Doctor, What Would You Do? An ANSWER for Patients Requesting Advice About Value-Laden Decisions

Abstract

This article presents a previously published framework, summarized in the mnemonic ANSWER (A, Active listening; N, Needs assessment; S, Self-awareness/reflection; W, Whose perspective?; E, Elicit values; R, Respond) for how to respond to the question, “Doctor, what would you do?” when considering medical decisions that are preference-sensitive, meaning there is limited or debatable evidence to guide clinical recommendations, or are value-laden, such that the “right” decision may differ based on the context or values of a given individual. Using the mnemonic and practical examples, we attempt to make the framework for an ethically appropriate approach to these conversations more accessible for clinicians. Rather than a decision rule, this mnemonic represents a set of points to consider when physicians are considering an ethically acceptable response that fosters trust and rapport. We apply this approach to a case of periviable counseling, among the more emotionally challenging and value-laden antenatal decisions faced by providers and patients.

Prospective parents’ perspectives on antenatal decision making for the anticipated birth of a periviable infant

“…We have argued that informed, shared decision-making is optimized when patients are presented with the full range of short and long-term outcomes that are possible, along with an indication of how probable those outcomes are to occur. 24 Our study is not without limitations. The parent study was conducted in a single state, among English-speaking women admitted to urban, academic medical systems and thus, the experiences of our participants may not be representative of, or generalizable to, other patient populations.…”