Choosing how to decide: empowering patients for shared decision-making in end-of-life care

Abstract Shared Decision-Making (SDM) is a process wherein patients and clinicians make healthcare decisions collaboratively. There are two main versions of SDM. The first is narrow SDM, wherein the clinician’s role is limited to things like providing information and eliciting (without challenging) the patient’s preferences. The second is broad SDM, wherein the clinician participates in the decision-making in various additional ways (e.g., by providing recommendations). In this paper, I argue that there are cases where a patient would not be wronged by a clinician letting them choose from a range of versions of SDM – including narrow SDM and types of broad SDM – for an end-of-life treatment decision. This paper’s structure is as follows. First, I explain my proposal. Second, I provide a brief rationale for it. Third, I thoroughly defend it from the likeliest objection, which holds that clinicians in the relevant cases should offer only narrow SDM because broad SDM would unduly influence patients. This paper’s originality comes from (i) presenting a new and uniquely detailed proposal for when and how to offer versions of SDM and (ii) exploring the ethical implications of a patient’s choice of a version, understood as an act of consent. The main purpose of my proposal’s many details is to maximize how much the SDM would advance patient autonomy (and, secondarily, patient wellbeing).