“Informed choice” in a time of too much medicine—no panacea for ethical difficulties
Date of this Version
Providing information to enable informed choices about healthcare sounds immediately appealing to most of us. But Minna Johansson and colleagues argue that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may inadvertently advance overmedicalisation
The idea of informed patients who make reasoned decisions about their treatment based on personal preferences is appealing in a Western cultural context, with its focus on the autonomous individual. Rightly, many doctors now reject paternalism if the patient does not specifically ask for it. They prefer to elicit the patient’s preferences and embrace an open discussion of risks and benefits of different options within a shared decision making approach. However, the rise of preventive medicine, the transformation of risk factors and common life experiences into diseases, and the lowering of diagnostic thresholds have changed the ethical premises of informed choice by pushing responsibility on to often ill prepared citizens. We call for careful reflection on the potential downsides of trusting informed choice to resolve ethical problems and complex value judgments in an era of “too much medicine.”
This document has been peer reviewed.