Medicine, Health Care and Philosophy

, Volume 15, Issue 2, pp 115–127 | Cite as

Adherence, shared decision-making and patient autonomy

  • Lars Sandman
  • Bradi B. Granger
  • Inger Ekman
  • Christian Munthe
Scientific Contribution


In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter.


Adherence Compliance Patient autonomy Patient best interest Shared decision-making 


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Lars Sandman
    • 1
  • Bradi B. Granger
    • 2
  • Inger Ekman
    • 3
    • 4
  • Christian Munthe
    • 4
    • 5
  1. 1.School of Health SciencesUniversity of BoråsBoråsSweden
  2. 2.Duke Heart CenterDurhamUSA
  3. 3.Institute of Health and Care Sciences, The Sahlgrenska AcademyUniversity of GothenburgGöteborgSweden
  4. 4.Centre for Person-Centred Care (GPCC)University of GothenburgGöteborgSweden
  5. 5.Department of Philosophy, Linguistics & Theory of ScienceUniversity of GothenburgGöteborgSweden

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