  There is a clear need to involve patients in medical decisions. However,
cognitive psychological research has highlighted the cognitive limitations of
humans with respect to 1. Probabilistic assessment of the patient state and of
potential outcomes of various decisions, 2. Elicitation of the patient utility
function, and 3. Integration of the probabilistic knowledge and of patient
preferences to determine the optimal strategy. Therefore, without adequate
computational support, current shared decision models have severe ethical
deficiencies. An informed consent model unfairly transfers the responsibility
to a patient who does not have the necessary knowledge, nor the integration
capability. A paternalistic model endows with exaggerated power a physician who
might not be aware of the patient preferences, is prone to multiple cognitive
biases, and whose computational integration capability is bounded. Recent
progress in Artificial Intelligence suggests adding a third agent: a computer,
in all deliberative medical decisions: Non emergency medical decisions in which
more than one alternative exists, the patient preferences can be elicited, the
therapeutic alternatives might be influenced by these preferences, medical
knowledge exists regarding the likelihood of the decision outcomes, and there
is sufficient decision time. Ethical physicians should exploit computational
decision support technologies, neither making the decisions solely on their
own, nor shirking their duty and shifting the responsibility to patients in the
name of informed consent. The resulting three way (patient, care provider,
computer) human machine model that we suggest emphasizes the patient
preferences, the physician knowledge, and the computational integration of both
aspects, does not diminish the physician role, but rather brings out the best
in human and machine.
