Article Text

Download PDFPDF
Deference to patients’ risk attitudes is contingent on medical norms
  1. Abeezar I Sarela
  1. Department of Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Abeezar I Sarela, Upper Gastrointestinal Surgery, St James's University Hospital, Leeds, UK; a.sarela{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Makin argues that doctors1 should defer to each patient’s attitude to risk, over and above standard, utility-based and outcome-focussed medical decision-making models, in selecting treatment options for that patient.1 Although Makin articulates the problem as a dilemma of whether ‘to give the treatment or to withhold it’, it can be assumed that his question is whether the doctor should offer a certain treatment; because both the General Medical Council and law require doctors to engage patients in shared decision-making (SDM) and to obtain consent before ‘giving’ any treatment. Yet, Makin is correct in asserting that doctors ‘make choices on behalf of their patients on a daily basis’ insofar that doctors do have to make certain a priori decisions. SDM requires a starting point—a range of clinically appropriate or reasonable options—on which patients and doctors can collaboratively deliberate in order to reach a treatment decision; and the doctor has to set out this starting point.2 Thus, Makin’s reductive claim is that doctors should take each patient’s risk attitude into account in setting out the starting points for SDM. In this commentary, I will explore UK case law in response to Makin’s proposal; because, ultimately, doctors have to work within the legal framework.

Makin relies on the bioethical principles of respect …

View Full Text


  • Twitter @AbeezarSarela

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • The term ‘doctors’ is used as shorthand for ‘healthcare professionals’.

  • The Supreme Court clarifies that ‘reasonable’ treatments and ‘clinically appropriate’ treatments are synonymous (para 59).

Linked Articles

Other content recommended for you