Peter Mathews (Dublin South, Fine Gael) | Oireachtas source

This is an excerpt from the chapter about frames and reality in Thinking, Fast and Slow by Daniel Kahneman, a Nobel prize-winning behavioural psychologist, economist and philosopher who has written perhaps this year's bestselling book. His reputation in the area is world class and is a hallmark. He and his colleague, Amos, carried out an experiment with colleagues at Harvard Medical School. It is a classic example of emotional framing.

Physician participants [and remember these are qualified physicians at Harvard] were given statistics about the outcomes of two treatments for lung cancer: surgery and radiation. The five-year survival rates clearly favor surgery, but in the short term surgery is riskier than radiation. Half the participants read statistics about survival rates, the others received the same information in terms of mortality rates. The two descriptions of the short-term outcomes of surgery were:The one-month survival rate is 90%.

There is 10% mortality in the first month.[It is the same information framed differently.] You already know the results: surgery was much more popular in the former frame (84% of physicians chose it) than in the latter (where 50% favored radiation). The logical equivalence of the two descriptions is transparent,and a reality-bound decision maker would make the same choice regardless of which version she saw [note that he switches to she]. But System 1, as we have gotten to know it, is rarely indifferent to emotional words: mortality is bad, survival is good, and 90% survival sounds encouraging whereas 10% mortality is frightening. An important finding of the study is that physicians were just as susceptible to the framing effect as medically unsophisticated people (hospital patients and graduate students in a business school). Medical training is, evidently, no defense against the power of framing.

I use the example to make a point about the title of the Bill, which I would love to do what it says it does. However, it does not do so because section 9 does not do it. The psychiatrists and the obstetricians said, if any Ministers had chosen to attend the hearings, there was a repugnant dilemma and that it was the labyrinth of the law that said if the mother said she did not want any of the medical treatments, the only way to avert the real and substantial risk of suicide was to terminate the pregnancy, which meant losing the life of the baby. They said it was a repugnant dilemma and they did not like it and it was all against their medical training, their medical objectives and their code of caring philosophy and everything.

We must be very careful about this. The legislation is supposed to provide clarity. As I said to the Minister earlier, iatrogenic medicine represents 25% of all medicine in the United States of America. It is probably the same here. It relates to doctors doing follow-up or tidy-up work on earlier medical interventions or diagnoses. We are human beings and we make mistakes, as happened in the unfortunate case of Savita Halappanavar in Galway. It is human error. How do we think that we can legislate to instruct doctors, who we hope have the objective of doing no harm and, in fact, doing good? We hope they will look after everybody, including mothers, fathers, children and older people. Within the frame of reference and principles of the Constitution, we should let them get on with it. Wisely, we do not legislate for how bridges should be built or brain, open-heart or eye surgery performed. We do not even tell solicitors how to do things or accountants how to measure profit or loss. They have developed ways of dealing with accruals and of observing prudential assessment. When professionals let their standards slip, as bankers and accountants did, the ratios and balance sheets, which should have been kept in check, fell by the wayside. Then, we saw the collapse. The difference in this case is that we have been told by the professionals what the realities are. Psychiatrists tell us that abortion is not a cure for suicidal intent. We are choosing to ignore that in framing the legislation. In the banking collapse, we were told lies, which led to a financial collapse. Do we want a social collapse?

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