Prudent evidence-fettered shared decision making

In its brief tenure evidence-based medicine (EBM) has proven to be a powerful magnet for criticism, while at the same time it has demonstrated impressive resilience. Located within the ongoing critical discourse surrounding the strengths and weaknesses of an EBM approach is the persistent question of the proper place of the social sciences relative to other disciplinary perspectives. This article considers one way the social sciences might usefully illuminate EBM-mediated human interactions to influence policy. We focus on the ethical nexus of the human impulse for unlimited consumption of health care resources in those situations where there exist competing clinical management options and suggest strategies for resource-preserving shared decision making. We conclude that a frugal default option is a fruitful avenue for future exploration in such situations.