Health Care Analysis 18 (1):60-84 (2010)

Authors
Christian Munthe
University of Gothenburg
Abstract
In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship.
Keywords Paternalism  Patient autonomy  Patient best interest  Patient centred care  Patient choice  Shared decision-making  Patient adherence
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DOI 10.1007/s10728-008-0108-6
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References found in this work BETA

Principles of Biomedical Ethics.Tom L. Beauchamp - 1979 - Oxford University Press.
Should Informed Consent Be Based on Rational Beliefs?J. Savulescu & R. W. Momeyer - 1997 - Journal of Medical Ethics 23 (5):282-288.

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Citations of this work BETA

Shared Decision-Making and Patient Autonomy.Lars Sandman & Christian Munthe - 2009 - Theoretical Medicine and Bioethics 30 (4):289-310.
Relational Autonomy as an Essential Component of Patient-Centered Care.Carolyn Ells, Matthew R. Hunt & Jane Chambers-Evans - 2011 - International Journal of Feminist Approaches to Bioethics 4 (2):79-101.
Autonomy, Rationality, and Contemporary Bioethics.Jonathan Pugh - 2020 - Oxford, UK: Oxford University Press.

View all 35 citations / Add more citations

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