Prognostication and bioethics

Daedalus

Volumn 128, Issue 4, 1999, Pages 197-214

  Christakis, Nicholas A ^a  

^a UNIVERSITY OF CHICAGO   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANALYTICAL APPROACH; ARTICLE; ATTITUDE; ATTITUDE TO DEATH; ATTITUDE TO HEALTH; BIOETHICS; BIOETHICS AND PROFESSIONAL ETHICS; DECISION MAKING; DOCTOR PATIENT RELATION; EMOTION; GENETIC COUNSELING; HEALTH CARE ORGANIZATION; HUMAN; INFORMED CONSENT; INTERPERSONAL COMMUNICATION; LIVING WILL; MEDICAL ETHICS; MENTAL STRESS; MORALITY; PATIENT CARE; PHYSICIAN; PHYSICIAN ATTITUDE; PROBABILITY; PROFESSIONAL COMPETENCE; PROFESSIONAL PATIENT RELATIONSHIP; PROGNOSIS; PSYCHOLOGY; RESOURCE ALLOCATION; SOCIAL BEHAVIOR; SOCIOLOGY; TERMINAL CARE; TREATMENT OUTCOME; UNCERTAINTY;

ANALYTICAL APPROACH; BIOETHICS AND PROFESSIONAL ETHICS; PROFESSIONAL PATIENT RELATIONSHIP;

ADVANCE DIRECTIVES; ATTITUDE; ATTITUDE TO DEATH; BIOETHICS; COMMUNICATION; DECISION MAKING; DISCLOSURE; EMOTIONS; ETHICS, CLINICAL; ETHICS, MEDICAL; GENETIC COUNSELING; HEALTH CARE RATIONING; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HUMANS; INFORMED CONSENT; MEDICAL FUTILITY; MORAL OBLIGATIONS; PATIENT CARE; PHYSICIAN'S ROLE; PHYSICIAN-PATIENT RELATIONS; PHYSICIANS; PROBABILITY; PROFESSIONAL COMPETENCE; PROGNOSIS; PSYCHOLOGY; RESOURCE ALLOCATION; SOCIAL RESPONSIBILITY; SOCIAL SCIENCES; SOCIOLOGY, MEDICAL; STRESS, PSYCHOLOGICAL; TERMINAL CARE; TREATMENT OUTCOME; TRUTH DISCLOSURE; UNCERTAINTY;

EID: 0033185846     PISSN: 00115266     EISSN: 15486192     Source Type: Journal    
DOI: None     Document Type: Article

References (50)

