J Med Ethics 36:349-352 doi:10.1136/jme.2009.033282
  • Clinical ethics

Medical decision-making and communication of risks: an ethical perspective

  1. Christof Breitsameter
  1. Correspondence to Dr Christof Breitsameter, Institut für Moraltheologie, Faculty of Catholic Theology, University of Bochum, Bochum D-44780, Germany; christof.breitsameter{at}
  • Received 6 October 2009
  • Revised 14 January 2010
  • Accepted 18 January 2010
  • Published Online First 28 May 2010


The medical decision-making process is currently in flux. Decisions are no longer made entirely at the physician's discretion: patients are becoming more and more involved in the process. There is a great deal of discussion about the ideal of ‘informed consent’, that is that diagnostic and therapeutic decisions should be made based on an interaction between physician and patient. This means that patients are informed about the advantages and disadvantages of a treatment as well as alternatives to the treatment; then, based on this information they can decide whether or not they want to undergo the treatment. However, recent studies show that the realisation of the ideal of ‘shared decision-making’ faces a number of difficulties related to the fact that patients are not provided with complete and accurate information. Using the example of breast cancer screening, this article examines the question of whether, in light of these difficulties, the ideal of informed decision-making is only an illusion or whether concrete steps can be taken towards the realisation of this ideal.


  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.