Luppo Kuillman

The predictive values of a Deliberative and a Paternalistic Attitude 109 5 INTRODUCTION In the last decades, patient behavior has changed (Barlem & Ramos, 2015), most likely because of the obviousness of shared decision-making. Patients have increasingly become more articulate and have a strong voice in their treatment. This development has many positive aspects, as it gives space to the patient’s preferences and ideas about treatment within the interplay of patient and healthcare provider besides offering freedom of choice. A downside of this change in patients’ position is that they negotiate for what they think is a superior treatment option instead of a standard treatment that may be sufficient and cost-effective (Saarni, Halila, Palmu, & Vanska, 2008; Stiggelbout et al., 2012). This phenomenon seems to be triggered by the easily accessible medical information available on the internet (Ford, 2000; Jacobson, 2007). The danger in this is that the patient, as a layperson, may think that (s)he is being denied the most optimal care. In such a situation, healthcare professionals can be trapped by the emerging moral conflict. This conflict between options pushes health care providers into a position where they need to weigh interests, which results in decisions that at times are not in line with the (moral) guidelines.  Moral conflict in relation tomoral action or yielding to pressure  Whenever healthcare providers and patients interact, disagreement can arise about beliefs, opinions, and values that both parties hold (Jormsri, 2004). When these different opinions or demands clash normatively, the philosophical literature speaks of a moral conflict and requires an incompatible action (Fourie, 2015). In this study, we focus onmoral conflicts that occur when themost rational option from the healthcare provider (based on medical standards, guidelines, and professional ethos) clashes with the opposite option. Most often, the opposite option is an emotionally directed one, the desired one of the patient or involved ones (McConnell, 2018). In other words, a moral conflict can be seen as a situation where one option prevails over the other. For example, when the healthcare professional proposes an evidence-based option A for a patient, but the patient (or relatives) prefers a non- evidence-based option B, the healthcare professional finds him- or herself in a conflict situation. Based on their professional stance, healthcare professionals are intrinsically driven to do good for the patients. However, they are also trained to consider the patient’s or the relative’s choices. This emotional dimension may blur the correctness of the decision and consequently cause the effect of what we introduce as “yielding