1. Noteworthy examples of such work include: Renée R. Anspach, Deciding Who Lives: Fateful Choices in the Intensive-Care Nursery (Berkeley: University of California Press, 1993);
2. Charles L. Bosk, "All God's Mistakes": Genetic Counseling in a Pediatric Hospital (Chicago: University of Chicago Press, 1992);
3. Renée C. Fox, Experiment Perilous (Boston: The Free Press, 1959);
4. Renée C. Fox and Judith P. Swazey, The Courage to Fail: A Social View of Organ Transplants and Dialysis, 2d ed., rev. (Chicago: University of Chicago Press, 1978);
5. Jonathan B. Imber, Abortion and the Private Practice of Medicine (New Haven, Conn.: Yale University Press, 1986);
6. Robert Zussman, Intensive Care: Medical Ethics and the Medical Profession (Chicago: University of Chicago Press, 1992).
7. Nicholas A. Christakis, Death Foretold: Prophecy and Prognosis in Medical Care (Chicago: University of Chicago Press, 1999).
8. Nicholas A. Christakis, Death Foretold: Prophecy and Prognosis in Medical Care Ibid., 90ff.
9. See also Jean S. Kutner et al., "Information Needs in Terminal Illness," Social Science and Medicine 48 (1999): 1341-1352.
10. Robert K. Merton and Elinor Barber, "Sociological Ambivalence," in Robert K. Merton, Sociological Ambivalence and Other Essays (New York: The Free Press, 1976), 8.
11. Christakis, Death Foretold.
12. See also Nicholas A. Christakis and Theodore J. Iwashyna, "Attitude and Self-Reported Practice Regarding Prognostication in a National Sample of Internists," Archives of Internal Medicine 158 (1998): 2389-2395.
13. See, for example, Lesley F. Degner et al., "Information Needs and Decisional Preferences in Women with Breast Cancer," Journal of the American Medical Association 277 (1997): 1485-1492;
14. Christina G. Blanchard et al., "Information and Decision-Making Preferences of Hospitalized Adult Cancer Patients," Social Science and Medicine 27 (1988): 1139-1145.
15. Nicholas A. Christakis, "The Ellipsis of Prognosis in Modern Medical Thought," Social Science and Medicine 44 (1997): 301-315.
16. Christakis, Death Foretold, 135-162.
17. As social theorist Talcott Parsons has argued: "The health situation is a classic one of the combination of uncertainty and strong emotional interests which produce a situation of strain and is very frequently a prominent focus of magic. But the fact that the basic cultural tradition of modern medicine is science precludes outright magic, which is explicitly non-scientific." See Talcott Parsons, The Social System (New York: The Free Press, 1951), 469. This type of magical thinking about prediction is in keeping with other forms of "scientific magic" seen in medicine.
18. See Renée C. Fox, "The Human Condition of Health Professionals," in Renée C. Fox, ed., Essays in Medical Sociology: Journeys into the Field (New Brunswick, N.J.: Transaction Books, 1988), 581
19. Renée C. Fox, The Sociology of Medicine (Englewood Cliffs, N.J.: Prentice Hall, 1989), 198.
20. Robert K. Merton, "The Self-Fulfilling Prophecy," in Robert K. Merton, Social Theory and Social Structure (New York: The Free Press, 1968), 475-490.
21. See also Robert K. Merton, "The Thomas Theorem and the Matthew Effect," Social Forces 74 (1995): 379-422.
22. For a broader consideration of the self-fulfilling prophecy, see Richard L. Henshel, "The Boundary of the Self-Fulfilling Prophecy and the Dilemma of Social Prediction," The British Journal of Sociology 33 (1982): 511-528.
23. Regarding the issue of the purposefulness of social systems more generally, see Karl Popper, The Open Universe: An Argument for Indeterminism (London: Routledge, 1982).
24. For example, one study found that, by one measure, 73 percent of physicians believed in positive and 61 percent in negative self-fulfilling prophecy. These beliefs were relatively homogeneously distributed among physicians. See Christakis, Death Foretold, 225.
25. Christakis, Death Foretold, 144-150. By "quasi-magical" I mean that the effectiveness of prediction depends partly on rational, explainable mechanisms and also simultaneously on nonrational, inexplicable mechanisms.
26. Marcel Mauss, A General Theory of Magic, trans. Robert Brain (New York: Norton, 1972).
27. See also Stanley J. Reiser, "Words as Scalpels: Transmitting Evidence in the Clinical Dialogue," Annals of Internal Medicine 92 (1980): 837-842.
28. This term was first used by Bronislaw Malinowski. See Bronislaw Malinowski, Magic, Science and Religion (Boston: Beacon Press, 1948), 70. It has been previously applied to medicine by Talcott Parsons and Renée Fox.
29. Margaret A. Drickamer, Melinda A. Lee, and Linda Ganzini, "Practical Issues in Physician-Assisted Suicide," Annals of Internal Medicine 126 (1997): 146-151;
30. Melinda A. Lee et al., "Legalizing Assisted Suicide - Views of Physicians in Oregon," New England Journal of Medicine 334 (1996): 310-315.
31. Nancy S. Jecker and Lawrence J. Schneiderman, "Medical Futility: The Duty Not to Treat," Cambridge Quarterly Healthcare Ethics 2 (1993): 151-159;
32. Lawrence J. Schneiderman and Nancy S. Jecker, "Futility in Practice," Archives of Internal Medicine 153 (1993): 437-441.
33. Ben A. Rich, "Prospective Autonomy and Critical Interests: A Narrative Defense of the Moral Authority of Advance Directives," Cambridge Quarterly of Healthcare Ethics 6 (1997): 138-147;
34. Steven H. Miles, Robert Koepp, and Eileen P. Weber, "Advance End-of-Life Treatment Planning: A Research Review," Archives of Internal Medicine 156 (1996): 1062-1068;
35. Lawrence J. Schneiderman et al., "Effects of Offering Advance Directives on Medical Treatments and Costs," Annals of Internal Medicine 117 (1992): 599-606.
36. James A. Tulsky et al., "Opening the Black Box: How Do Physicians Communicate about Advance Directives?" Annals of Internal Medicine 129 (1998): 441-449.
37. Ruth R. Faden and Tom L. Beauchamp, A History and Theory of Informed Consent (New York: Oxford University Press, 1986).
38. See, for elaboration, Nicholas A. Christakis, "Ethics Are Local: Engaging Cross-Cultural Variation in the Ethics for Clinical Research," Social Science and Medicine 35 (1992): 1079-1091.
39. Christakis, Death Foretold, 179-199.
40. See Daniel Callahan, The Troubled Dream of Life: In Search of a Peaceful Death (New York: Simon and Schuster, 1993)
41. Arthur Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition (New York: Basic Books, 1988).
42. A corollary of the asymmetry in power between patient and physician is that prognostication is open to venal manipulation by the physician for self-serving ends; it requires vigilance on the part of the doctor to avoid this.
43. See, for example, Nicholas A. Christakis and Elizabeth B. Lamont, "The Extent and Determinants of Error in Physicians' Prognoses in Terminally Ill Patients: A Prospective Cohort Study," British Medical Journal (in press);
44. Elizabeth B. Lamont and Nicholas A. Christakis, "Physicians' Preferences for Prognostic Disclosure to Terminally Ill Cancer Patients," unpublished manuscript.
45. For illustrative reviews, see Nicholas A. Christakis and Greg A. Sachs, "The Role of Prognosis in Clinical Decision Making," Journal of General Internal Medicine 11 (1996): 422-425;
46. James F. Fries and George B. Ehrlich, Prognosis: Contemporary Outcomes of Disease (Bowie, Md.: Charles Press, 1981);
47. Charles M. Wattts and William A. Knaus, "The Case for Using Objective Scoring Systems to Predict Intensive Care Unit Outcome, Critical Care Clinics 10 (1994): 73-89;
48. Michael Seneff and William A. Knaus, "Predicting Patient Outcome from Intensive Care: A Guide to APACHE, MPM, SAPS, PRISM, and Other Prognostic Scoring Systems," Journal of Intensive Care Medicine 5 (1990): 33-52.
49. See, for example, Robert Buckman, How to Break Bad News: A Guide for Health Care Professionals (Baltimore, Md.: Johns Hopkins University Press, 1992).
50. Alvan R. Feinstein, "An Additional Basic Science for Clinical Medicine I: The Constraining Fundamental Paradigms," Annals of Internal Medicine 99 (1983): 394.