The Ethics of Shared Decision Making

After enthusiastically welcoming the participation of patients in shared decision making, physicians are sorting out what, exactly, the term means. How much medical information must patients have in order to “share” meaningfully in treatment decisions? How much information is too much? Are statistical probabilities of risk and benefit helpful to patients? Should physicians only offer those diagnostic and treatment alternatives that they believe are in the patient’s best interest? This month’s authors explore the legal and ethical demands and limits of shared decision making.

Volume 14, Number 7: 527-598 Full Issue PDF
  • Case and Commentary
    Jul 2012

    Discounting a Surgical Risk: Data, Understanding, and Gist

    Peter H. Schwartz, MD, PhD
    The physician must help patients understand that all options—further testing, surgery, no action—carry risks and benefits. Disclosing the statistical probability of injury and other possible outcomes might help, but it can also hinder the process.
    Virtual Mentor. 2012;14(7):532-538. doi: 10.1001/virtualmentor.2012.14.7.ecas1-1207.
  • Case and Commentary
    Jul 2012

    When Patients Seem Overly Optimistic

    Jane deLima Thomas, MD
    After assessing the reasons for a patient’s unrealistic hopefulness in the face of clear understanding, a clinician may believe that significant harm will come to the patient if he or she does not acknowledge the seriousness of the illness.
    Virtual Mentor. 2012;14(7):539-544. doi: 10.1001/virtualmentor.2012.14.7.ecas2-1207.
  • Case and Commentary
    Jul 2012

    The Use of Informed Assent in Withholding Cardiopulmonary Resuscitation in the ICU

    J. Randall Curtis, MD, MPH
    Informed assent, in which the family or surrogate decision makers for a patient are invited to defer to clinicians' judgment rather than specifically consenting to withholding or withdrawing futile treatments, is consistent with quality care and may protect surrogates from feeling responsible for the patient’s death.
    Virtual Mentor. 2012;14(7):545-550. doi: 10.1001/virtualmentor.2012.14.7.ecas3-1207.
  • Medical Education
    Jul 2012

    Investing in Each Other: Balint Groups and the Patient-Doctor Relationship

    Steve Crossman, MD
    Balint groups, discussion groups for medical students to reflect on their relationships with patients, are an effective way of investing in the patient-physician relationship.
    Virtual Mentor. 2012;14(7):551-554. doi: 10.1001/virtualmentor.2012.14.7.medu1-1207.
  • In the Literature
    Jul 2012

    Exploring Physicians' Attitudes about and Behavior in Communicating with Patients

    Sorcha A. Brophy
    A survey suggests that there is broad consensus among physicians about the importance of honesty with patients, but there is variation in physicians' behavior in disclosing certain information to patients.
    Virtual Mentor. 2012;14(7):557-559. doi: 10.1001/virtualmentor.2012.14.7.jdsc1-1207.
  • Health Law
    Jul 2012

    Informed Consent: What Must a Physician Disclose to a Patient?

    Bryan Murray
    Requirements for informed consent are relatively vague and the exceptions are few, so it is in the physician’s best interest to inform patients about proposed treatment options, ascertain that they understand their choices, and secure their consent.
    Virtual Mentor. 2012;14(7):563-566. doi: 10.1001/virtualmentor.2012.14.7.hlaw1-1207.
  • Policy Forum
    Jul 2012

    Vermont's Single-Payer Health Care System: An Interview with Allan Ramsay

    Claire K. Ankuda, MD, MPH
    An interview with Allan Ramsay, one of the five appointed members of the Green Mountain Care Board, which oversees the development of Vermont’s single-payer health care system.
    Virtual Mentor. 2012;14(7):567-570. doi: 10.1001/virtualmentor.2012.14.7.pfor1-1207.
  • Medicine and Society
    Jul 2012

    The Role of Perception in Quality Communication

    Judith A. Hall, PhD
    There is evidence that physicians' communication styles and ability to perceive others' emotional states correlate with better health outcomes and patient adherence.
    Virtual Mentor. 2012;14(7):571-575. doi: 10.1001/virtualmentor.2012.14.7.msoc1-1207.
  • Viewpoint
    Jul 2012

    Informed Consent for Off-Label Use of Prescription Medications

    Zain Mithani, MD
    Whether or not to inform patients of off-label drug prescribing has been the subject of heated debate for a long time, with convincing arguments made on both sides of the issue and no consensus reached.
    Virtual Mentor. 2012;14(7):576-581. doi: 10.1001/virtualmentor.2012.14.7.oped1-1207.
  • Viewpoint
    Jul 2012

    Selective Paternalism

    Brian C. Drolet, MD and Candace L. White, MD, MA
    While respecting patient autonomy and involving patients in decision making, physicians must recognize that some situations call for them to exercise selective paternalism in order to fulfill their professional duty to uphold standards of care.
    Virtual Mentor. 2012;14(7):582-588. doi: 10.1001/virtualmentor.2012.14.7.oped2-1207.