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In Reply: While I am not a pilot, I am reasonably sure that the likelihood of crashing, as described by Dr Waggoner, is decreased by having a navigator alongside a pilot in the cockpit. The physician, even if a navigator, is still an intimate member of the team. The communication about harm and benefit is improved by the duality. The point of the metaphor was that a physician piloting alone is not the best model of decision making; on this Waggoner and I agree.

The physician can only guide the patient on how to go about choosing; there is no guarantee about what that choice will be. My description of informed choice should not lead to an assumption that understanding trade-offs of harm and benefit in the context of personal values will ensure that choices will be utilitarian. The value to gain or lose is modified by many factors . . . [Full Text of this Article]

Robert A. McNutt, MD
robert_mcnutt@rush.edu
Contributing Editor, JAMA

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