Shared decision making

Trade-offs between narrower and broader conceptions

A. Cribb, V.A. Entwistle

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Shared decision-making approaches, by recognizing the autonomy and responsibility of both health professionals and patients, aim for an ethical 'middle way' between 'paternalistic' and 'consumerist' models of clinical decision making. Shared decision making has been understood in various ways. In this paper, we distinguish narrow and broader conceptions of shared decision making and explore their relative strengths and weaknesses. In the first part of the paper, we construct a summary characterization of an archetypal narrow conception of shared decision making (a conception that does not coincide with any specific published model but which reflects features of a variety of models). We show the shortcomings of such a conception and highlight the need to broaden out our thinking about shared decision making if the ethical (and instrumental) goals of shared decision making are to be realized. In the second part of the paper, we acknowledge and explore the advantages and disadvantages of operating with broader conceptions of shared decision making by considering the analogies between health professional-patient relationships and familiar examples of 'open-ended' relationships (e.g. friendships). We conclude by arguing that the illustrated 'trade-offs' between narrow conceptions (which may protect patients from inappropriately paternalistic professionals but preclude important forms of professional support) and broad conceptions (which render more forms of professional support legitimate but may require skills or virtues that not all health professionals possess) suggest the need to find ways, in principle and in practice, of taking seriously both patient autonomy and autonomy-supportive professional intervention.
Original languageEnglish
Pages (from-to)210-219
Number of pages10
JournalHealth Expectations
Volume14
Issue number2
Early online date19 May 2011
DOIs
Publication statusPublished - Jun 2011

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Decision Making
Professional-Patient Relations
Health
Professional Autonomy

Keywords

  • autonomy
  • clinical ethics
  • patient participation
  • professional-patient relations
  • shared decision-making

Cite this

Shared decision making : Trade-offs between narrower and broader conceptions. / Cribb, A.; Entwistle, V.A.

In: Health Expectations, Vol. 14, No. 2, 06.2011, p. 210-219.

Research output: Contribution to journalArticle

Cribb, A. ; Entwistle, V.A. / Shared decision making : Trade-offs between narrower and broader conceptions. In: Health Expectations. 2011 ; Vol. 14, No. 2. pp. 210-219.
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