Asking Too Much: Autonomy and Responsibility at the End of Life
Journal of Contemporary Health Law and Policy, Vol. 26, p. 72, 2009
11 Pages Posted: 19 Feb 2010
Date Written: 2009
This essay identifies four situations in which limits to patient choices about life-sustaining treatment should be recognized, even when those choices are clearly expressed and carefully documented. The four situations are (1) the refusal of medical treatment in a suicide attempt, (2) the request for futile treatment, narrowly defined, (3) the refusal of hand feeding by surrogate or advance directive, and (4) the refusal of non-burdensome treatment for people who become profoundly disabled but are neither permanently unconscious nor terminally ill or injured. In each of these situations, patient demands (by proxy or otherwise) are unreasonable because they ask people to deny their basic impulses to treat others humanely. The author argues that not only do individuals have no right to make such demands, they have a responsibility not to make them.
Keywords: autonomy, patient, end-of-life, life-sustaining treatment, hand feeding, futile treatment, suicide, minimally conscious, michael martin, advance directive, living will, health care proxy, patient responsibility, patient rights, Wooltorton, Motl Brody, surrogate decision-making, substituted judgment
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