Beyond autonomy: diversifying end-of-life decision-making approaches to serve patients and families.

Published

Journal Article (Review)

Efforts to improve end-of-life decision-making quality have emphasized the principle of individual autonomy to better ensure that patients receive care consistent with their preferences. This principle has primarily been defined through court decisions during the past 3 decades as a patient's right to refuse medical technologies and avoid life-prolonging treatments. However, autonomy as traditionally defined only serves a small segment of dying patients. Patients might not value autonomy or consider autonomy important but define it differently than decision-making self-determination. Some patients also think in terms of their care goals rather than individual treatment preferences. Patients' functional and cognitive abilities, age, racial and ethnic backgrounds, and desire to avoid burdening loved ones may influence attitudes and definitions regarding autonomy. To improve end-of-life decision-making for an increasingly multicultural and aging population, the following priorities should be set: (1) Increase the flexibility of advance care planning and decision-making strategies used with capable patients to encompass diverse perceptions of autonomy; and (2) Improve communication between physicians and patients' families when patients lack decision-making capacity to facilitate decision-making and address families' emotional burdens. The goal of these priorities is to promote understanding of patients' and families' decision-making preferences and goals and to minimize decision-making burdens on families.

Full Text

Cited Authors

  • Winzelberg, GS; Hanson, LC; Tulsky, JA

Published Date

  • June 2005

Published In

Volume / Issue

  • 53 / 6

Start / End Page

  • 1046 - 1050

PubMed ID

  • 15935032

Pubmed Central ID

  • 15935032

Electronic International Standard Serial Number (EISSN)

  • 1532-5415

International Standard Serial Number (ISSN)

  • 0002-8614

Digital Object Identifier (DOI)

  • 10.1111/j.1532-5415.2005.53317.x

Language

  • eng