Intended for healthcare professionals


The role of risk communication in shared decision making

BMJ 2003; 327 doi: (Published 25 September 2003) Cite this as: BMJ 2003;327:692
  1. William Godolphin, professor of pathology (
  1. University of British Columbia, Vancouver, BC, Canada V6T 2B5

    First let's get to choices

    I want to feel like a rational and autonomous person, even when I'm ill. Doctors ought to use their power (legal and knowledge) not only to relieve suffering but to enhance patients' autonomy.1 A prescription for this is shared decision making, a middle ground between “nanny knows best” paternalism and rampant consumerism–an ideal that aims to reconcile the fact of professional power with the ethic of informed choice.

    Laws are leaning towards informed choice. For example, the supreme court of Canada in 1980 ruled that doctors have a legal obligation to disclose, unasked, whatever a reasonable person in that patient's particular position would want to know before making a decision. The ethical positions of medical guilds have more or less followed suit: “Duties of a doctor [are to] give patients information in a way they can understand; respect the rights …

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