In the instance of organ allocation, doctors are forced to make life altering decisions based on knowledge that is presented to them. They have to decide if a patient is getting the organ for all the right reasons, Should the doctor’s faith and intuition play a role in their decisions? Or should doctors make decisions solely on reason and without emotions? Analyzing this situation presents us with the question of “In what ways should professional judgements require accepting conclusions that go beyond the evidence presented?”
For doctors to produce the knowledge that a patient needs a new organ, theoretically they should only be looking at the facts about the patient and the requirements the patient must possess in order to be placed on the waiting list. But, doctors can also alter the patients course of care if it meant a higher spot on the waiting list. Certain medications and treatments can drastically improve a patient’s chance of getting an organ and this is where the doctor must make a professional judgement based on the factual evidence that is placed before them and the emotional factors in the case. They have to accept the conclusion that the patient might not need the organ as urgently as the doctor’s emotions want them to.
Being a doctor is a very emotional profession and people everyday are placing their life in doctor’s hands. Are emotions important in professional judgements or should they be completely disregarded? According to renowned neurologist Antonio Damasio, emotions are very important in decision making and in order to make a proper decision emotions must be involved. He uses his somatic marker hypothesis to explain. “When individuals are faced with complex decisions, their cognitive processes become too overwhelmed, and emotional processes take over to guide their behavior.” Doctors will often make decisions based on what “feels right.”
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Some would argue that a profession in medicine should not include judgements based on emotions and all decisions should just be by the book. It is easy to see that emotions can alter your sense of reason and bring you to make the wrong decision. Even though the patient’s health is deteriorating, they should trust the organ allocation system and not decrease another patient’s odds of getting an organ just because they are emotionally invested into the case.
The ways of knowing play a major role in professional judgements and the ethics behind them. There are many different layers to the production of knowledge and you have to go deeper than the evidence that is provided in order to make the proper decision. The doctors use language in their initial evaluations of the patient when they listen to what their symptoms are and how they are feeling. The doctors then use sense perception, logic, intuition, and memory in order to reach a diagnosis. The doctors then use language and emotion to tell the patients what is wrong with them. This whole process can be a very emotional one and sometimes doctor’s let their emotions get the best of them.
In a survey conducted by Dr. Joana Vilela de Silva, it was found that “Fifty-two physicians (43.0%) reported experiencing intense emotions frequently. Although most physicians (88.6%) tried to control their reactions, several reported not controlling themselves.” In conclusion, she noted that “Experiencing intense emotions in the presence of patients was frequent among physicians, and the type of reaction affected the clinical relationship. Because many physicians reported experiencing long-lasting emotions, these may have important clinical implications for patients visiting physicians while these emotions last. Further studies are needed to clarify these results.” One of the goals of this survey was to evaluate the impact of the emotional reactions on the physician- patient relationship. Dr. Vilela de Silva also noted that “This study took a first step in the inspection of what happens when physicians experience strong emotions while seeing patients, and further research is needed for a better understanding of the results.”
It can also be argued that especially in the medical field, that these emotional relationships are necessary so that the patient feels as comfortable as they can. For example. If the doctor is too emotionless and becomes unpersonable, the patient might feel closed off and would not open up about embarrassing symptoms that they might have, but that the doctor needs to know. Physician-patient relationships are very fragile and it is important that the patient has a sense of security and trust with them because they are literally putting their lives in their hands.
There has been an increase in the importance of teaching doctors empathy in the workplace and they have even added a section on the MCAT that measures student knowledge on the behavioral, social, and psychological elements of health care. Mohammadreza Hojat, the director of Thomas Jefferson University’s Longitudinal Study of Medical Education says, “While I agree that adding a completely new scale to the MCATs is a very good idea, hopefully it is supported by some changes in medical education emphasizing the art of caring for the patient.” Caring for the patient can be interpreted in different ways and how involved emotions are.
As a counterclaim, it can be argued that the ways of knowing should not play a role in professional judgements at all and in the situation of a medical physician, should solely be based on scientific reason. Physicians see patients of all different backgrounds and certain biases that doctors have towards them might affect how the doctor cares for them. This can be positive and negative.
When certain ways of knowing, like emotion or imagination, are involved in judgements especially within medicine, where the stakes are so high, the wrong decision can be made. For example, in the instance of organ allocation, emotions can sway the doctor’s decisions about course of treatment. If he or she gets too emotionally involved with the patient, they will get too attached and go beyond the means that are ethical in order to ensure them a top spot on the waiting list.
This creates major dilemmas in the medical world. If one patient is moved higher on the list, that has to mean that one is dropped and that doctor has just created a flaw in a system that essentially decides who lives or dies. In this example, if the doctor had not become emotionally involved in the decision making, it would have remained ethical and the waitlist would have gone through the process in which it was created.
A good representation of how the production of knowledge requires accepting conclusions that go beyond the evidence for them is found in a patient-physician relationship, one where emotions are heavily involved and the ways of knowing help answer those questions.
