Hi,

I hope that this is not too late. 

The points you make are excellent. 

It also pays to remember that the medical professionals are also going through similar processes in their decision making and conversations with a patient. 

Mary Jane Jerde
NEDP Assessor
Howard Community College




________________________________
From: "MarkH38514 at aol.com" <MarkH38514 at aol.com>
To: healthliteracy at nifl.gov
Sent: Tuesday, November 18, 2008 3:12:06 PM
Subject: [HealthLiteracy 2474] Re: Treatment refusal and verbal abilities

Mary: 
 
Much of the research on informed consent philosophically 
assumes that the decision to be treated or not be treated is a logical one. But 
there is much emerging research on the brain's role in decision making and the 
importance of emotion, logic, and even intuition.  
 
For example, psychologist George Lowenstein and his colleagues 
published a paper on "Risk as Feelings." (Lowenstein, G.F., et al. Risk as 
feelings. Psychological Bulletin, 2001, 127: 267-286). Because 
decisions aren't just logical thoughts, but emotional reactions, it's not 
surprising that patients may find it difficult to articulate why they don't want 
treatment. 
 
Malcolm Gladwell's 2005 book "blink. The Power of Thinking 
without Thinking" described how people use "thin slicing" to extract relevant 
information from all the information around them. David Myers, in his book 
"Intuition" (2002) describes "knowing without awareness"--how people can know 
things automatically (unconsciously) or cognitively (consciously). He summarized 
Seymour Epstein's description of experiential knowing (intuitive, 
automatic and nonverbal) or rational knowing (rational, analytic, 
verbal).  Consent decisions based on experiential knowing may not be easy 
for patients to explain verbally. 
 
I've done a few articles that touch on the issue, but may not 
be specific enough for your needs. One is available online:  
 
Hochhauser, M. The anatomy of informed consent. Applied Clinical Trials, March 2005, 82. 
http://appliedclinicaltrialsonline.findpharma.com/appliedclinicaltrials/Sites+Articles/The-Anatomy-of-Informed-Consent/ArticleStandard/Article/detail/149967
 
I can send you pdf versions of: 
 
Hochhauser, M. Emotion and logic in the informed consent 
process. Research Practitioner, 2005, 5(4), 138-141. 
 
Hochhauser, M. Informed consent or intuitive consent? SoCRA Source, February 2006, (Publication of the Society of 
Clinical Research Associates, #47, 32-33. 
 
Mark
 
Mark Hochhauser, Ph.D.
Readability Consultant
3344 Scott Avenue North
Golden Valley, MN  55422
Phone: 763-521-4672
Fax: 763-521-5069    
Cell: 612-281-1517
email: MarkH38514 at aol.com
 
 
 
 
 




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