This study empirically examined historical trajectories of the semantic landscape of legal conflicts over medical decision-making. We unveiled the lexical structures of lawsuit verdicts, tracing how the core concepts of shared decision-making (SDM)-duty of care, duty to explain, self-determination-have developed and been contextualized in legal discourses. We retrieved publicly available court verdicts using the search keyword ‘patient’ and screened them for relevance to doctor-patient communications. The final corpus comprised 251 South Korean verdicts issued between 1974 and 2023. We analyzed the verdicts using neural topic modeling and semantic network analysis. Our study showed that topic diversity has expanded over time, indicating increased complexity of semantic structures regarding medical decision-making conflicts. We also found two dominant topics: disputes over healthcare providers’ liability and disputes over the compensation for medical malpractice. The results of semantic network analysis showed that the rhetorics of patients’ right to medical self-determination are not closely tied to the professional responsibility to explain and care. The decoupled semantic relationships of patients’ right and health professionals’ duties revealed the barriers of SDM implementations.