[Shared decision-making: ethical issues]

ETHICAL ISSUES. Shared decision-making is a decision-making model and a model of interaction between healthcare professionals and healthcare users. Putting together medical-scientific data, experience, values and preferences of the caregiver on the one hand, and knowledge, needs, expectations, values andpreferences of the patient on the other, leads, if both parties wish so, to a discussion followed by a decision based on a common agreement. Cancer area, either in screening or treatment, in the curative or palliative phase, is well suited to shared decision-making. Shared decision-making is based on ethical principles and classical philosophical streams. Autonomy principle is in the foreground but must not become "an ethical injunction". The relationship between caregiver and patient should recognize above all ability and willingness to participate, or not, in decision-making. Key issues are those of mutual listening, uncertainty recognition and the role of emotions as powerful ethical levers.