I am grateful to the editor for the chance to comment on this intriguing review by Drs. Ray and Simpson about risk-related shared decision-making (RR-SDM) in forensic practice. All good papers raise as many questions as they answer, and in this commentary, I address three questions that were stimulated by this useful review. What is the ethics basis of SDM? Why is SDM problematic in forensic psychiatry? How can we use SDM in the pursuit of security and risk reduction? I draw on examples from the United Kingdom and from published literature, while acknowledging that there is an extensive literature from other countries and cultures that would also be relevant.