Making Clinical Ethical Decisions: Common Fallacies: 1. Ad Hominem

The first fallacy to be considered is “ad hominem” which is translated “to the man”: switching the discussion from the argument or defense of the facts presented to an attack of the opponent as a person.

Here is the scenario in a clinical setting as an example of the first fallacy to consider: ad hominem.

The 68 year old father of 5 children has had known prostate cancer for the past year treated by surgery and radiation but now is experiencing back pain which was found on x-ray to be an apparent metastasis of the cancer. The family had already experienced cancer in the family with the death of their mother at age 62 from breast cancer. One son, upset by the finding of the metastasis and in place of discussing with the urologist the appropriate steps to take next interrupts the urologist accusing the urologist of misdiagnosing and mistreating his father and that the urologist probably just "squeeked through" medical school. On returning home, the son spoke to each of his siblings about his conclusion, to which, however, they didn't agree. Instead of listing the known facts in the physician's diagnosis and treatment of his father and explaining how he reached his conclusion from the facts, the son had simply personally attacked the urologist's professional history and skills. This response by the son was an "ad hominem" attack instead of a reasoned conclusion. This reaction is usually in response to frustration where no definite explanation can be given and so attack is the last approach.

Ad hominem can also occur on the other side of the patient-doctor interaction. Think about the 42 year old male who is suspected by some and known by others to be a drug addict and has come to the hospital emergency room on many occasions requesting pain medication for various aches and pains. He is well known in the ER for this and sometimes he gets what he wants. This time, he came complaining of chest pain of 2 hours duration which he had never experienced previously but was unable to have a chance to say that since he was brought to the attention of the emergency room doctor with the acronym "AALFD" and sent back to the waiting area to later collapse from an acute myocardial infarction. Unfortunately for this patient, the facts were not obtained this time but he was simply given an ad hominem designation. Oh, yes.. you did want to know what the doctor understood as "AALFD"? From messybeast.com : "AALFD - Another A**hole Looking For Drugs"

The fallacy regarding ad hominem is that not only is ad hominem an uncivil act, it is not a substitute for supported facts and supported argument.

In making decisions for patient care, both the ethics consultants and the stakeholders have to avoid the use of an ad hominem assertion in place of providing facts or arguments in supporting ones view. ..Maurice.