Editor's Note: Parallel Paper Presentation from CBHD's 2009 Annual Conference, Global Bioethics: Emerging Challenges Facing Human Dignity

Abstract: Paternalism is often invoked in circumstances that it does not apply. Any physician that dares to share an opinion or give direction to a patient or proxy is accused of this pejorative. Paternalism clearly occurs when a physician decides for a patient and does not communicate the decision with the patient, thus not presenting burdens, benefits, or alternatives. If the decision is discussed can it be paternalism? How directive would shared decision making have to be to be labeled paternalistic? Does the term really help? If the decision is communicated, in some since it becomes shared decision making, as the patient at very least has the opportunity to refuse his physician’s plan. Shared decision making has been heralded as the great victor over the evil paternalism. However, sharing in the decision making does not guarantee a just process or good decision. Shared decision making can be done well and it can be done poorly. Further, several styles of shared decision making exist and some are ethically defensible while others are not.

This presentation discusses paternalism and 6 styles of shared decision making, examining whether each style is ethically defensible. The spectrum spans from least directive to most: abdication, informational, guidance, persuasion, manipulation, and coercion. Clinical examples of each will be given. A suggested model to improve when to utilize each style will also be offered.