The ethics of risk communication in lifestyle interventions: Consequences of patient centredness

Background: Broader patient access to information, expanding clinical options and greater accommodation of patients' personal values makes clinical decision-processes increasingly complex. Given the challenges and implications of risk communication, it is important to explore what is happening when clinicians adopt different approaches to consultations. Aim: To perform an ethical analysis of personal risk communication based around a scenario of cardiovascular risk reduction by exploring how different consultation models raise different ethical implications. Method: We based our analysis on the triangle of autonomy, utility and justice. Because ethical questions arise during consultations, consultation approach is a basic context for interpretations. We chose four distinct approaches; paternalistic, shared decision-making, mandatory autonomist and narrative. Results: The ethical principles of autonomy, utility and justice proved ambiguous. Tradeoffs exist between principles to balance the rights of individual patients (autonomy and protection of personal rights and the patient's personal view on utility), with medical utility seen from the perspective of the health care system (with limited resources), equity and solidarity. Patient centredness is believed to enhance trust in the doctor -patient relationship, but the decisional authority given to patients in such approaches may hazard biomedical utility in the individual consultation and make prioritizing between tasks in the health care sector difficult. Conclusion: The consultation style of the GP has implications for the individual patient, for population health and for the cost of health care. This debate is unavoidable