Health decision-making can be paternalistic, self-reliant or shared. In the past, a paternalistic approach was the most widespread. The physician was considered to be the best person to know the risks and benefits of treatment and therefore must make the decision for the patient (Charles et al. 1999). The development of medical ethics at the end of the 20th century led to a change in attitudes that favoured the common decision-making model over the paternalistic approach (Bunch and Dvonch 2004). Patients want to be informed of treatment alternatives and be involved in the decision-making process (Guadagnoli and Ward 1998). In the common decision-making model, patients and physicians share information and decide together. Physicians should explain all treatment alternatives, their risk and usefulness, while the patient must provide the physician with information about his or her interests, preferences and cultural, social and financial background (Charles et al. 1999).

There is collaboration in the decision-making process, and the patient and physician accept the chosen treatment (Charles et al. 1999; Whitney et al. 2004). The (autonomous) model of informed consent involves the patient making an independent choice; decision-making is one-sided, undivided (Whitney et al. 2004). In this model, the physician`s mission is to explain the possibilities of diagnosis and treatment and must accept the patient`s decision (Meisel and Kuczewski 1996). “A high school basketball star, who is hoping to get a sports scholarship to the university, has seriously injured his knee. He informed his doctor that he wanted to hide the extent of his injury, lest it affect his chances of obtaining a scholarship. Team representatives contacted the doctor and inquired about the status of the player`s knee. Is it ethically defensible to disclose this information without the player`s consent? On the other hand, wouldn`t it be equally unethical not to tell the team that there will be a scholarship to an athlete whose career is at best precarious? This is what Han Brunner, a geneticist at Radboud University Medical Centre in Nijmegen in the Netherlands, hoped for.

Last year, he launched a project to sequence the Exome — the regions encoding proteins in the genome — of 500 children and adults who are researching the genetic causes of mental disabilities, blindness, deafness and other disorders. Brunner proposed to allow participants to choose between three options: they were able to learn everything the researchers had divinely learned about the vulnerability of diseases; only information relevant to the disease for which its genomes have been studied; or no information. Ethics critics have drawn on his proposal. “They said that in practice, it would be impossible for people to draw these lines, because the people who agree cannot predict all the possible conclusions of the study,” Brunner explains. Instead, all study participants must agree to know all relevant medical information resulting from the analysis of their genomes. Brunner recently had to inform the family of a child with a developmental disability that the child also had a genetic predisposition to colon cancer. Not all researchers support the idea of informing children about diseases that could affect them as adults. In this case, the doctors recommended early detection, and Brunner says, “The family handled it very well; They said, “This is not what we expected, but it is useful information.”