Comparativism and the Grounds for Person-Centered Care and Shared Decision Making

Area of Science:

• Bioethics
• Clinical Decision-Making
• Health Policy

Background:

• Current justifications for person-centered care and shared decision-making (SDM) often rely on achieving good health outcomes or ethical principles like patient autonomy.
• Clinical settings frequently present situations of comparative non-determinacy, where no single treatment is demonstrably superior to all others.
• The existing framework may not fully capture the unique value proposition of SDM in navigating these complex, non-deterministic choices.

Purpose of the Study:

• To propose a novel value-theoretical argument for person-centered care and SDM, grounding its justification in the preservation of rationality.
• To explore how SDM can enable rational decision-making when faced with non-deterministic clinical choices.
• To redefine the role and application of SDM based on this new theoretical foundation.

Main Methods:

• The study adapts Ruth Chang's philosophical argument on invoking reasons through acts of willing to address clinical decision-making.
• It analyzes the concept of comparative non-determinacy in treatment selection.
• A theoretical framework is developed to link SDM with the preservation of rational choice under uncertainty.

Main Results:

• Shared decision-making (SDM) is presented as a mechanism to resolve non-determinacy problems in clinical settings, enabling rational choices.
• The preservation of rationality, rather than solely focusing on outcomes or autonomy, offers a robust justification for SDM.
• This perspective provides a new understanding of SDM's nature and its appropriate application in patient care.

Conclusions:

• Person-centered care and SDM are fundamentally valuable for enabling rational decision-making, especially when faced with complex clinical uncertainties.
• The theoretical grounding of SDM in preserving rationality offers a clearer framework for determining when its use is most appropriate.
• This approach enhances our understanding of the core function of SDM in empowering patients and clinicians to navigate non-deterministic choices.