LIBERAL RATIONALISM AND MEDICAL DECISION-MAKING

I contrast Robert Veatch's recent liberal vision of medical decision-m aking with a more rationalist liberal model. According to Veatch, phys icians are biased in their determination of what is in their patient's overall interests in favour of their medical interests. Because of th e extent of this bias, we should abandon the practice of physicians of fering what they guess to be the best treatment option. Patients shoul d buddy up with physicians who share the same values - 'deep value pai ring'. The goal of choice is maximal promotion of patient values. I ar gue that if subjectivism about value and valuing is true, this move is plausible. However, if objectivism about value is true - that there r eally are states which are good for people regardless of whether they desire to be in them - then we should accept a more rationalist libera l alternative. According to this alternative, what if required to deci de which course is best is rational dialogue between physicians and pa tients, both about the patient's circumstances and her values, and not the seeking out of people, physicians or others, who share the same v alues. Rational discussion requires that physicians be reasonable and empathic. I describe one possible account of a reasonable physician.