Respecting Human Autonomy in Critical Care Clinical Decision Support

Monique Hendriks,Francesco Sartor,Martijn C. Willemsen,Jettie Hoonhout

doi:10.3389/fcomp.2021.690576

Abstract

Clinical Decision Support (CDS) aims at helping physicians optimize their decisions. However, as each patient is unique in their characteristics and preferences, it is difficult to define the optimal outcome. Human physicians should retain autonomy over their decisions, to ensure that tradeoffs are made in a way that fits the unique patient. We tend to consider autonomy in the sense of not influencing decision-making. However, as CDS aims to improve decision-making, its very aim is to influence decision-making. We advocate for an alternative notion of autonomy as enabling the physician to make decisions in accordance with their professional goals and values and the goals and values of the patient. This perspective retains the role of autonomy as a gatekeeper for safeguarding other human values, while letting go of the idea that CDS should not influence the physician in any way. Rather than trying to refrain from incorporating human values into CDS, we should instead aim for a value-aware CDS that actively supports the physician in considering tradeoffs in human values. We suggest a conversational AI approach to enable the CDS to become value-aware and the use of story structures to help the user integrate facts and data-driven learnings provided by the CDS with their own value judgements in a natural way.

Highlights

This conceptual analysis article presents a rationale for the investigation of a value-aware Clinical Decision Support (CDS) system in the critical care environment
In line with the work of Verbeek (2017), we have suggested to investigate how rather than trying to refrain from making any value judgements, CDS can play a role in helping the physician to more explicitly consider their professional values as well as the patient’s personal values in their decisionmaking
We advocate for a value-aware CDS that is able to determine through conversational AI which cues, goals and courses of action are in line with what the physician is trying to achieve and to adapt its interaction with the physician to the values of the physician, patient and society

Summary

Introduction

This conceptual analysis article presents a rationale for the investigation of a value-aware Clinical Decision Support (CDS) system in the critical care environment. We argue that in order to respect autonomy, rather than refraining from making any value judgements, CDS in the critical care environment should support the critical care team to make decisions in line with their professional values and the personal values of the patient. In the psychology of human judgement and decision-making, the word bias is used to indicate that a judgement is not in accordance with the facts or that a decision is suboptimal in view of a utilitarian perspective that aims to optimize the expected outcome in quantifiable terms (e.g., to optimize survival or a cost-benefit analysis of the expected outcome of a treatment).

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