, Volume 1, Issue 1, pp 11–28 | Cite as

Rational justification for therapeutic decisions

  • Wilfrid I. Card


A rational justification for therapeutic decisions can be developed using probability and decision theory. The set of treatments and their outcomes or consequences, which are states of health, have to be defined; and estimates made of the probabilities of outcomes, their utilities, and the costs of treatments. Most difficult is the estimation of utilities of states of health but this may be possible using a ‘wagering’ technique. Until it is possible to establish some equivalence between utility and money, costs may be introduced by measuring the efficiency of treatment by comparing expected utilities per unit cost. The whole method is examined practically in a plausible clinical setting. Emphasis is laid on the value of testing the completed model using a computer to get an intimate feel of the problem using different assumptions and different values for all the parameters.

Key words

Therapeutic decision Decision theory Monetary value of life 


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  1. [1]
    Bunker, J. P., Barnes, B. A., and Mosteller, F. (eds.),Costs, Risks, and Benefits of Surgery, Oxford University Press, New York, 1977.Google Scholar
  2. [2]
    Card, W. I., “Development of a formal structure for clinical management decisions; a mathematical analysis’, inOutcome of Severe Damage to the Central Nervous System, Ciba Foundation Symposium 34 (new series), Elsevier, North-Holland, Amsterdam, 1975.Google Scholar
  3. [3]
    Card, W. I., and Good, I. J., ‘A logical analysis of medicine’, inA Companion To Medical Studies, Vol. 3, edited by Passmore, R. and Robson, J. S., Blackwell Scientific Publications, Oxford, 1974.Google Scholar
  4. [4]
    Card, W. I., and Mooney, G. H., ‘What is the monetary value of a human life?’Brit. med. J. 1977/II, 1627–1629.Google Scholar
  5. [5]
    Card, W. I., Rusinkiewicz, M., and Phillips, C. I., ‘Utility estimation of a set of states of health’,Meth. Inform. Med. 16, (1977) 168–175.Google Scholar
  6. [6]
    Carney, M. W. P., Roth, M., and Garside, R. F., ‘The diagnosis of depressive syndromes and the prediction of E. C. T. response’,Brit. J. Psychiat. 111, (1965) 659–674.Google Scholar
  7. [7]
    Cay, Elizabeth L., Philip, A. E., Small, W. P., Neilson, J., and Henderson, M. A., ‘Patients assessment of the result of surgery for peptic ulcer’,Lancet 1975/I, 29–34.Google Scholar
  8. [8]
    Dawson, R. F. F.,Current Costs of Road Accidents in Great Britain, Road Research Laboratory, London, 1971.Google Scholar
  9. [9]
    DeGroot, M. H.,Optimal Statistical Decisions, McGraw Hill Book Co., New York, 1970.Google Scholar
  10. [10]
    Jones-Lee, M. W.,The Value of Life, Martin Robertson, London, 1976.Google Scholar
  11. [11]
    Lindley, D. V.,Making Decisions, Wiley Interscience, London, 1971.Google Scholar
  12. [12]
    Lindley, D. V., ‘The effect of ethical design considerations on statistical analysis’,J. roy. stat. Soc., Series C 24, (1975) 218–228.Google Scholar
  13. [13]
    Milholland, V. V., Wheeler, S. G., and Heieck, J. J., ‘Medical assessment by a Delphi group opinion technic’,New Engl. J. Med. 288, (1973) 1272–1275.Google Scholar
  14. [14]
    Neuhauser, D., and Lewicki, A. M., ‘What do we gain from the sixth stool guaiac?’New Engl. J. Med. 293, (1975) 226–228.Google Scholar
  15. [15]
    von Neumann, J., and Morgenstern, O.,Theory of Games and Economic Behaviour, 3rd edn., Princeton University Press, Princeton, 1953.Google Scholar
  16. [16]
    Weinstein, M. C., Pliskin, J. S., and Stason, W. B., ‘Coronary artery bypass surgery: decision and policy analysis’, in Bunker, Barnes and Mosteller [1], 342–361.Google Scholar

Copyright information

© D. Reidel Publishing Company 1980

Authors and Affiliations

  • Wilfrid I. Card
    • 1
  1. 1.Diagnostic Methodology Research UnitSouthern General HospitalGlasgowScotland

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