for patient's autonomy rose from the vulnerabilities that were pointed out in regards to autonomy.

However, autonomy does not only apply in a research context. Users of the health care system have the right to be treated with respect for their autonomy, instead of being dominated by the physician. This is referred to as paternalism. While paternalism is meant to be overall good for the patient, this can very easily interfere with autonomy. Through the therapeutic relationship, a thoughtful dialogue between the client and the physician may lead to better outcomes for the client, as he or she is more of a participant in decision-making.

There are many different definitions of autonomy, many of which place the individual in a social context. See also: relational autonomy, which suggests that a person is defined through their relationships with others, and "supported autonomy" which suggests that in specific circumstances it may be necessary to temporarily compromise the autonomy of the person in the short term in order to preserve their autonomy in the long-term. Other definitions of the autonomy imagine the person as a contained and self-sufficient being whose rights should not be compromised under any circumstance.

There are also differing views with regard to whether modern health care systems should be shifting to greater patient autonomy or a more paternalistic approach. For example, there are such arguments that suggest the current patient autonomy practiced is plagued by flaws such as misconceptions of treatment and cultural differences, and that health care systems should be shifting to greater paternalism on the part of the physician given their expertise. On the other hand, other approaches suggest that there simply needs to be an increase in relational understanding between patients and health practitioners to improve patient autonomy.

One argument in favor of greater patient autonomy and its benefits is by Dave deBronkart, who believes that in the technological advancement age, patients are capable of doing a lot of their research on medical issues from their home. According to deBronkart, this helps to promote better discussions between patients and physicians during hospital visits, ultimately easing up the workload of physicians. deBronkart argues that this leads to greater patient empowerment and a more educative health care system. In opposition to this view, technological advancements can sometimes be viewed as an unfavorable way of promoting patient autonomy. For example, self-testing medical procedures which have become increasingly common are argued by Greaney et. al. to increase patient autonomy, however, may not be promoting what is best for the patient. In this argument, contrary to deBronkart, the current perceptions of patient autonomy are excessively over-selling the benefits of individual autonomy, and is not the most suitable way to go about treating patients. Instead, a more inclusive form of autonomy should be implemented, relational autonomy, which factors into consideration those close to the patient as well as the physician. These different concepts of autonomy can be troublesome as the acting physician is faced with deciding which concept he/she will implement into their clinical practice.

Autonomy varies and some patients find it overwhelming especially the minors when faced with emergency situations. It is important to note that not every patient is capable of making an autonomous decision. Those who are unable to make the decisions prompt a challenge to medical practitioners since it becomes difficult to determine the ability of a patient to make a decision. To some extent, it has been said that emphasis of autonomy in health care has undermined the practice of health care practitioners to improve the health of their patient as necessary. The scenario has led to tension in the relationship between a patient and a health care practitioner. This is because as much as a physician want to prevent a patient from suffering, he or she still has to respect autonomy. Beneficence allows physicians to act responsibly in their practice, which may involve overlooking autonomy. The gap between a patient and a physician has led to problems because in other cases, the patients have complained of not being adequately informed.

The seven elements of informed consent (as defined by Beauchamp and Childress) include threshold elements (competence and voluntariness), information elements (disclosure, recommendation, and understanding) and consent elements (decision and authorization). Some philosophers such as Harry Frankfurt consider Beauchamp and Childress criteria insufficient. They claim that an action can only be considered autonomous if it involves the exercise of the capacity to form higher-order values about desires when acting intentionally. What this means is that patients may understand their situation and choices but would not be autonomous unless the patient is able to form value judgements about their reasons for choosing treatment options they would not be acting autonomously.

