Patient autonomy in end of life decisions

Abstract

End of life scenarios must be patient driven and focused. In this thesis it is argued that patient intention is often misrepresented by being assimilated to extreme and clear-cut cases where patients are committed to a certain path of action. The role of the patient in decision-making, a role that has developed through the advent of autonomy and subsequently informed consent, has created an environment that is so dependent upon the patient that our duty of care and the role of experience in difficult clinical decisions can be obscured or forgotten. Given the experience of clinicians and the conflicting duties to which they often find themselves subject, questions have been raised over the intent of physicians in end of life situations but the extent to which these should lead to the very same questions being asked of patients is under-explored in the literature. The varying end of life decisions and the moral acceptability attached to them is a concept that is poorly understood by a mainstream audience. This, among other things is part of the misconceptions that are commonly held about euthanasia. Finally I explore what the future holds for euthanasia and end of life decisions. The part the patient plays in these decisions is coming under more scrutiny and as it does, the role of the physician is being examined as well. Happenings in the Netherlands over the last decade have prompted a new surge of calls for reform in this most ancient of debates, this surge I propose could lead to a new era of dialogue and relationship focused care in end of life, where a one size fits all approach is not welcome.