Experience Matters

A patient-centered approach to medical decision making empowers patients but it also imposes new responsibilities upon them. Shared decision making neither relieves physicians of their obligation to guide patients when necessary nor obligates them to agree to patient requests that run counter to their deeply held moral convictions and professional integrity. The patient–physician relationship is now a reciprocal one, with rights and responsibilities on both sides. In this chapter, we will present clinical scenarios that illustrate ethical challenges that often arise during shared decision making, outline ethical principles that pertain to the scenarios, and describe key strategies and skills that physicians need to partner with the patient and family to develop the best plan of care.