Abstract: Medical forms, such as advance directives, are often used to gather information, guide decisions, and sometimes serve as a proxy for decision-making within clinical care. While bioethicists have discussed challenges around application and interpretation, the design of medical forms themselves as information-gathering tools has drawn significantly less attention. In this presentation, we consider the ethical and epistemic implications of considering a form as a tool for information-gathering with decision- and action-guiding objectives.
For example, when soliciting values and preferences from patients, we demonstrate that a tradeoff emerges between pairing questions and response formats. Questions with tightly restricted response formats, such as limited multiple-choice response options, optimize clarity, pre-determine the relevance of response options, and minimize the risk of misunderstanding. In contrast, unstructured, free-text responses support narrative structure, nuance, and the patient’s own voice. Within this spectrum, unique risks emerge. Overly restrictive response options may prevent patients from sharing important information that falls outside of the pre-determined response options, but free-text responses may also draw out information or preferences that are irrelevant, incoherent, contradictory, or beyond what can reasonably be offered in a clinical context. Given this, determining the best pairing of specific inquiries with corresponding response options becomes a value-laden judgement that requires the balance of several considerations.
We end by discussing these tradeoffs through the process of revising a blood product refusal form, where we aimed to strike a balance between providing patients adequate space to detail their specific preferences and creating a form that represented clinically reasonable options
Keywords: Medical Decision-Making, Medical Forms, Clinical Ethics
Learning Objectives:
After participating in this conference, attendees should be able to:
Introduce to the audience the different ethical and epistemic stakes that emerge from a critical analysis of medical form design
Demonstrate how these design choices, specific to the inquiry and paired response formats, can influence decision-making and action guidance specific to the work of clinical ethics.
Provide an opportunity to share insights from a current form-revising project and seek input from the audience on how ethicists can best move these projects forward.
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