Prudence in Shared Decision-Making: The Missing Link between the "Technically Correct" and the "Morally Good" in Medical Decision-Making.

Abstract

Shared Decision-Making is a widely accepted model of the physician-patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise-complementary in nature, equal in importance-is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma's proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.