"I can't believe that's why you want that!" How are reasons ethically relevant in medical decision-making?

Abstract: Sometimes, clinical teams must navigate how to respond to patients and families who offer ethically dubious reasons. For instance, sometimes families decline certain treatments for seemingly ableist reasons or request specific medical providers based on explicit racist beliefs. Other times, family members point to some fact, but it’s unclear whether or how that fact is ethically relevant to the decision at hand. An example of this might be when family members cite historic injustice toward members of their community to explain why they are declining a highly effective and beneficial treatment for the patient due to mistrust of the health system.

This panel will explore the following three questions: First, do patients’ and families’ reasons matter in assessing whether a refusal of a recommended medical treatment is ethically permissible? Second, might patients’ and families’ reasons be ethically relevant in other ways? And, finally, how should clinicians respond when they encounter patients and families who base their decisions on merely purported reasons or morally repugnant reasons?

Keywords: The relevancy of reasons to permissible medical decisions, How clinicians should respond to patients' and families' questionable reasons, Reasons and the differences between pediatric and adult contexts