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. 2020 Jun 30;21(1):50.
doi: 10.1186/s12910-020-00495-1.

Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities

Carlos Gómez-Vírseda  1 , Yves de Maeseneer  2 , Chris Gastmans  3
Affiliations

Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities

Carlos Gómez-Vírseda et al. BMC Med Ethics. .

Abstract

Background: Respect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients' preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of 'relational autonomy' may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.

Main body: Here, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.

Conclusion: This article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices.

Keywords: Advance Care Planning; Decision making; End-of-life; Euthanasia; Medical ethics; Palliative Care; Patient Preference; Relational autonomy.

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Conflict of interest statement

The authors declare that they have no financial competing interests.

Figures

Fig. 1
Fig. 1
Schematic diagram of a relational approach to patient autonomy in end-of-life decision-making. Contextualized understanding of relational autonomy emphasizes interactions of primary stakeholders and the influence of sociocultural context
See this image and copyright information in PMC

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