Deprescribing in advanced illness is often treated as a technical response to polypharmacy, treatment burden, or limited prognosis, yet continuation and discontinuation are also preference-sensitive decisions distributed across patients, families, nurses, prescribers, and care systems. This article develops a stakeholder shared-decision account that distinguishes medication appraisal from the relational work of eliciting goals, negotiating family involvement, clarifying professional responsibilities, and acting under uncertainty. Continued therapy, modification, staged withdrawal, deferral, and deprescribing can each be legitimate when clinically defensible and aligned with patient goals. The central contribution is a conditional view of shared deprescribing: good decisions depend on role-legible deliberation, explicit uncertainty, and sufficient capability and opportunity to implement the chosen course safely. Shared decision-making therefore neither requires unanimous agreement nor presumes that deprescribing is the preferred endpoint.
