On the rationality of decision-making studies: Part 1: Decision models of treatment choice

With reference to both critiques and empirical studies, the theoretical and methodological grounding of anthropological research on medical decision making is examined in this article, giving particular attention to the construction and evaluation of cognitively oriented decision models. A decision-modeling study carried out in the Mexican village of Pichátaro (in conjunction with James C. Young) frames an exploration of some of the tensions and points of contention about the aims and designs of cognitively oriented studies of decision modeling. While a decision model can provide a reasonably good guide to an understanding of treatment actions and the culturally based rationality that underlies them, such models fall short when they are oriented primarily around predicting treatment accounts. They should also attend to the jointly cultural, personal, social, and cognitive constructive processes through which meaning is conferred upon the occurrence of illness.