First the facts, then the values? Implicit normativity in evidence-based decision aids for shared decision-making

Bert Molewijk, Anne M. Stiggelbout, Wilma Otten, Heleen M. Dupuis, Job Kievit

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8 Citations (Scopus)


This paper focuses on the ethics of constructing and using a specific evidence-based decision aid that aims to contribute to clinical shared decision-making processes. Results of this integrated empirical ethics study demonstrate how both the production and presentation of scientific information in an evidence-based decision-support contain implicit presuppositions and values, which pre-structure the moral environment of the shared decision-making process. As a consequence, the evidencebased decision support did not only support the decision-making process; it also transformed it in a morally significant way. This phenomenon undermines the assumption within much of the literature on patient autonomy and shared decision-making implying that information disclosure is a conditional requirement before patient autonomy and shared decision-making even starts. The central point of this paper is that decision aids and evidence-based medicine are not value-free and that patient autonomy and shared decision-making are already influenced during the production and presentation of scientific information, Consequences for both the development of decision-aids and the practice of shared decision-making are discussed.

Original languageEnglish
Pages (from-to)415-420
Number of pages6
JournalZeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen
Issue number7
Publication statusPublished - 1 Jan 2008


  • Decision aids
  • Empirical ethics
  • Evidence-based medicine
  • Implicit normativity
  • Shared decision-making

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