Does shared decision making respect a patient's relational autonomy?

Abstract

According to many of its proponents, shared decision making (“SDM”) is the right way to interpret the clinician‐patient relationship because it respects patient autonomy in decision‐making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, this paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy.

Ethics and palliative care: a case of patient’s autonomy

“…Sometimes patients’ autonomy is compromised due to severe physical decline, cognitive impairment, and/or emotional distress. In these situations, decision-making is automatically resigned to other people, such as a family member, a surrogate or a health-care team member ( 5 , 6 ).…”

Toma de decisiones compartidas en salud mental: una propuesta novedosa

“…Varios autores establecen que la TDC es un proceso que promueve la autonomía relacional de los pacientes, no sólo para poner en valor lo que el paciente necesita, sino que involucra a otras personas en el proceso de toma de decisiones, recuperando el contexto relacional del paciente como co-constituyente de la identidad del paciente y, como tal, necesariamente presente en el proceso de la toma de decisiones (35,36,37). En una posición crítica, otros autores sostienen que el término «compartido» en la TDC otorga más autoridad a los médicos y que no respeta el lugar decisorio de los pacientes (38,39,40).…”

“…Several authors state that SDM is a process that promotes patients’ relational autonomy, not only to value what the patient needs, but also to involve other people in the decision-making process, recovering the patient’s relational context as a co-constituent of the patient’s identity and, as such, necessarily present in the decision-making process ( 35 , 36 , and 37 ). In a critical position, other authors argue that the term «shared» in SDM seems to give more authority to physicians and that it does not respect the decision-making place of patients ( 38 , 39 , and 40 ).…”

Decisional capacity determination and serious mental illness in oncology: Implications for equitable and beneficent care

“…On the other hand, this standardized cross‐sectional approach may not allow for the appreciation of factors that make up the patient's worldview and influence how the patient may interact with medical professionals at a given encounter. The longitudinal aspects of care are often not adequately appreciated for patients with SMI and impaired relational ability that is otherwise necessary for SDM 13 . For medical teams, the permissiveness of care (i.e., is this the right clinical decision?)…”

“…The longitudinal aspects of care are often not adequately appreciated for patients with SMI and impaired relational ability that is otherwise necessary for SDM. 13 For medical teams, the permissiveness of care (i.e., is this the right clinical decision?) can be confused with obtaining a positive DMC determination.…”