Decision-making in nephrology: shared decision making?

Shared decision-making is considered an important ideal for physician-patie nt interaction. The ideal states that health-related values should be discu ssed together. It raises two questions: (a) for which decisions is the idea l of shared decision-making relevant? (b) Which aspects of treatment should be discussed? The nephrological practice under consideration in this artic le answers question (a) as follows: decisions about the type of dialysis ar e shared decisions, while decisions about the moment to start dialysis are medical decisions that should be taken by nephrologists. This situation can be criticized as important health-related values play a role in decisions about starting dialysis. Question (b) is answered in the nephrological prac tice under consideration by discussing at least all important health-relate d aspects that raise uncertainty about its worth for a patient. This approa ch to question (b) is morally and practically defensible. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.