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When Shared Decision-Making Breaks Down: Solving Moral Dilemmas in Antipsychotic Deprescribing
Helene Speyer1, Ju Zhang, John Lysaker
1From Copenhagen Research Center for Mental Health-CORE, Copenhagen, DK (Dr. Speyer); Center for Ethics, Emory University, Atlanta, GA (Drs. Zhang and Lysaker); Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, IL (Dr. Roe).
Harvard Review of Psychiatry
|May 9, 2025
Summary
Shared decision-making (SDM) often fails when patients with psychosis and providers disagree on antipsychotic medication. Shared deliberation offers a new model for resolving these conflicts through mutual value sharing.
Area of Science:
- Psychiatry
- Psychology
- Philosophy
Background:
- Many individuals with psychosis attempt to discontinue antipsychotic medications.
- Disagreements between service users and healthcare providers can impede treatment adherence.
- Shared decision-making (SDM) is a key component of patient-centered care.
Purpose of the Study:
- To examine breakdowns in SDM during antipsychotic medication discontinuation.
- To explore philosophical, psychological, and psychiatric perspectives on healthcare disagreements.
- To propose shared deliberation as a model for resolving SDM failures.
Main Methods:
- Analysis of three clinical case snapshots illustrating SDM breakdown.
- Application of philosophical, psychological, and psychiatric frameworks to understand disagreement.
- Conceptualization of shared deliberation as an alternative model.
Main Results:
- SDM failures in medication discontinuation are common.
- Disagreement stems from differing values and perspectives.
- Shared deliberation offers a structured approach to navigate these conflicts.
Conclusions:
- Shared deliberation can facilitate resolution when SDM fails.
- An iterative process of mutual value sharing is crucial.
- This model moves beyond binary decision-making in psychiatric care.
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