Ethical borders of shared decision-making in young athletes with cardiac disease at risk

Implementation of the shared decision making (SDM), by actively engaging the patient in developing an informed decision regarding the management of the cardiac condition, is highly recommended in the clinical practice. However, implementation of the SDM may be challenging and may occasionally show limitations and potential pitfalls in managing professional athletes with cardiac conditions at risk. As exemplified by cases here described, the assessment of individual risk profile may result particularly difficult when the diagnosis remains equivocal or controversial; indeed, it generates a conflict between the medical viewpoint based on prudence vs. the athlete's personal aspiration for progression in the professional career. Non rarely, there is difficulty in balancing the athlete's desires with medical safety, and we should start asking ourselves when it is ethically correct to set limits on athlete's ambitions. It is ethically correct for a physician prioritize the patient's desires and aspirations over a more prudent medical management, especially when the risk of an adverse event is high? While we pay full respect for the patient's values, we believe that medical decisions in such unequivocally risky situations should prioritize the patient's well-being and minimize the risk, regardless of other considerations linked to professional opportunities, financial gains, and personal fame.