The Case Against Shared Decision-Making

To conclude this 3-part series, I will discuss the relationship between shared decision-making (SDM) and evidence-based medicine (EBM), as the two are intimately connected.

As I indicated in part 1, SDM did not attract the attention of academics until the late 1990s.  It is only then that publications on SDM began to appear routinely in the medical literature, and their numbers have exploded since the early 2010s (see chart).  Yet shared decision-making was proposed by the Presidential Commission’s ethicists as far back as 1982.  What accounts for the delay in interest?

The simple answer is that the development of SDM had to wait for the appearance of the evidence-based medicine movement on the healthcare scene in the early 1990s.  And it makes perfect sense that SDM would require EBM to flourish, since EBM was proposed precisely as a scientific and objective antidote to “eminence-based medicine,” which is one expression of the culture of medical paternalism that SDM was supposed to be countering.

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