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Sliding-Scale Shared Decision Making for Patients With Reduced Capacity.

Tim Lahey¹, Glyn Elwyn²

¹Director of ethics at the University of Vermont Medical Center, professor of medicine at the University of Vermont Larner College of Medicine in Burlington.

AMA Journal of Ethics

|May 26, 2020

Summary

Shared decision making respects patient autonomy but is difficult with impaired capacity. This paper introduces a capacity-adjusted "sliding scale" approach for shared decision making in such cases.

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Area of Science:

Medical Ethics
Patient Autonomy
Clinical Decision Making

Background:

Shared decision making (SDM) is crucial for preference-sensitive medical choices.
Patient autonomy is a core ethical principle in healthcare.
Impaired decision-making capacity presents challenges to effective SDM.

Purpose of the Study:

To propose a novel approach to shared decision making for patients with impaired capacity.
To adapt the principles of SDM to varying levels of patient decision-making ability.

Main Methods:

Presentation of an illustrative case example.
Development of a capacity-adjusted "sliding scale" model for SDM.
Conceptual framework for ethical application of the proposed model.

Main Results:

The proposed "sliding scale" offers a structured method to engage patients with impaired capacity in decision making.
This approach aims to maximize patient involvement appropriate to their cognitive abilities.
It provides a practical framework for clinicians navigating complex ethical scenarios.

Conclusions:

A capacity-adjusted "sliding scale" can facilitate shared decision making for patients with impaired capacity.
This model supports patient autonomy while acknowledging limitations in decision-making ability.
Further research and clinical implementation are warranted to refine and validate this approach.