Ethical implications of shared decision-making in Parkinson’s disease treatment

Abstract

Shared decision-making (SDM) involves an active participation of the patient in deciding treatment choice, based on his/her preferences, beliefs, and values. In the context of Parkinson's disease (PD), physicians encounter limitations in applying this model related to cognitive decline and other disease-related complications. Discussing the ethics of this approach on the context of these limitations the PD patient suffers is thus of great importance. This review intends to analyze ethical challenges of SDM in PD related to decision-making capacity, surrogates' role in patient's identity, and patients' and physicians' preferences. Although skepticism could arise when dealing with surrogates' decisions, a key for flourishing the patient's autonomy is acknowledging its relational context, as relatives' beliefs and values are imprinted in the patient's identity. To do so, empathy should be encouraged in physicians, recognizing the different value attribution that patients and their relatives have in the decision process.

An overview on the promotion on patient-centered care and shared decision-making in Mexico

“…To know more about them, we carried out a search using keywords both in English and Spanish. We found 11 studies carried out in Mexico [9,13,[15][16][17][18][19][20][21][22]. One of these in process of publication.…”

“…One of these in process of publication. Four studies were published in English [16][17][18]22], and the rest in Spanish. Five of them were original research [16][17][18][19][20], five were literature reviews [9,13,15,[21][22].…”

“…The theoretical importance of SDM to achieve PCC is supported by various authors [9,13,15,22]. Great importance is placed on the instruments designed to promote patient participation in decision making [16,[19][20][21] as is on the analysis of programs and policies that promote SDM [17].…”