Time and Adherence: A Principle of Foresight

Abstract

When we consider two possible and contradictory actions, their adjacent desires have corresponding rewards, which might not be available at the same time. Thus time influences our decision , leading to what is described as intertemporal choice : Often, in chronic diseases, the choice of adherence or nonadherence can be seen as a choice between an abstract and distant reward, maintaining health, and a near and concrete reward, for example the pleasure of smoking. Many people are naturally impatient, preferring a small, near reward to a large, distant reward. This trait, patient or impatient, may be linked to adherence. I propose that, in the particular case of akrasia represented by patient nonadherence to long-term therapies, there is such disequilibrium between the two types of actions, the continent and the incontinent , that it does not allow the principle of continence to express itself, or rather this principle becomes insufficient, or even inappropriate, if used alone. This leads me to propose a hypothesis introducing a second principle, which I call the principle of foresight , which pushes us to give priority to the future , i.e., to accept taking care of ourselves. Maybe we have here something that is essentially human. One can also speculate that this differentiation is accomplished slowly in adults, leading from the simple age of reason to an age of foresight . According to this hypothesis, not conforming to this principle leads to nonadherence.