The process of shared decision making (SDM) between doctors, patients, and family members is complex and nuanced. It requires a delicate dance as the balance of power shifts back and forth among participants in the process. In many cases, decisions require input from many different doctors. Patients too are embedded in complex family systems. Furthermore, there is never just one decision to be made. Clinical care for complex illnesses requires many different decisions in the context of continuously changing clinical situations. At its best, it leads to a fascinating synergy between doctor and patient through which each party’s input is considered and creates a holistic understanding that is greater than the sum of its parts. At its worst, it leads to a confusing or antagonistic mess. This book offers perspectives on the process of SDM to help health professionals and patients do it better. It shows how the process itself has evolved over time and how it changes in different clinical contexts. It discusses the reasons that paternalism has gone out of fashion and introduces the concept of “titrated directiveness” to suggest that sometimes when doctors need to be more paternalistic than is usual these days. It also offers practical suggestions to stimulate a robust process of SDM.