Background: Shared decision-making introduces evidence-based medicine into the doctor-patient interaction to effectively consider best treatment options and interject patient values. This strategy preserves patient autonomy in clinical problems where mortality and morbidity are similar across options. While shared decision-making is heralded as an optimal doctor-patient engagement strategy, there are human factors to confuse this interaction. Objectives: Apply dual insights from behavioral economics and bioethics to determine fair and just principles to structure choices among clinically viable alternatives, while preserving patient autonomy within the limitations of health care resource constraints. Methods: Case analysis of two paradigmatic situations: non-medically indicated surgical birth and pharmacological management vs. percutaneous coronary intervention in stable angina. Results: A simple rule: offer the frugal choice as the default, with the option to over-ride showing documented evidence-informed choice offers a fair and just shared decision-making strategy. We argue that autonomy should be viewed as a negative right (refusal of unwanted intervention) wherein a patient does not have the unfettered positive right to simply choose a desired treatment. Unfettered shared decision-making trusts the patient to be the agent of rationality, an expectation unsupported by data and insights from behavioral economics. Patients often value expensive interventions even when the best evidence does not support such interventions. They also are loss averse and value doing something over doing nothing, even when intervention is accompanied by iatrogenic risk. Conclusions: On the basis of prudent resource use, the equipoise model of shared decision-making is not viable, and is not a defensible extension of the autonomy principle. We instead suggest an evidence-fettered, resource-sensitive approach to the presentation of information in shared decision-making. We argue for general application in circumstances where the ‘best’ decision is unclear, or where the evidence supports more than one clinical option to reach a similar outcome.