Prolonging Medical Procedures to Exploit the Peak-End Rule: An Ethical Analysis

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-08-28 DOI:10.1111/jep.70264

Richard C. Armitage

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引用次数: 0

Abstract

Introduction

The Peak-End Rule (PER) impacts how individuals remember events: experiences are primarily remembered according to the emotions associated with the experience's most intense moment (the peak) and those associated with its end (the end). The potential utility of exploiting the PER for improving patients' willingness to repeat unpleasant but medically useful procedures in the future has been demonstrated.

Methods

This paper conducts an analysis of the ethical issues surrounding the prolongation of medical procedures to exploit the PER.

Findings and Discussion

Prolonging medical procedures to exploit the PER appears to satisfy the bioethical principles of beneficence and justice. It is unclear whether, by fully informing patients that the PER is being exploited by prolonging their painful medical procedures, the effect of the PER will persist. While it is unreasonable to expect doctors to provide patients with a full explanation of every medical decision involved in their care, the degree of transparency should reflect the significance that patients are likely to attach to those decisions. It is likely that patients will consider the decision to expose them to prolonged pain without immediate clinical benefits a significant decision. Accordingly, by failing to fully inform patients that the PER is being exploited (for fear of diminishing or eradicating its effect), patients are unable to make fully informed decisions, meaning doctors fail to respect patient autonomy while also acting in an unethically paternalistic manner. Furthermore, exploiting the PER in this manner might also violate the principle of non-maleficence, while appeals to the doctrine of double effect to justify this decision would likely be unsuccessful. A further analysis of the ethical issues surrounding the other ways in which the PER can be exploited in clinical practice, such as by reducing the intensity of pain at the peak of the experience with analgesia, is needed.

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延长医疗程序以利用峰终规则：一个伦理分析

高峰-结束规则（PER）影响个人记忆事件的方式：人们对经历的记忆主要是根据与经历最激烈的时刻（高峰）和与经历结束（结束）相关的情绪。利用PER的潜在效用已被证明可以提高病人在将来重复不愉快但医学上有用的手术的意愿。方法对利用PER延长医疗程序的伦理问题进行分析。延长医疗程序以利用PER似乎符合仁慈和正义的生物伦理原则。目前尚不清楚的是，通过充分告知患者，通过延长他们痛苦的医疗程序来利用PER， PER的效果是否会持续下去。虽然期望医生向患者提供涉及其护理的每一个医疗决定的充分解释是不合理的，但透明度的程度应反映出患者可能对这些决定的重视程度。患者很可能会考虑让他们暴露在没有立即临床益处的长期疼痛下的决定是一个重要的决定。因此，由于没有充分告知患者PER正在被利用（因为害怕减少或消除其效果），患者无法做出充分知情的决定，这意味着医生既不尊重患者的自主权，也以不道德的家长式方式行事。此外，以这种方式利用刑法也可能违反非恶意原则，而诉诸双重效果原则来证明这一决定的正当性可能不会成功。需要进一步分析围绕在临床实践中可以利用PER的其他方式的伦理问题，例如通过减少镇痛体验高峰时的疼痛强度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.