Throughout their lives, patients are frequently faced with making complex medical decisions, requiring them to choose between many options, to face uncertain outcomes, and to weigh the potential benefits and harms of treatment—all decision-making components that are valued differently by each individual. At no time is shared decision-making more important than near the end of life.
Shared decision-making is neither clearly nor consistently defined in the medical literature. However, the essence of shared decision-making moves medical decision-making from the extremes of paternalistic, physician-centered beneficent decisions and patient-autonomous decisions to a person-centered model in which the physician and patient share the process.
Clinical evidence suggests that many patients undergo treatment and procedures that they would decline if fully informed. Failure to communicate the relevant risks, benefits, and alternatives of a procedure violates medical ethics and wastes medical resources. Integrating shared decision-making, a method of communication between the physician or nurse practitioner and patient, into medical decisions can satisfy physicians’ and nurse practitioners’ ethical obligations and reduce unwanted treatment and procedures.
Basic ethical principles are the same no matter where we live. However, laws and regulations vary from state to state. Subsequent to passage of the Patient Self-Determination Act – a federal law that guarantees our right to accept and/or refuse treatment, individual states developed laws and regulations to protect these patient rights, including those who never had the ability to make decisions. New York Public Health Law pertaining to advance care planning, palliative care and pain management is featured as this website is based in New York. Consult your state’s Department of Health for state-specific information on laws and regulations.
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