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Shared Medical Decision Making
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To the Editor: Paternalism in medical care is dead; long live neopaternalism. Such is the disheartening conclusion we reach upon reading Dr McNutt’s Commentary on shared medical decision making.1 Arguing for a model of informed decision making based upon a concept of mandatory autonomy, McNutt asserts that "the consequences of a patient’s choices cannot be shared with anyone else," and therefore, "physicians should never make a choice for a patient—even if the patient wants [it]." Furthermore, he believes that patients, when required to reflect on quantified benefits and burdens of treatment, "will learn to accept the responsibility of choosing" and follow a utilitarian model of "the best course of action for decision making."
We disagree for 3 reasons. First, ironically, McNutt’s claims regarding the ideal mode of decision making lack the very quantitative elements about benefits and burdens that he maintains should be the foundation of shared decision making. Scant . . . [Full Text of this Article]
Maria J. Silveira, MD, MA, MPH
mariajs@umich.edu
Health Services Research and Development Center of Excellence
Ann Arbor Veterans Administration Medical Center
Ann Arbor, Mich
Chris Feudtner, MD, PhD, MPH
The Pediatric Generalists Research Group
The Children’s Hospital of Philadelphia
Philadelphia, Pa
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