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Does shared decision making respect a patient's relational autonomy?

Jonathan Lewis1

  • 1Institute of Ethics, Dublin City University, Dublin, Ireland.

Journal of Evaluation in Clinical Practice
|June 1, 2019
PubMed
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Shared decision making (SDM) is often seen as respecting patient autonomy. However, this paper argues standard SDM approaches may actually undermine relational autonomy and patient self-governance.

Area of Science:

  • Bioethics
  • Clinical Decision-Making
  • Patient Autonomy

Background:

  • Shared decision making (SDM) is widely promoted as ethically ideal for the clinician-patient relationship.
  • SDM is claimed to uphold patient autonomy, particularly relational autonomy, which relies on social and interpersonal factors.
  • Existing ethical frameworks for SDM may not fully capture the complexities of patient autonomy.

Purpose of the Study:

  • To challenge the assertion that standard shared decision making (SDM) respects patient autonomy.
  • To analyze how SDM impacts relational autonomy through two distinct theoretical lenses.
  • To identify ethical obligations for respecting relational autonomy within clinical practice.

Main Methods:

  • Conceptual analysis of shared decision making (SDM) in relation to autonomy.
Keywords:
consentmedical decisionsrecognitionrelational autonomyshared decision makingsovereignty

Related Experiment Videos

  • Examination of two primary philosophical approaches to relational autonomy.
  • Ethical argumentation regarding the alignment of SDM with respect for patient autonomy.

    • Main Results:

    • Standard models of shared decision making (SDM) may inadvertently diminish patient autonomy.
    • The concept of relational autonomy requires a deeper consideration of interpersonal and social contexts than typically addressed in SDM.
    • Current SDM accounts overlook crucial obligations necessary for truly respecting patient autonomy.

    Conclusions:

    • Shared decision making (SDM) requires re-evaluation to ensure it genuinely supports, rather than undermines, patient autonomy.
    • Respecting relational autonomy necessitates a more nuanced approach that integrates patient relationships and social conditions into decision-making.
    • Clinical practice must adopt updated ethical obligations to align with the principle of respect for relational autonomy.