Medical Decision-Making: An Evaluation of Three Models

Esther Warshauer-Baker, Dartmouth College

There are several models for medical decision-making within the doctor-patient relationship, and this paper discusses three of these models: paternalism, informed decision-making, and shared decision-making. I describe each model and give arguments for the plausibility of each. I conclude that each is problematic. Paternalism, the traditional model, is problematic because it relies on a false ideal of medical certainty, and it devalues patient autonomy. This becomes apparent when one examines medical decisions involved in prostate cancer diagnosis and treatment. Informed decision-making, while possessing the merit of valuing patient autonomy, is also flawed, because it limits the roll of the doctor to a technician and information source, and it calls for an impossible bifurcation between information and values. Shared decision-making is the ideal model for most medical decisions, especially those involving a great deal of medical uncertainty. However, by examining the problem of doctors providing antibiotics to patients who do not have bacterial infections, it becomes clear that shared decision-making is not always appropriate. Doctors may have non-medical incentives to prefer what patients prefer. Indeed, to develop a non-problematic model for medical decision-making, we must take into account the societal and structural context within which medical decisions take place

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