Cognitive Dualism in End-of-Life Decision-Making
Alex Dubov, PhDc., Assistant Professor, Loma Linda University
Whitny Braun, PhD, Assistant Professor of Ethics, Loma Linda University
In this presentation we will discuss the phenomenon of ‘cognitive dualism’ especially as it applies to decision-making in critical care. Cognitive dualism is observed in both religious students of science and in religious science-trained professions and involves the capacity of individuals to maintain apparently contradictory beliefs about some facts – such as the natural history of human beings – that admits of scientific investigation. Cognitive dualism challenges the premise that such beliefs are genuinely contradictory. For instance, a religious doctor might explain that the answer to whether he ‘believes’ in evolution depends on where he is: at work, where he uses knowledge of human evolution in his practice as an oncologist; or at home, where he is a member of a religious community. There is no contradiction because these apparently opposing beliefs exist only within the mental routines that enable him to do those particular activities and those activities are not mutually exclusive. The cognitive dualism phenomenon exists in other spheres of life that may not involve religion. For instance, public opinion studies consistently find that farmers are deeply skeptical of climate change. However, at work, climate-skeptical farmers are adopting practices based on available evidence of man-made climate change (i.e. new patterns of crop rotation or adjustments in growing season projection). Therefore, according to Kahan (2015) whether people say they believe or disbelieve in human-caused climate change (or evolution) is not a valid measure of what they know about these issues, but it is rather an indicator of their identity.
In critical care and end-of-life decision making, a number of important decisions may be grounded in religious identity of patients or their surrogates. For instance, despite overwhelming medical evidence supporting the withdrawal of intensive care in extremely ill children who are unlikely to survive, parents who have deeply held religious beliefs may hold out for a miracle. The immediate assumption of healthcare professionals in such cases would be that parents either lack knowledge or understanding of the disease progression. Doctors and nurses will try to provide more information in hopes to avoid prolonged provision of futile critical care. However, just as in the examples above, parents’ decisions may not be a valid measure of what they know about the disease progression, but rather an indicator of their identity. Recent studies support the idea that people accept facts and statements that reinforce their connection to others with whom they share important commitments. On the other hand, they will process information differently when they perceive it runs against their identity. Therefore, it is important to present information in a manner that affirms rather than threatens people’s values and identity. Since the connection to a group of people with shared commitments is important in upholding one’s identity, healthcare professionals may also need to explore ways of presenting the important information that would strengthen the existing connection (by inviting leaders or members of religious community to be a part of the dialogue).
Whitny Braun, PhD, Assistant Professor of Ethics, Loma Linda University
In this presentation we will discuss the phenomenon of ‘cognitive dualism’ especially as it applies to decision-making in critical care. Cognitive dualism is observed in both religious students of science and in religious science-trained professions and involves the capacity of individuals to maintain apparently contradictory beliefs about some facts – such as the natural history of human beings – that admits of scientific investigation. Cognitive dualism challenges the premise that such beliefs are genuinely contradictory. For instance, a religious doctor might explain that the answer to whether he ‘believes’ in evolution depends on where he is: at work, where he uses knowledge of human evolution in his practice as an oncologist; or at home, where he is a member of a religious community. There is no contradiction because these apparently opposing beliefs exist only within the mental routines that enable him to do those particular activities and those activities are not mutually exclusive. The cognitive dualism phenomenon exists in other spheres of life that may not involve religion. For instance, public opinion studies consistently find that farmers are deeply skeptical of climate change. However, at work, climate-skeptical farmers are adopting practices based on available evidence of man-made climate change (i.e. new patterns of crop rotation or adjustments in growing season projection). Therefore, according to Kahan (2015) whether people say they believe or disbelieve in human-caused climate change (or evolution) is not a valid measure of what they know about these issues, but it is rather an indicator of their identity.
In critical care and end-of-life decision making, a number of important decisions may be grounded in religious identity of patients or their surrogates. For instance, despite overwhelming medical evidence supporting the withdrawal of intensive care in extremely ill children who are unlikely to survive, parents who have deeply held religious beliefs may hold out for a miracle. The immediate assumption of healthcare professionals in such cases would be that parents either lack knowledge or understanding of the disease progression. Doctors and nurses will try to provide more information in hopes to avoid prolonged provision of futile critical care. However, just as in the examples above, parents’ decisions may not be a valid measure of what they know about the disease progression, but rather an indicator of their identity. Recent studies support the idea that people accept facts and statements that reinforce their connection to others with whom they share important commitments. On the other hand, they will process information differently when they perceive it runs against their identity. Therefore, it is important to present information in a manner that affirms rather than threatens people’s values and identity. Since the connection to a group of people with shared commitments is important in upholding one’s identity, healthcare professionals may also need to explore ways of presenting the important information that would strengthen the existing connection (by inviting leaders or members of religious community to be a part of the dialogue).