From informed consent to shared decision-making

Abstract

Morality in medicine was long dominated by paternalism: the belief, based on the principles of beneficence (best interests) and non-maleficence (no harm), that doctors knew best and only shared information with patients that the doctor felt was necessary. Attitudes today have shifted and there is a recognition that doctors don’t ‘know best’. Patients are entitled to choose for themselves, and respect for patient autonomy (self-determination) is now dominant. Shared decision-making, an approach whereby doctors and patients make decisions together using the best available evidence, extends the respect for patient autonomy beyond the narrow legalistic confines of informed consent. Patient autonomy is respected and patients have the opportunity to engage with the healthcare process. Shared decision-making has become more prominent partly because there is an ethical imperative to involve patients properly in decisions about their care, and partly because there is increasing evidence that this approach has benefits.