Korean J Med Ethics.  2024 Sep;27(3):155-176. 10.35301/ksme.2024.27.3.155.

Shared Decision-making: What is Shared? Who Decides? How is the Decision Made?

• Choi K

• KMID: 2577653
• DOI: http://doi.org/10.35301/ksme.2024.27.3.155

Abstract

In this article, I analyze the concept of shared decision-making to explain what is shared, who decides, how the decision is made, and how shared decision-making differs from informed consent. Building on the work of Veatch and Charles, I argue that shared decision-making has two essential features: (a) it helps patients make decisions while respecting their right to self-determination, and (b) it maintains the integrity of both physicians and patients. Furthermore, using the three-talk model and the six steps approach to shared decision-making, I explicate the concept of “mutual acceptance,” which is central to this process. Mutual acceptance of the final decision is a two-step process: physicians first formulate options that align with their own integrity, and then patients deliberate and choose the options that best suit their needs, wishes, and constraints. Thus, I argue that mutual acceptance represents physicians’ acceptance of their patients’ final decisions. Furthermore, the closer the original options are to equipoise, the less psychological burden physicians will experience regarding the choices their patients make.

Keyword

shared decision-making; informed consent; right to self-determination; integrity; mutual acceptance; equipoise