
Abstract
Health beliefs about one’s own future should be clearly expressed, sincere, and enduring to be taken seriously by clinicians when assessing risks and benefits in key health decisions. This cartoon considers how clinicians’ expressions of doubt about those beliefs can undermine patient-clinician relationships and a patient’s epistemic authority.
Figure. Childless by Choice
When clinicians treat patients with a uterus with an intervention that poses fertility risks, shared decision-making requires clinicians to express respect for a patient’s clear communication that they do not want to use their own bodies to procreate, do not want children, or some other view about how they relate their future selves to their procreative capacities. Clinicians’ overemphasis on future pregnancy and fertility or continued expressions of doubt about the sincerity or endurance of a preference undermines a patient’s epistemic authority in decision-making. The patient in this work has carefully staged what they want to say and clearly states their view with a garland of capital letters while dressed in a top hat and suit. Even with fireworks as background spectacle, their clinician still seems to find room for doubt about the patient’s performative communication and their preferences and desires for their future self. Clinicians’ expressions of doubt, especially when persistent, can also make patients feel unheard and dismissed and, perhaps, cause them to wonder, Why do you think I’ve not thought about this? Why do I have to demonstrate the endurance or sincerity of my view? This cartoon also asks, What kind of show must patients, who can bear children but choose not to, perform for their clinicians in order to be taken at their word?