This article explores ethical aspects of using open argumentation in person-centered care (PCC), where health professionals (HPs)
openly criticize or contradict factual claims, assumptions, preferences, or value commitments of patients. We argue that such
disputing may be claimed to have an important place in advanced versions of PCC, but that it actualizes
important clinical ethical aspects of doing such disputation well. This may prompt caution in the implementation of PCC, but also
inspire educational and organizational reform. We also probe the notion of openly disputing with patients when PCC is applied in
less standard settings (where it is nevertheless advocated), using the cases of children, psychiatry, and public health
interventions, such as antibiotic stewardship programs, as examples. These contexts offer new reasons for why PCC may or should
include open disputing with patients, but also introduce new ethical complications. Some of these may transform either to
arguments against PCC implementation in these areas, or to a more open view of the extent a HP may seek to dominate patients in a
PCC setting. We are especially skeptical of the meaningfulness of applying advanced PCC in areas of psychiatry with high levels of
compulsory elements, such as forensic psychiatric detention.
2014 “Deciding Together? Best Interests and Shared Decision-making in Paediatric Intensive Care.” Health Care Analysis 221: 203–222.
Boman, Åse, Margareta Bohlin, Mats Eklöf, Gun Forsander, Christian Munthe, and Marianne Törner
2017 “Health Care to Empower Self-care in Adolescents with Type 1 Diabetes Mellitus, and an Immigrant Minority Background.” Sage Open Medicine 51: 1–8.
Brown, Marie T., Alfredo Mena Lora, Mary C. Anderson, and Christine A. Sinsky
2014 “Resolving Patients’ Vaccination Uncertainty: Going from “No Thanks!” to “of Course!”.” Family practice management 21 (2): 22–26.
Charon, Rita, Sayantani DasGupta, Nellie Hermann, Craig Irvine, Eric R. Marcus, Edgar Rivera Colón, Danielle Spencer, and Maura Spiegel
2017The Principles and Practice of Narrative Medicine. New York: Oxford University Press.
Coulter, Angela
2002The Autonomous Patient: Ending Paternalism in Medical Care. London: Stationery Office (for the Nuffield Trust).
Coulter, Angela, and John Oldham
2016 “Person-centred Care: What Is It and How Do We Get There?” Future Hospital Journal 3 (2): 114–116.
Dawson, Angus
(ed.)2011Public Health Ethics: Key Concepts and Issues in Policy and Practice. Cambridge: Cambridge University Press.
Delaney, Clare, and Jane Galvin
2014 “Ethics and Shared Decision-making in Paediatric Occupational Therapy Practice.” Developmental Neurorehabilitation 17 (5): 347–354.
Ekman, Inger, Karl Swedberg, Charles Taft, Anders Lindseth, Astrid Norberg, Eva Brink, Jane Carlsson, Synneve Dahlin-Ivanoff, Inga-Lill Johansson, Karin Kjellgren, Eva Lidén, Joakim Öhlén, Lars-Eric Olsson, Henrik Rosén, Martin Rydmark, and Katharina Stibrant Sunnerhagen
2011 “Person-centered Care – Ready for Prime Time.” European Journal of Cardiovascular Nursing 10 (4): 248–251.
El-Alti, Leila, Lars Sandman, and Christian Munthe
2017 “Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?” Health Care Analysis. Published online 21September 2017 doi:
Entwistle, Vikki A., and Ian S. Watt
2013 “Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-centered Care.” American Journal of Bioethics 13 (8): 29–39.
Fenton, Anny T., Marc N. Elliott, David C. Schwebel, Zahava Berkowitz, Nicole C. Liddon, Susan R. Tortolero, Paula M. Cuccaro, Suzy L. Davies, and Mark A. Schuster
2017 “Unequal Interactions: Examining the Role of Patient-centered Care in Reducing Inequitable Diffusion of a Medical Innovation, the Human Papillomavirus (HPV) Vaccine.” Social Science and Medicine. Published online September 2017 doi:
Gabrielsson, Sebastian, Stefan Sävenstedt, and Karin Zingmark
2015 “Person-centred Care: Clarifying the Concept in the Context of Inpatient Psychiatry.” Scandinavian Journal of Caring Sciences 29 (3): 555–562.
Gustavsson, Erik, and Lars Sandman
2015 “Health-care Needs and Shared Decision-making in Priority-setting.” Medicine, Healthcare and Philosophy 18 (1): 13–22.
Hartvigsson, Thomas, Gun Forsander, and Christian Munthe
2018 “Error Trawling and Fringe Decision Competence: Ethical Hazards in Monitoring and Addressing Patient Decision Capacity in Clinical Practice.” Clinical Ethics. Published online 10January 2018 doi:
Herlitz, Anders, Christian Munthe, Marianne Törner, and Gun Forsander
2016 “The Counselling, Self-care, Adherence Approach to Person-centred Care and Shared Decision-making: Moral Psychology, Executive Autonomy, and Ethics in Multi-dimensional Care Decisions.” Health Communication 31 (8): 964–973.
