Decisions and Choices

Our cat has been diagnosed with a rare and complicated disease. The usual prognosis is one of lifelong management through medication, diet, and possibly frequent medical intervention, unless we are very lucky and she responds well to initial treatment. We have gone from having a very relaxed and inconsequential life to having to make life-or-death decisions for our cat every day for the last few weeks.

At one point, at the height of our worry and her pain, there was no choice that seemed like the right one. We were struggling with taking her to the ER, because it would cause her pain after a week of near constant stress, but we were afraid to stay home for fear of her health.

One of the people we asked for advice said that there were no wrong choices, because we didn't know what the outcome would have been, but some ways of making certain choices did feel wrong. I realized we weren't struggling with which choice to make; we were strugglying with making sure that we could live with whatever choice we did make.

a choice is not a decision

I realized that our advisor was right: there were no wrong choices. Whatever action we chose to undertake might work out well or poorly and since we couldn't know which, we wouldn't really be responsible for the outcome. But even in the worst case, as long as we felt that we had made the choice in the right way, we could have lived with ourselves.

On the other hand, taking an action that had a positive outcome, if we did it out of selfish fear, might leave us feeling like we had taken advantage of our cat.

So, I came up with this model of choices and decisions: a choice is the action you take and can be good or poor; a decision is the process of how you got there, and can actually be right or wrong. A choice is the outcome of a decision.

Decisions are motivated by inputs and answer the question, "how do I want to respond to this situation?" Choices answer the question, "What do I want to get out of this situation?"

It's not perfect, and it doesn't really mesh with how we use the terms in everyday life, but it works for me because it allows me to understand what is happening psychologically when I am struggling with making a decision and confusing it with making a good choice.

gather information to make your choice, know yourself and those you are responsible for to make your decision

This helped me come up with a rough framework for making decisions. Before starting the decision-making process, gather as much information as possible on the different choices available to me. What do I need to have in order to make each choice? What will the probable outcomes of the choice be? What will their costs be?

I think there is also an art to knowing when I have enough information to form a decision. Maybe it doesn't matter that much, and I can decide either way without much impact on my values. But sometimes I will need to know more to know how a choice will interact with my values. And sometimes seeking more information is just avoiding the decision.

Once that process is complete to whatever extent possible, and only then, I can commit to making the decision. Know what I want to get out of a situation. Do I want to keep my cat alive at all costs, or do I want to ensure a good quality of life for her? Do I want to feel that I am taking good care of her, or do I just need her to be alive, regardless of our relationship after all is said and done? How much money am I willing to spend on treating her, and how do I feel about the answer to that question?

These are values-based questions, and are entirely subjective, but they allow me to take a stance on the actions and choices I need to make. If I know my values, and my wife's values, in respect to the situation, I can formulate a position with her that will inform my choices. If we are clear on our values, we can be assured of picking the choice that is most in accord with our values (making the right decision). The more information, the better we can be certain that the choice accords with our values, but even with little information, we can go with what we do know.

Then, we are staying aligned with our values, not just waffling between one choice and another.

decisions framing choices

Once I figured out how I wanted to respond to my cat's sickness, it became a bit easier to know what choices to make. I wanted to approach the situation with compassion, to support her well-being, with an understanding that she may have to suffer a bit to get better, but always being aware of my own selfish desire to quell my fears with certainty instead of taking care of her. We also realized we didn't mind taking on a fairly heavy financial burden if she could live a full life at the end of the treatment process.

In deciding whether to proceed with the more extreme medical interventions, we have recognized that our need to have certainty and a quick resolution is not necessarily in her best interest. Letting her recover at her own pace between visits to the doctors, or even ride out the disease for a week or two as she builds up her strength, and using less intensive diagnostics to keep on top of maintanence, felt like a much more compassionate plan. It respected her need for a slower pace, and it recognized that our desire for quick, dramatic progress was more for us than for her. It also gives her a chance to manage the disease in her own way, whic accords with the way we wanted to relate to our cat as a member of the family rather then a pet with no agency (whether others agree with that or not).

While the choices are still high stakes (and it's possible we are endangering her by dragging out treatment), the decision feels right. We consulted with her doctors, and they agreed, though I thought it was interesting that their attitude seemed to be based on our own. Instead of telling us what was the better choice, they seemed to be focusing on how we expressed our ideas and where we sounded more or less confident.

the hardest choices

During a military-style group event, I was assigned to lead the group, which mostly just meant walking in front, but at one point where the trail narrowed, I had to decide whether to go ahead or wait for another group to pass us coming the other direction. I wavered, calling for a stop, then half-heartedly starting up again when the other group seemed to be giving way, then called another stop when they started walking anyway. It was awkward and since my group was carrying sandbags, they were righly annoyed. I was afraid they wouldn't respect me or follow me if I made a poor choice, but by trying so hard to make the right choice without enough information about the other group, I made no decision (which was the wrong decision).

There was a former army infantryman in my group, and afterwards he told me, "Just make a decision. It doesn't have to be the right one, but they will follow you anyway. You're the leader."

I could have called for a stop, and waved the other group through. It might have been the wrong choice, because my group would be standing there with sandbags, but they would have respected the decision because it would have been made in the right way.

I imagine that infantryman had had some experience with much harder decisions, both making them and following them, and I imagine he'd been on the receiving end of some bad decisions, and some good decisions that led to poor choices. But what I got from what he was saying is that making a decision is more important than figuring out the right choice. In that situation, any decision would have been the right one, except the non-decision I chose.

I imagine surgeons and generals have to make those sorts of decisions a lot, often without knowing whether the action they choose to take will lead to death or salvation. So what makes a good decisionmaker? Probably the better decisionmakers can connect their values to their choices, by making the right decision.