In his critique of Stiggelbout et al. for their article on shared decision making (1),(2), James Penston chides the authors for their overzealous attitude and endorsement of shared decision making within the clinical context.

His chastisement of the authors appears to be motivated by concerns revolving around the present financial state of the NHS.

While Penston deserves credit for being first to raise a baton in defense of the NHS, his statement that "their case seems to rest on the somewhat dubious mixture of ethical considerations interspersed with claims of possible reduction in healthcare expenditure" (2) should be brought to account.

Why should we look askance at ethical considerations but not at finances? Are NHS doctors not confronted daily with ethical dilemmas?

We are no longer in the Dark Ages. It is imperative that a physician balances self-interest not just against cost, but also against ethical aspirations and the interests of the patient. Ethical issues and cost-effective health care ought not to be mutually exclusive. (3), (4)

Andem Effiong

References

1. Stiggelbout AM, Van der Weijden T, De Wit MPT, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ 2012;344;e256.

2. Penston J. Is real shared decision making possible? Re: BMJ 2012; 344;e256.

3. Maynard A. Is doctors’ self interest undermining the NHS. BMJ 2007; 334:234.

4. Pellegrino, ED. Altruism, Self-interest, and Medical Ethics. JAMA.1987;258(14):1939-1940

Competing interests: None declared