Beneficent Persuasion: Techniques and Ethical Guidelines to Improve Patients’ Decisions

J. S. Swindell; Amy L. McGuire; Scott D. Halpern

doi:10.1370/afm.1118

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Health Care Reform-- a radical change
Dyck Dewid

Published on: 20 May 2010
Beneficent Persuasion or Beneficent Coersion?
Laura Weil

Published on: 18 May 2010

Published on: (20 May 2010)
Page navigation anchor for Health Care Reform-- a radical change
Health Care Reform-- a radical change
Dyck Dewid, Wake Forest, USA
Your article interests me from the standpoint of Health Care Reform and it's complex milieu and catastrophe. I assume for the moment that accessibility and costs to treat and prevent disease & injury in the US is unsustainable.
If this is true change will eventually ensue and it will not likely be orderly nor comfortable.
I bring into question the premise of the American patient... what we want...
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Your article interests me from the standpoint of Health Care Reform and it's complex milieu and catastrophe. I assume for the moment that accessibility and costs to treat and prevent disease & injury in the US is unsustainable.
If this is true change will eventually ensue and it will not likely be orderly nor comfortable.
I bring into question the premise of the American patient... what we want when we need help with our discomfort/dis-ease and turn to the medical community, and affecting our decisions.
Among our needs are: Relief of pain. Resumption of activities. Stem loss of wages or missed commitments. Stem loss of image, strength, dexterity, competitiveness, self esteem, etc..
So, my hypothesis is this drives patient demands, and hence medical professional response. Thus begins pressure for instantaneous relief of pain, restriction, or limitations which interfere with everyday life. And interventions take this into account. For example prescribing drugs for self-limiting ailments, or drugs to mask or ease symptoms until the body heals itself. There is also the circumstance of drugs that relieve symptoms so that an exacerbating lifestyle may be continued. An example is prescribing Nexium to relieve what dietary changes might resolve.
I am tentative about my knowledge and value more the 'good question'. As a layman I've researched health related issues deeper than most. My energy is related to complex family circumstances and imposed limitations by conventional and paternal thinking of government and medical professionals.
Within this I begin to offer an exploration to look for ways to change our behaviors as a society. Your work in Beneficent Behaviors suggests possibilities for change on a grand scale that is humble, ethical, and sensible dealing with what is real and practical.
A somewhat limited but passionate start, is my proposal 5 Steps to Health Care Reform (see esp step 3) http://bit.ly/9wmOLT
ps, I have some insight & experience in what the mind does versus what the body knowledge does. The two most often being exclusive, desperate, and conflicting. This 'tentative knowing' would seem to impinge on your hypothesis of decision making based in 'knowing' in the mind alone.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (18 May 2010)
Page navigation anchor for Beneficent Persuasion or Beneficent Coersion?
Beneficent Persuasion or Beneficent Coersion?
Laura Weil, Bronxville, NY
Interesting discussion of strategies clinicians might use to help their patients make reasoned health care decisions.
What's disturbing, however, is that the idea of how physicians' biases might factor into these conversations is not addressed until the last section. It's essential that everyone in the mix acknowledge the inevitability of personal bias - it's certainly not just on the patient side. The use of...
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Interesting discussion of strategies clinicians might use to help their patients make reasoned health care decisions.
What's disturbing, however, is that the idea of how physicians' biases might factor into these conversations is not addressed until the last section. It's essential that everyone in the mix acknowledge the inevitability of personal bias - it's certainly not just on the patient side. The use of aversive statements or information, while perhaps effective in focusing patients on the dangers of foregoing routine diagnostic procedures or vaccinations, can also be used in a less beneficent manner, especially at the end of life. For instance, family members or surrogates of a patient with advanced dementia and difficulty swallowing may make the difficult decision to reject artificial nutrition for their loved one - on the basis of "best interests," their knowledge of the firmly held values and preferences of the patient. So often these decisions are met with a shocked "Do you want her to starve to death?" from health care providers. This would be an example of beneficent persuasion, influenced by provider bias, gone terribly wrong.
Competing interests: None declared
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Competing Interests: None declared.