When Shared Decision-Making Breaks Down: Solving Moral Dilemmas in Antipsychotic Deprescribing

Abstract

Many individuals diagnosed with psychosis make multiple attempts to discontinue antipsychotic medications. In this clinical challenge, we examine three snapshots in which shared decision-making (SDM) breaks down due to ongoing disagreement between the service user and the health care provider. We offer three perspectives on how to think about such disagreement: philosophical, psychological, and psychiatric perspectives. Finally, we propose shared deliberation as a potential model for when SDM fails, emphasizing an iterative process of mutual value sharing that avoids binary yes/no responses.

Keywords: autonomy; justice; psychosis; shared decision-making; shared deliberation.