Setting up the discussion with the family and maintaining a positive working relationship with Philomena is the challenge in this case. Philomena has the agenda of challenging the family's position and handling her own emotional resonance of her personal perspective for the care of her own mother. 

It's a reasonable challenge as to whether this is an objective decision for her, and this could be handled poorly or insensitively.

Notice the language of shared decision making- the explicit use of 'we' and what this means. The GP makes it clear that she respects where Philomena is coming from, and tries to see if she could appreciate the family's perspective of living with the decision, and the various insights each party will have. 

Here you can see the collaborative tone with no blame for either perspective and the use of 'we' in the planning phase of the consultation is far removed from a 'Doctor knows best' stance. Framing this in a best interests viewpoint helps to ensure this is being approached from an objective professional process. 

Is 'we' always a Shared Decision? What situations could it be misinterpreted?

Sometimes it could be felt to mean 

• 'We, the medical profession' 
• 'We, the surgery' or 
• 'We, together me and you'

If this is ambiguous, make it clear what you mean when using the word 'we' to reach that common understanding.