Challenges of shared decision-making in virtual care: Whom should we care for, and how?

• In bioethics, the concept of autonomy is closely related to shared decision making and virtual care. • In virtual care, there is a distinction between users as patients and consumers. • The contrast between consumer-driven care and patient-centred care through shared decision making is pronounced in virtual care. This article examines challenges in implementing shared decision-making within virtual care. Virtual care platforms emphasise quick delivery, patient choice and empowerment, offering convenient access to remote medical consultations at patients’ homes. However, shared decision-making is a collaborative and deliberative process that does not prioritise efficiency and individual decisions over the principles of sound medical practice. Recognised as the gold standard in healthcare, extending shared decision-making to virtual care platforms is indispensable, but it would encounter difficulties in implementation. Combining an empirical methodology with ethical reasoning, an integrated approach facilitates critical discourse on shared decision-making within virtual care settings. This involves an ethical premise concerning shared decision-making norms, followed by an ethical analysis drawing upon empirical findings from literature via keyword searches. Adopting an interdisciplinary perspective, the study merges ethical and social viewpoints to elucidate shared decision-making's significance and policy implications in virtual care. The investigation identifies four significant factors that may challenge implementing shared decision-making within virtual care contexts. These include consumer-like behaviours, the absence of pre-existing relationships, information expansion, and physicians’ evolving roles. It is concluded that a collaborative approach to a caring relationship that focuses on patients’ needs and values, continuity of care, and medical professionalism is essential to this new integration of virtual care and shared decision-making.