PubMed · 11271879
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K Steven. 2001. Shared decision-making.. https://pubmed.ncbi.nlm.nih.gov/11271879/
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The moral dilemmas faced by surgeons worldwide who treat patients infected with the human immunodeficiency virus (HIV) can be viewed against the background of experience in sub-Saharan countries, where the community prevalence is in excess of 25% (90% of hospital inpatients). When seeking consent for an HIV test before surgery, frank communication regarding the surgeons' perspective of risks to themselves and the patient is helpful. When consent for a test must be obtained from a substitute decision-maker, the surgeon should consider if the patient would want the decision-maker to know the result. Understanding the natural history of HIV in the surgical setting can help deal with the uncertainties encountered and should be a research priority for developing countries. International professional organizations are useful platforms for the exchange of ideas when surgeons encounter uncertainty by increasing access to journals and creating opportunities for discussion. Although supervisory bodies in some parts of the world prevent HIV-infected surgeons from putting patients at risk by offering surgery, the withdrawal of their services in developing countries can cause more harm than good. Surgeons in that position may be entitled to offer surgery but only with full disclosure of the risk of HIV infection to the patient. The decision-making process known as "accountability for reasonableness" allows surgeons to determine fairness, legitimacy, and acceptability when making resource allocation decisions involving patients with HIV.
Reaction times generally follow a simple law economically described by the LATER model, in which a decision signal rises linearly in response to information about a target to a threshold at which a response is initiated, at a rate that varies from trial to trial with a Gaussian distribution. Functionally, LATER may be regarded as an ideal decision mechanism incorporating prior probability, information, and criterion level or urgency; this can be tested quantitatively by seeing whether LATER accurately predicts the effects on latency distributions of manipulating these variables: in this case, information and urgency. We presented subjects with random-dot kinematograms while fixating a central LED. The information content of the display was varied by altering the proportion of the dots moving coherently together either left or right rather than randomly. As soon as subjects detected the direction of coherent movement, they made a saccade in the same direction to one of a pair of LEDs on each side of the fixation target. Subjects responded either carefully, taking time to ensure an accurate judgement, or more hastily and with less regard for accuracy. The distributions of latencies under the different combinations of conditions were found to conform to LATER's predictions. Providing more information or increasing urgency both reduce latency; but they alter the observed distributions in different ways, equivalent to increasing the mean rate of rise on the one hand or reducing the criterion level on the other. Making only simple assumptions about the underlying mechanisms, the observed changes can be accounted for quantitatively.
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