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For years, health professionals have provided certainty, basing their decisions on
medical science and ‘clinical judgement’. Questions about, for example, who should be
given renal replacement therapy is couched in medical terms such as prognosis, clinical
benefit and scientific evidence. However, the period of uncertainty between the old
paradigm and the new paradigm has resulted in the destabilisation of traditional social
conventions and revealed the certainty of clinical judgement as a façade.
Consider again Sartre’s portrayal of our human response to the realisation of our
freedom and choice to make decisions about the situations that confront us in daily life.
Through his fictional character Antoinne, Sartre portrayed our response to this freedom
and choice as anguish and nausea (Sartre, 1962). Antoinne’s response seemed both
extreme and ridiculous in the context of ordinary events in our daily lives, like ordering
a drink in a café or observing an oak tree in a park.
Imagine instead that you have to make a decision whether to permanently remove the
reproductive capacity of a young woman with learning disability, or to end the life of
young man in a persistent vegetative state by discontinuing food and hydration. Sartre’s
representation comes to life. The enormity and finality of the decision and the absence
of complete certainty about whether your decision is right or wrong renders a response
of almost dizzying anxiety completely understandable.
This leaves us on shaky ground. We know this. We also know that when we make
choices, we have to take responsibility for them. So we attempt to create certainty. As
Sartre suggests, in an attempt to achieve certainty, we may use methods of
objectification. And if we then detach our own subjective judgement from the process
what results is bad faith. This tendency has been observed in health professionals.
Research tells us that doctors shroud value judgements in technical justifications
(Spiers, 1997). This in itself is not bad faith. But what if the objectification is used to
avoid the complexity of the decisions or to remove their subjective selves from the
process? Sayers and Perera (2002) examined end of life treatment decisions by general
practitioners and geriatricians in response to case studies. Each case study concerned
whether to initiate acute, routine medical treatment for elderly people with terminal
illnesses without which they would die. For instance, the doctors were asked whether a
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