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The Patient Who Changes His Mind

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Behavioral Economics and Bioethics

Part of the book series: Palgrave Advances in Behavioral Economics ((PABE))

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Abstract

Bioethics should adopt the more nuanced view of rationality from behavioral economics. Most of us are conscious and capable of making decisions, but we are not consistently rational about all the issues all the time in all phases of life. And it is not to be taken for granted that we like to make decisions, whatever they are and whatever their consequences are. In this chapter, I make a case for bringing behavioral economics to bear on bioethics, so we have a bioethics that recognizes bounded rationality. I believe that such a “behavioral bioethics” will benefit both physicians and patients by bringing them together.

This chapter is adapted from Lee (2011).

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Notes

  1. 1.

    Veatch (2003, p. 105) says that mentally incompetent patients put bioethics in a state of “moral chaos.”

  2. 2.

    A large literature loosely known as “behavioral ethics” (Trevino et al. 2006) explains how people come to behave more or less ethically.

  3. 3.

    In 1900, the average life expectancy of Americans was 47 years, while today it stands at nearly 78 years (Heron et al. 2009). This is an amazing change in 100 years, when Homo sapiens are said to have roamed the Earth for at least 100,000 years before this century. Another reason is that all phases of life, young and old, are getting longer. The President’s Council on Bioethics puts it this way (2005, pp. 6–7, emphasis theirs): “The defining characteristic of our time seems to be that we are both younger longer and older longer….” The later life is most dramatically prolonged. Those who have lived to be 65 years old can expect to live to be 83.5 years old on average. And those who have lived to be 85 years old can expect to live to be 91.4 years old.

  4. 4.

    Philosophers are interested in two-self models as well. See, for example, Parfit (1984), Daniels (1988), Buchanan and Brock (1989), and Dresser and Robertson (1989).

  5. 5.

    Mrs. Natanson lived well into the sixties and died of cancer of an unknown origin (Breast Cancer Action, Newsletter 83, Fall 2004).

  6. 6.

    For the purposes of this chapter, an advance directive and a living will are interchangeable terms. Technically, an advance directive consists of two parts: a living will and a healthcare proxy.

  7. 7.

    Suspicion that one self can exploit the other underlies laws against suicide. A young self who commits suicide effectively prevents the old self from coming into existence.

  8. 8.

    Posner (1995, pp. 259–260) and Veatch (2003, p. 106) suggest that “the principle of autonomy extended” can be applied to a person who was previously competent but has fallen into a permanent vegetative state. A vegetative state is presumably inert, while a demented state—merely mysterious—is not inert.

  9. 9.

    See Veatch et al. (2010) for case studies.

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Authors and Affiliations

  1. Wayne State University, Detroit, MI, USA

    Li Way Lee

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  1. Li Way Lee
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Correspondence to Li Way Lee .

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Lee, L.W. (2018). The Patient Who Changes His Mind. In: Behavioral Economics and Bioethics. Palgrave Advances in Behavioral Economics. Palgrave Pivot, Cham. https://doi.org/10.1007/978-3-319-89779-0_2

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