Shared Decision Making and the Role of Maternalism in Resolving Difficult End-of-Life Decisions

We explore the spectrum of shared decision making, specifically the idea of maternalism, which combines patient or surrogate preferences and goals with the clinician's responsibility to provide care within the boundaries of acceptable medical practice. We examine a clinical quandary in which a patient was hospitalized for a prolonged period in a persistent vegetative state and the family and surgical team were at odds, then show how the standoff was resolved by invoking aspects of shared decision making, namely, the use of communication strategies that draw on maternalism and agreement by non-dissent.