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In the past decades, at the same time as the theory and practice of Shared Decision Making have achieved increasing prominence, threads of epistemological, ethical and political concern have converged to render the concept itself problematic. How does the “evidence based medicine” purveyed by the clinician differ from the evidence used by the patient? Whose values and preferences are meant to take precedence, and how does the social and political milieu impinge upon, or determine, the exercise of decision making (if indeed that is the main point of the health care encounter)?

In this exploratory, conceptual, and deliberately provocative talk, I will seek to blow up and then reconstruct shared decision making along both more defensible yet more ambitious lines, arguing that saving SDM as an approach to health care means saving our system from moral and empirical blindness.