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

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.