Shared Decision-Making and the Role of Maternalism in Resolving Difficult End-of-Life Decisions

We explore the spectrum of shared decision-making, especially the idea of maternalism, which combines patient or surrogate preferences and goals with the clinician's responsibility to provide care within the boundaries of acceptable medical practice. We examine a clinical quandary in which a patient was hospitalized for a prolonged period in a persistent vegetative state and the family and surgical team were at odds, then show how the standoff was resolved by invoking aspects of shared decision-making, namely, the use of communication strategies that draw on maternalism and agreement by nondissent.