INTRODUCTION
In this analysis we challenge the conceptual honesty of ‘shared decision making’, arguing that, although it is held up as an ideal decision-making standard, it is used too often to describe (and justify) decision-making practices that are not shared at all. This is problematic because, if the legitimacy of a decision relies on it being ‘shared’, but it is not in fact shared, the decision loses legitimacy, or is falsely legitimised by the appearance of being shared. We argue that the realities of clinical practice mean that genuinely shared decision making is not completely impossible but difficult to achieve in a sincere and just manner. We articulate an intentionally controversial stance, with the aim of generating thought and debate.
DECISION MAKING AND THE CLINICIAN/PATIENT RELATIONSHIP
Shared decision making has been offered as a way of better respecting patient autonomy, leading to management plans or actions that are in tune with patient values and therefore improving concordance. It provides a platform for respecting autonomy while avoiding abandoning patients to their autonomy, by giving them information without assistance in interpretation; this allows them to arrive at informed decisions that are in accord with their beliefs, values, and preferences. This ideal accords with the deliberative model of the clinician/patient relationship put forward by Emmanuel and Emmanuel being morally preferable to a paternalistic or informative/commercial relationship.1
In arguing that shared decision making is the pinnacle of patient-centred care, Barry and Edgman-Levitan describe it in the following terms:
‘… the clinician offers options and describes their risks and benefits, and the patient expresses his or her preferences and values. Each participant …