When Shared Decision-Making Breaks Down: Solving Moral Dilemmas in Antipsychotic Deprescribing

Many individuals diagnosed with psychosis make multiple attempts to discontinue antipsychotic medications. In this clinical challenge, we examine three snapshots in which shared decision-making (SDM) breaks down due to ongoing disagreement between the service user and the health care provider. We offer three perspectives on how to think about such disagreement: philosophical, psychological, and psychiatric perspectives. Finally, we propose shared deliberation as a potential model for when SDM fails, emphasizing an iterative process of mutual value sharing that avoids binary yes/no responses.