When doctors mention ‘regret’ for refusing care, who is really being protected?

When Doctors Cite x27Regretx27 to Deny Care Who Is Really Protected

Historically, doctors made make decisions on behalf of their patients. That changed in the course of the 20th century, when the principle of informed consent took hold in medicine and patients gained more control over their own bodies.

At the same time, drugs became not only life-saving but also life-enhancing, and Americans in particular began to see themselves as smart consumers of such drugs, as opposed to passive recipients of expert care. The study of regret, first developed in behavioral economics and then spilling over into other fields, including medicine, promulgated the model of loss aversion, in which the mere possibility of loss can often overshadow likely gains. Now doctors who want to deny procedures like abortion and sterilization for other reasons could point to a larger theory of medical regret.

This interest in regret is still evident in clinical settings today. Researchers seeking to understand the psychological effects of various medical interventions often use the Decision Regret Scale, which asks people to rate five simple statements, such as “It was the right decision” and “The choice did me a lot of harm.” on a scale of one (strongly agree) to five (strongly disagree). The more points a person accumulates, the more he supposedly regrets his decision. But the lived experience of regret has never been so simple.

First, regret can change over time, just like people do. The word contains multitudes, from guilt to resentment to curiosity. And new experiences can give old decisions new meaning. In the US, for example, there is still a largely unfounded fear that having an abortion could hinder future fertility; a person who “regrets” his abortion for this reason may no longer do so if he chooses to bear a child later in life and is able to do so.

Despite the current popularity of the “no regrets” mantra, reflecting on past mistakes can also help people define their values ​​and make better decisions in the future. “This thing that’s everywhere doesn’t feel right – why is that?” says Daniel H. Pink, author of a recent book called The Power of Regret: How Looking Backward Moves Us Forward. “The scientific answer is that it serves a purpose.” For Pink, regret offers clarity, insight and instruction.

Perhaps most importantly, regret can be culturally constructed, even if it feels very personal. What one regrets – and what not – is shaped by shared values ​​and a sense of acceptance by friends, family or the community. A decision can “do a lot of harm” not because it was wrong for them, but because those around them didn’t agree.

That seems to be the case for the 34 female sociologist Carolyn Mackelcan Morell whom she interviewed for her 1994 book, Unwomanly Conduct: The Challenges of Intentional Childlessness. Morell found that these women did not regret their decision. Rather, they shared ‘melancholic’ feelings, or disturbing ‘rumbles’ or ‘twinks’ of doubt, or ‘passing thoughts’ about the road not taken.’ These feelings were acceptable to the women and often easy to control.

But the persistence of such thoughts among Morell’s participants shows how the mere threat of regret can lead even the most determined of people to question their beliefs. As confident as these women were in their choice, they still had to face ongoing societal pressures to conform. “Some women seem impervious to popular notions of non-mothering as incomplete, as inadequate, as having an inferior life,” wrote Morell, who was childless herself. “For me, being childless requires a certain amount of courage.”

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