Huddle Thomas
Kennedy Inst Ethics J. 2016;26(4):457-482. doi: 10.1353/ken.2016.0038.
The recommended model for patient participation in medical decision-making is the shared decision-making model (SDM). That model is ambiguous as to how much physician influence on patient decision-making is desirable or permissible. Most discussants suggest that physician influence on medical decisions, while allowable, should be limited. Empirical studies of medical decision-making have shown that much medical practice does not conform to the SDM. The author recommends a different model for medical decision-making, "professional norm-guided medical decision-making," which, he suggests, much medical practice actually follows. This model does not defer to patient autonomy to the extent usually recommended by the SDM and permits a greater degree of physician influence on patient medical decisions than usual versions of that model. Having described the working of the the professional norm-guided decision-making model, the author specifies the form of patient autonomy respected by it and offers a case for preferring this model of medical decision-making to the SDM.
推荐的患者参与医疗决策的模式是共同决策模式（SDM）。该模式对于医生对患者决策的影响程度在多大程度上是可取的或可允许的并不明确。大多数讨论者认为，医生对医疗决策的影响虽然是允许的，但应该受到限制。医疗决策的实证研究表明，许多医疗实践并不符合共同决策模式。作者推荐了一种不同的医疗决策模式，即“专业规范指导的医疗决策”，他认为许多医疗实践实际上遵循的就是这种模式。该模式不像共同决策模式通常所推荐的那样尊重患者自主权，并且比该模式的常见版本允许医生对患者医疗决策有更大程度的影响。在描述了专业规范指导的决策模式的运作之后，作者明确了它所尊重的患者自主权的形式，并提出了一个比起共同决策模式更喜欢这种医疗决策模式的理由。
