• Mental Health
• Decision Making
• Ethics- Medical

In ‘Patients, doctors and risk attitudes,’ Makins argues for ‘straightforwardly’ (Makins1 p1) extending antipaternalistic views about medical decision-making to include deferential considerations of risk attitudes that a patient might endorse. Reflecting on Makins’ important contribution to higher order attitudes in decision theory, we seek to clarify the practical applicability of his argument to specific clinical settings, namely in mental health. We argue that considering low and higher order risk preferences are not only practically difficult, but also potentially ethically fraught and especially so in the provision of mental healthcare. Deferring to risk attitudes potentially mutes a more robust curiosity of patients’ preferences and desires that can promote both autonomy and beneficence but are explicitly relationally grounded. We argue that a relational understanding of autonomy is a much more robust way of thinking about the value of risk attitudes among other patient preferences, attitudes and goals.

Makins rightly expounds on the challenges faced by healthcare professionals who are often required to make determinative recommendations for their patients. Providers must explain uncertain benefits in relation to uncertain risks, therefore, exploring the risk attitudes of patients, appears, prima facie, a rational, patient-centred and autonomy-promoting choice. It invariably invites discussion of Perske’s 1972 dignity of …