Concepts of health, ethics, and communication in shared decision making


  • Lauris Christopher Kaldjian Carver College of Medicine, University of Iowa



communication, concepts of health, dialogue, ethics, medicine, shared decision making


Shared decision making depends on respectful dialogue that allows patients and clinicians to discuss medical facts and the beliefs and values that give them meaning for a particular patient. This dialogue is most likely to succeed when tests and treatments are placed within a purpose-oriented landscape that sets goals of care in the foreground so that the direction of decision making is clear before too much focus is placed on interventional options. The beliefs and values that guide patients allow them to identify and prioritize their most important goals of care in light of other dimensions of decision making. These beliefs and values will also reveal concepts of health that anchor goals of care. When patients and clinicians disagree about treatments or goals, it may be because a clinician is guided by a biostatistical concept of health, while a patient is guided by one that prioritizes well-being. Such disagreements may also be described in terms of patient preference (autonomy) and the clinician’s assessment of the patient’s best interests (beneficence). By probing the beliefs and values that explain goals of care and concepts of health, dialogue can help reconcile disagreements in shared decision making. And even when resolution is not forthcoming, and a decision must be ‘un-shared’, dialogue can demonstrate respect for patients through the consideration clinicians show when they take time to understand and explain.

Author Biography

Lauris Christopher Kaldjian, Carver College of Medicine, University of Iowa

Lauris Kaldjian received his Md from the University of Michigan and PhD in Christian ethics from Yale University. He is a Professor and the director of the Program in Bioethics and Humanities at the Carver College of Medicine, University of Iowa. His research interests include physician–patient communication, philosophical and religious beliefs in clinical decision making, and ethics education.




How to Cite

Kaldjian, L. C. (2017). Concepts of health, ethics, and communication in shared decision making. Communication and Medicine, 14(1), 83–95.



Forum Discussion