Who decides? For thousands of years, doctor knew best, but recently respect for patient autonomy has emerged as a key ethical principle in decision making. This has led to the suggestion that decisions should be shared between patients, families and the medical team. An international consensus conference embraced this model for end of life decision making in ICU. But what is shared decision making, does it improve outcomes and is it legally safe? This podcast suggests that the answer so far is a definite maybe.