Ethical Issues in Decision Analysis

To the Editor: The purpose of decision analysis is to protect patients from the sort of reasoning in which Dr. Brett indulges (November 5 issue).* Consider his hypothetical example: diseases X and Y are indistinguishable until they have run their course. Among patients with the symptoms, X occurs 20 per cent of the time and has 60 per cent mortality unless treated with an operation that has 10 per cent mortality. Disease Y occurs 80 per cent of the time and always resolves spontaneously. Decision analysis indicates that the best strategy is to operate on all patients with the symptoms. . . . No extract is available for articles shorter than 400 words.