The Ethics of Shared Decision Making
Helps patients understand the nature of the choices that they face when they must decide among alternative medical treatments
Edited by John Lantos
Oxford University Press
Patients today are more empowered and knowledgeable than they have ever been. By law, they must be told about the risks and benefits of proposed treatments and give informed consent before treatment is initiated. Through the democratization of medical information, they have access to peer-reviewed medical journals. Social media allows patients to share stories with others and to learn about other people's experiences with various treatments. There are websites written by experts at leading medical schools to help patients understand diseases and treatments. They have the right to see their medical records. The net result of all changes is a shift in the power balance between doctors and patients. Ideally, as a result of these shifts, the patients' values and preferences should guide treatment decisions.
However, this proliferation of information often leads to confusion rather than clarity. Publicly available information often includes seemingly contradictory conclusions and recommendations. Patients don't know which opinions to trust. So, although patients have more information than ever, and many want to make decisions for themselves, they need more guidance than ever to help them process an avalanche of information.
This volume aims to help both medical professionals and their patients navigate the evolving healthcare landscape by analyzing the process of shared decision-making (SDM) in clinical medicine. The concept of SDM has emerged in the last two decades as a middle ground between, on the one hand, old-fashioned physician paternalism of the "doctor-knows-best" variety and, on the other hand, unfettered patient autonomy by which patients are thought capable of individually and independently choosing their own medical interventions. Advocates of SDM imagine that decisions will be made best if
they follow a complex discussion and negotiation between doctor and patient; such discussions should incorporate the doctor's medical and technical expertise as well as the patient's goals, values, and preferences. SDM takes different forms for different patients in different clinical circumstances.
"Helps patients understand the nature of the choices that they face when they must decide among alternative medical treatments"
"Advises doctors on how to structure choices, promote patient autonomy, and communicate complex ideas"
"Authors comprise a multidisciplinary group, whose background and experiences complement each other and allow for a deep understanding of the complexity of shared decision making"
About the Author
John Lantos grew up in the rugged mountains of western Pennsylvania coal country. His father, a physician, was his childhood hero and role model. His mother, a poet at heart, inspired him to become a writer. He is an award-winning pediatrician, a prolific author, a beloved teacher, and an inspirational speaker.
Lantos was a resident in DC during the national controversy about Baby Doe, a baby with Down Syndrome. That sparked a lifelong interest in bioethics and led to a post-doc fellowship at The University of Chicago. There, his groundbreaking work on neonatal bioethics and health policy led to leadership roles as Chief of General Pediatrics and Associate Director of the MacLean Center for Clinical Medical Ethics, and Associate Editor of Pediatrics. Fifteen years ago, he moved to Kansas City to create and develop the Children’s Mercy Bioethics Center.