Joseph, Stephen
(ed.)2017The Handbook of Person-centred Therapy and Mental Health: Theory, Research and Practice. Monmouth: PCCS Books.
Littmann, Jasper, and Adrian M. Viens
2015 “The Ethical Significance of Antimicrobial Resistance.” Public Health Ethics 8 (3): 209–224.
Luxford, Karen, Donella A. Piper, Nicola Dunbar, and Naomi Poole
2010Patient-centred care: Improving quality and safety by focusing care on patients and consumers. Sydney: Australian Commission of Quality and Safety in Health Care.
Mead, Nicola, and Peter Bower
2000 “Patient-centredness: A Conceptual Framework and Review of the Empirical Literature.” Social Science and Medicine 511: 1087–1110.
Meharry, Pamela M., Regina M. Cusson, Robert Stiller, and Marietta Vázquez
2014 “Maternal Influenza Vaccination: Evaluation of a Patient-centered Pamphlet Designed to Increase Uptake in Pregnancy.” Maternal and Child Health Journal 18 (5): 1205–1214.
Mezzich, Juan E., Michel Botbol, George N. Christodoulou, C. Robert Cloninger, and Ihsan M. Salloum
2009 “Shared Decision-making and Patient Autonomy.” Theoretical Medicine and Bioethics 30 (4): 289–310.
Sandman, Lars, and Christian Munthe
2010 “Shared Decision Making, Paternalism and Patient Choice.” Health Care Analysis 181: 60–84.
Sandman, Lars, Bradi B. Granger, Inger Ekman, and Christian Munthe
2012 “Adherence, Shared Decision-making and Patient Autonomy.” Medicine, Health Care and Philosophy 15 (2): 115–127.
Sandman, Lars, Erik Gustavsson, and Christian Munthe
2016 “Individual Responsibility as Ground for Priority Setting in Shared Decision-making.” Journal of Medical Ethics 421: 653–658.
Selgelid, Michael, Margaret Battin, and Charles B. Smith
(eds.)2006Ethics and Infectious Disease. Oxford: Blackwell.
Smith, Rachel A., Madisen Quesnell, Lydia Glick, Nicole Hackman, and Nkuchia M. M’lkanatha
2015 “Preparing for Antibiotic Resistance Campaigns: A Person-centered Approach to Audience Segmentation.” Journal of Health Communication 20 (12): 1433–1440.
Tindall, William N., Mona M. Sedrak, and John M. Boltri
(eds)2014Patient-centered Pharmacology: Learning System for the Conscientious Prescriber. Philadelphia: F.A. Davis Company.
Verweij, Marcel, and Angus Dawson
2004 “Ethical Principles for Collective Immunisation Programmes. Vaccine 221: 3122–3126.
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Akkermans, Aranka, Sanne Prins, Amber S. Spijkers, Jean Wagemans, Nanon H. M. Labrie, Dick L. Willems, Marcus J. Schultz, Thomas G. V. Cherpanath, Job B. M. van Woensel, Marc van Heerde, Anton H. van Kaam, Moniek van de Loo, Anne Stiggelbout, Ellen M. A. Smets & Mirjam A. de Vos
2023. Argumentation in end-of-life conversations with families in Dutch intensive care units: a qualitative observational study. Intensive Care Medicine 49:4 ► pp. 421 ff.
El-Alti, Leila
2023. Shared Decision Making in Psychiatry: Dissolving the Responsibility Problem. Health Care Analysis 31:2 ► pp. 65 ff.
El-Alti, Leila, Lars Sandman, Christian Munthe & Tella Lantta
2022. Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care. PLOS ONE 17:9 ► pp. e0275205 ff.
2020. An Interview Study of Professional Carers’ Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting. Issues in Mental Health Nursing 41:3 ► pp. 201 ff.
Söderberg, Andreas, Märta Wallinius, Christian Munthe, Mikael Rask & Ulrica Hörberg
2022. Patients’ Experiences of Participation in High-Security, Forensic Psychiatric Care. Issues in Mental Health Nursing 43:7 ► pp. 683 ff.
Westgård, Theresa, Katarina Wilhelmson, Synneve Dahlin-Ivanoff & Isabelle Ottenvall Hammar
2019. Feeling Respected as a Person: a Qualitative Analysis of Frail Older People’s Experiences on an Acute Geriatric Ward Practicing a Comprehensive Geriatric Assessment. Geriatrics 4:1 ► pp. 16 ff.
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