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Manipulation and free will in shared decision making.

Regina Christiansen1,2, Jakob Emiliussen1,2

  • 1Department for the Study of Culture, University of Southern Denmark, Odense, Denmark.

Journal of Evaluation in Clinical Practice
|September 19, 2019
PubMed
Summary

Patient involvement in healthcare is key. Shared decision-making aims to balance patient preferences with clinical expertise, ensuring informed choices and avoiding paternalism through a focus on reasons-responsiveness.

Keywords:
health carehealth services researchhumanitypatient-centred carephilosophy of medicine

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Area of Science:

  • Bioethics
  • Medical Ethics
  • Philosophy of Medicine

Background:

  • Growing emphasis on patient involvement in healthcare decision-making.
  • Introduction of shared decision-making (SDM) to mitigate clinician paternalism.
  • SDM aims for informed patient choices by integrating evidence with patient needs and preferences.

Purpose of the Study:

  • To analyze the extent to which paternalism can be avoided in clinical practice.
  • To explore the application of the philosophical theory of reasons-responsiveness to patient autonomy.
  • To examine the clinician's role in the context of patient involvement and expertise.

Main Methods:

  • Theoretical analysis using the philosophical concept of reasons-responsiveness.
  • Examination of the clinician's authoritative role and knowledge.
  • Discussion on the extent of patient free will and control in treatment planning.

Main Results:

  • Clinician's role as an authority with expertise presents challenges to fully avoiding paternalism.
  • Reasons-responsiveness theory offers a framework to understand patient autonomy and control.
  • The clinician's role is best understood as an ally, not a manipulator, in the decision-making process.

Conclusions:

  • Shared decision-making requires careful consideration of the clinician's expertise and the patient's autonomy.
  • The clinician-patient relationship can be framed as a partnership, guided by reasons-responsiveness.
  • Balancing clinical authority with patient preferences is crucial for ethical and effective healthcare.