Shared decision-making and patient autonomy.
In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice.
Sandman
Lars
L
Department of Philosophy, Linguistics and Theory of Science, Gothenburg University, Sweden. lars.sandman@hb.se
Munthe
Christian
C
D002755:Choice Behavior / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D006801:Humans; D017008:Negotiating; D026706:Paternalism; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D017009:Professional Autonomy; D014342:Truth Disclosure / Q000941:ethics
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