Deciding with Others: Interdependent Decision-Making

Abstract

Over the course of human life, health care decision-making is often interdependent. In this article, we use "interdependence" to refer to patients' engagement of nonclinicians-for example, family members or trusted friends-to reach health care decisions. Interdependence, we suggest, is common for patients in all stages of life, from early childhood to late adulthood. This view contrasts with the common bioethical assumption that medical decisions are either wholly independent or dependent and that independence or dependence is tightly coupled with a person's decision-making capacity. In this article, we array various approaches to decision-making along a continuum of interdependence. An appreciation of this continuum can empower patients and elucidate ethical challenges that arise when people transition between different kinds of interdependence across the life span.

Keywords: assent; capacity; clinical ethics; communication; informed consent; surrogate decision-making.

Figure 1.

The decision-making continuum spans from wholly independent self-directed decision making to wholly dependent surrogate decision making. Patients are not required to make decisions along the frontier, although doing so would let them exercise their full decision-making abilities. Patients might, for instance, delegate a decision to others; for a patient with full capacity, this would move them to the upper left corner – that is, full capacity, other(s) only. The gray area is null.