Making Clinical Ethical Decisions: Common Fallacies: 5. Argumentum ex Silentio
argumentum ex silentio is a fallacy appealing to ignorance as evidence to argue that something exists or doesn't exist. For example, the argument goes:" since we have no evidence that God doesn't exist, therefore he must exist". Or "because we have no knowledge of alien visitors to our earth from other planets, that would mean that alien visitors don't exist."
The state law allows the CEO of a hospital to permit organ donation of a patient was without friends who know him or family and who died without any sign that the patient had previously stated whether or not to allow his organs donated at death. An ethics committee met to decide the ethics of whether it was appropriate ethically for the hospital CEO to give permission for organ retrival on this patient. The ethical principle of beneficence would suggest that procurement of a vital organ from this deceased patient and transfer to a needy patient would be an ethical decision to consider. There are no other facts for the ethics committee to consider.
Yet, a troublesome factor can be introduced if the fallacy argumentum ex silentio is not rejected but used to make a decision. One can say, that even in death, patient autonomy while alive should be respected and since there is no information that the patient had accepted organ donation therefore one could argue that organ donation was unwanted. Or.. since there is no information that the patient rejected organ donation therefore one could argue that organ donation would have been acceptable to the patient. One could also argue one way or the other with regard to whether the patient had religious restrictions to transplant.
Avoiding the fallacy would have allowed the following logic: "we are ignorant regarding whether or not the patient had made any decision about organ donation, therefore there are no other facts for us to use to make a decision about whether or not it would be unethical for the CEO to decide to authorize organ procurement except the fact that donation would be considered as beneficence toward the recipient and thus on that basis the CEO's approval would be considered ethical."
Can you think of some other examples of use of this fallacy in making an argument? ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:37:00 PM
3 comments
3 Comments:
argumentum ex silentio is a fallacy appealing to ignorance as evidence to argue that something exists or doesn't exist. For example, the argument goes:" since we have no evidence that God doesn't exist, therefore he must exist". Or "because we have no knowledge of alien visitors to our earth from other planets, that would mean that alien visitors don't exist."
Or...because patients don't verbally express desires for specific gender care, esp. for intimate procedures -- gender and modesty isn't an important issue in for them.
Or...because men in particular play it macho and don't complain about modesty issues, they are perfectly satisfied with how the medical system treams them in that regard.
Or...because patients don't ask any questions, that means they don't have any questions.
Or...what patients don't know happens when they're knocked out, won't bother them or matter to them later.
Doug Capra
Doug, that is why an argument appealing to ignorance is really not an appealing argument. ..Maurice.
With the exception of the "what patients don't know happens...", this is a difficult dilemma. For example, it may be that the potential donor would have wanted to give their organs.
That said, I think I would want to err on the whichever side of this would be the least intrusive. The decision to donate an organ is very significant. I am troubled that a CEO would be given the authority to make that decision. In this case, I don't think the organs should be used, though I understand why a hospital would want to. I separate this particular question from the others because it is a decision a patient cannot possibly make at the time it comes up, and it is a potentially life saving decision that must be made relatively quickly.
The other issues mentioned do not involve the life of another. I think they are more about paying attention to the living patient and maybe having to inconvenience the provider a bit if the patient is given a choice.
The other cases really are associated with respectful treatment and possibly how one defines abuse (such as practicing giving pelvic exams while a patient is unconscious).
I have stated on other threads that I consider the new rules about electronic medical records and the ease with which they can be accessed to be utterly unacceptable. One of the excuses for creating these records is so that information can be shared in case of an emergency.
While I do not believe safety has anything to do with the electronic medical record, one potentially positive result is that these questions can be asked directly of patients so there is no ambiguity. It can be asked, but if it is, the provider must be willing to respect the wishes of the patient (which I think is why most providers prefer not to ask). Standard question: Would you want your organs donated? Would you prefer a same gender provider and how strongly to you feel about this? What are some ways you do/do not want to be treated while you are a patient? This could even be done as a checklist for the most common concerns.
Since medical records are no longer really private, whoever is assigned to treat a patient will see the answer to these questions and there will be no ignorance defense.
CD
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