Understanding Medical Decision Making

To establish a medical indication is regarded as a genuine task of physicians. However, in recent years, new developments in patients rights, greater awareness of the autonomy of the patients, and discussions on economic resources of the health care system and on the amplification of aims of modern medicine have contributed to a new discussion on the criteria for good medical decision making. As F. Anschütz put it, the process of reflection that accompanies the act of establishing a medical indication is the only (and genuine) place where ethical considerations regarding the good for the patient enter the professional routine of the physician. This project sheds new light on medical indication. It provides an analysis of the process of establishing a medical indication from the point of view of hermeneutical theological ethics, by delineating comparable components, e.g. its interdisciplinary methods (combining knowledge of facts about persons and scientific knowledge as well as professional standards and moral principles), its orientation towards the aim of a fruitful intervention, and its inter- personal dimension of the decision that includes the relationship to the persons affected by the action. These central components qualify the establishment of a medical indication as a value-driven decision-making process. Values like pursuing health or maintaining quality of life of a concrete person and the weighing up of possible benefit and harm that accompanies the process, as well as moral principles as the dignity and autonomy of the person that enter the decision, allow interpreting medical indication as an act of ethical decision making. Both ethical research and medical practice can benefit from the results of this project. Because of the detailed practical applications and far-reaching consequences of medical indication, ethical research can learn to understand more deeply the opportunities and personal challenges of such decisions. On the contrary, medical practice can profit from understanding the interdisciplinary, inter-personal and moral challenges of this central task of physicians, in order to create awareness of the rationale and improve the ethical sustainability of such decisions. This project can draw on the works of F. Anschütz and K. Gahl who have prepared the grounds for understanding ethical dimensions of medical indication. With respect to theological ethical analysis, the works of K. Demmer and D. Mieth will provide the framework of analysis because they provide tools to combine interdisciplinary, philosophical and religious or meaning-oriented reflection that plays an important role especially in situations of severe illness. In addition, the work of H. Bouillard will be used to analyze especially the possibility of reaching a consensual definition of aims of treatment in the interaction between physician and patient.