In certain unique circumstances, government may have the right to temporarily override the right to bodily integrity in order to preserve the life and well-being of the person. Such action can be described using the principle of "supported autonomy", a concept that was developed to describe unique situations in mental health (examples include the forced feeding of a person dying from the eating disorder anorexia nervosa, or the temporary treatment of a person living with a psychotic disorder with antipsychotic medication). While controversial, the principle of supported autonomy aligns with the role of government to protect the life and liberty of its citizens. Terrence F. Ackerman has highlighted problems with these situations, he claims that by undertaking this course of action physician or governments run the risk of misinterpreting a conflict of values as a constraining effect of illness on a patient's autonomy.

Since the 1960s, there have been attempts to increase patient autonomy including the requirement that physician's take bioethics courses during their time in medical school. Despite large-scale commitment to promoting patient autonomy, public mistrust of medicine in developed countries has remained. Onora O'Neill has ascribed this lack of trust to medical institutions and professionals introducing measures that benefit themselves, not the patient. O'Neill claims that this focus on autonomy promotion has been at the expense of issues like distribution of healthcare resources and public health. One proposal to increase patient autonomy is through the use of support staff. The use of support staff including medical assistants, physician assistants, nurse practitioners, nurses, and other staff that can promote patient interests and better patient care. Nurses especially can learn about patient beliefs and values in order to increase informed consent and possibly persuade the patient through logic and reason to entertain a certain treatment plan. This would promote both autonomy and beneficence, while keeping the physician's integrity intact. Furthermore, Humphreys asserts that nurses should have professional autonomy within their scope of practice (35-37). Humphreys argues that if nurses exercise their professional autonomy more, then there will be an increase patient autonomy (35-37).

Drafting my Section

Adding this to medical section:

In addition to autonomy varying on a patient basis, there are many different views with regard to whether modern health care systems should be shifting to greater patient autonomy or a more paternalistic approach. For example, there are such arguments that suggest the current patient autonomy practiced is plagued by flaws such as misconceptions of treatment and cultural differences, and that health care systems should be shifting to more paternalism on the part of the physician given their expertise. On the other hand, other approaches suggest that there simply needs to be an increase in relational understanding between patients and health practitioners to improve patient autonomy.

One argument in favor of greater patient autonomy and its benefits is by Dave deBronkart, who believes that in the technological advancement age, patients are capable of doing a lot of their research on medical issues from their home. According to deBronkart, this helps to promote better discussions between patients and physicians during hospital visits, ultimately easing up the workload of physicians. deBronkart argues that this leads to greater patient empowerment and a more educative health care system. In opposition to this view, technological advancements can sometimes be viewed as an unfavorable way of promoting patient autonomy. For example, self-testing medical procedures which have become increasingly common are argued by Greaney et. al. to increase patient autonomy, however, may not be promoting what is best for the patient. In this argument, contrary to deBronkart, the current perceptions of patient autonomy are excessively over-selling the benefits of individual autonomy, and is not the most suitable way to go about treating patients. Instead, a more inclusive form of autonomy should be implemented, relational autonomy, which factors into consideration those close to the patient as well as the physician. These different concepts of autonomy can be troublesome as the acting physician is faced with deciding which concept he/she will implement into their clinical practice.

There are also arguments with regard to who should have autonomy. For example, a commonly proposed question is at what age children should be partaking in treatment decisions. This question arises as children develop differently, therefore making it difficult to establish a standard age at which children should become more autonomous.

Issues also arise in emergency room situations where there may not be time to consider the principle of patient autonomy. Various ethical challenges are faced in the emergency room when time is critical, and patient consciousness may be limited. However, in such settings where informed consent may be compromised, the working physician evaluates each individual case to make the most professional and ethically sound decision. For example, it is believed that neurosurgeons in such situations, should generally do everything they can to respect patient autonomy. In the situation in which a patient is unable to make an autonomous decision, the neurosurgeon should discuss with the surrogate decision maker in order to aid in the decision making process. Performing surgery on a patient without informed consent is in general thought to only be ethically justified when the neurosurgeon and his/her team render the patient to not have the capacity to make autonomous decisions. If the patient is capable of making an autonomous decision, these situations are generally less ethically strenuous as the decision is typically respected.