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The rights of patients tobeinformedaboutcaredecisions in clinical practice is yet again under scrutiny, both in the United States and around the world. The well-ingrained ethical-legal process of informed consent, so fundamental to patient autonomy-or the patient's right to selfdetermination-was the subject of a 2015 UK Supreme Court case (Montgomery v Lanarkshire Health Board). Yet the treating obstetrician (andotherexpertphysicianscalledtotrial)claimedthatthe ensuing risk was very small and thus appropriately not communicated because a cesarean delivery is not in the maternal interest. The obstetrician reported that "had I raised it the risks of shoulder dystocia with her then yes, she would have no doubt requested a caesarean section, as would any diabetic today." In rendering this decision, the court swept away decades of medical paternalism in the United Kingdom to embrace a new patient-centered standard. Perhaps more compelling, the head of the Royal College of Surgeons urged that the only way to operationalize such a substantial and needed change is through shared decision making, a collaborative communication processbetweencliniciansandpatientsthatintegratesthe best evidence available with the patients' values and preferences, to promote high-quality health care decisions.
Spatz et al. (Thu,) studied this question.