Prudence in Shared Decision-Making: The Missing Link between the "Technically Correct" and the "Morally Good" in Medical Decision-Making

Bayesian learning-based agent negotiation model to support doctor-patient shared decision making

BACKGROUND

Agent negotiation is widely used in e-commerce negotiation, cloud service service-level agreements, and power transactions. However, few studies have adapted alternative negotiation models to negotiation processes between healthcare professionals and patients due to the fuzziness, ethics, and importance of medical decision making.

METHOD

We propose a Bayesian learning based bilateral fuzzy constraint agent negotiation model (BLFCAN). It support mutually beneficial agreement on treatment between doctors and patients. The proposed model expresses the imprecise preferences and behaviors of doctors and patients through fuzzy constrained agents. To improve negotiation efficiency and social welfare, the Bayesian learning method is adopted in the proposed model to predict the opponent's preference.

RESULTS

The proposed model achieves 55.4% to 64.2% satisfaction for doctors and 69-74.5% satisfaction for patients in terms of individual satisfaction. In addition, the proposed BLFCAN can increase overall satisfaction by 26.5-29% in fewer rounds, and it can alter the negotiation strategy in a flexible manner for various negotiation scenarios.

CONCLUSIONS

BLFCAN reduces communication time and cost, helps avoid potential conflicts, and reduces the impact of emotions and biases on decision-making. In addition, the BLFCAN model improves the agreement satisfaction of both parties and the total social welfare.

Life-Saving Cancer Care

What, precisely, are we seeking to achieve in offering 'life-saving' treatment to patients with cancer? Research funding agencies and pharmaceutical industry media releases, and government cancer screening programs all promise that their cancer programs save lives. But everybody dies. The nature of life and death from cancer is explored philosophically in this essay, with particular reference to the quality of life, and its meaning, during the period of prolongation of survival by 'life-saving' cancer care.

Ignorance is Not Bliss: The Case for Comprehensive Reproductive Counseling for Women with Chronic Kidney Disease

The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population.

Responsible Radionuclide Cancer Care

The landscape of nuclear oncology is rapidly changing. The advent of molecular radionuclide theranostics, multidisciplinary tumor board decision making, artificial intelligence and radiomics interpretation of diagnostic imaging, evolution of pharmacogenomics prediction of tumor response, and regulatory requirements for prospective individual dosimetry are just some of the elements which are broadening the essence of physician responsibility. The burgeoning knowledge base essential for mastering the emergent technologies, and their profound effect on moral philosophic aspects of provision of cancer care, are challenging. The new relationship of the theranostic nuclear physician with respect to shared care of the individual patient, particularly with regard to transparency, accountability, and responsibility for targeted radionuclide diagnosis and therapy of cancer, will be explored in this update.

The Importance of Clear and Careful Thinking in Clinical Ethics

Clear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.