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esponse demonstrates the complexity of decision making and its possible constituents.
Imagine that you are Jane and have just witnessed the crash. Your heart is racing, your
hands are sweaty, and you are anxious about what you might find when you get to the
scene of the accident. The anxiety is, however, tempered when you recall the
appointment you have regarding the possibility of having a baby. You process all that is
going on around you, the consequences of whether you help or not, whether you value
your appointment over helping the car crash victims and so on. Even using this
extremely simplified portrayal of Jane’s possible response we see how reason, emotion,
the context, her life goals and even a physical response all culminate in a split second to
guide her decision making.
This example is quite different from the context of the court room or the hospital
bedside. However, it serves to demonstrate the complex, multi-dimensional reality of
human reasoning which is not accounted for by legal positivist or ‘fact centred’ medical
approaches to decision making. Is it possible, or even desirable, to unravel the multi-
layered decision making process to achieve a theoretical, yet realistic model of
reasoning?
Clearly, comprehensive accounts of best interest determinations (as with any other
decision) can only be achieved if all the components of decision making are recognised
and revealed. However, to accept this fuller conception of reasoning raises some
significant philosophical challenges. Specifically, if questions of right and wrong and
good and bad are perceived as matters of individual preference, do we fail to respect the
gravity and lessen the import of decisions about, for example, whether to withdraw life
support from adults in a persistent vegetative state? Furthermore, if we adopt this
approach we have to accept that there are no objective moral truths. Is this problematic?
And does this inevitably lead to a relativist position which, at its most extreme,
suggests that there may be different accounts of the facts in the world and emphasises
differences and the non-assimilation of worlds with each other? (Described by
O’Grady, 2002, p.11.) Surely it is preferable to tackle these concerns than to use
positivist frameworks which only account for a part of the decision making picture.
Seedhouse’s rational fields theory offers a comprehensive model of decision making
which also addresses these important philosophical questions.
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