Honoring Informed Consent and Shared Decision-Making: Ethical Considerations

Medical literature suggests that a shift towards shared decision-making has been ongoing for more than 40 years and has coincided with a transition in medicine from paternalism toward greater patient autonomy in decision making. While many definitions of shared decision-making have been developed, most describe a collaborative process where the physician's medical expertise and the patient's values and goals are considered when evaluating and deciding on treatment options. Patient decision aids and other tools, including ethics consultations, may be used to promote the shared decision-making process. Ongoing challenges for physicians include variation among patients concerning the extent to which the patient wants to participate in making decisions, and shifting patient perspectives on their treatment decisions. The use of the internet, social media and the growth of direct to consumer advertising, as well as the rapidly expanding use of artificial intelligence, may create additional challenges to shared decision-making. Finally, challenges may develop if perspectives are misaligned and the patient requests drugs or treatments that conflict with a physician's personal ethics or deeply held beliefs. Shared decision-making is a fluid process requiring an ongoing commitment and engagement with patients.