Uncharted Terrain: Preference Construction at the End of Life
Document Type
Article
Publication Date
Summer 2014
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Abstract
Respect for patients' self-determination has long been considered central to efforts to improve end-of-life care, yet efforts to promote advance directives or engage patients in end-of-life discussions are often unsuccessful. In this article, I contend that this is because the shared decision-making approach typically used in healthcare assumes patients' capacity to make rational choices, which is not always possible in end-of-life decisions. Drawing on decision theory, behavioral psychology, and related studies of end-of-life care, I present a growing body of evidence that suggests the novelty, complexity, and uncertainty of end-of-life circumstances make rational and stable preferences difficult to establish. I argue that an effective decision-making approach for the terminally ill must recognize and respond to the unique characteristics of end-of-life choices, including their nonrational dimensions. I conclude with a description of an initiative that appears to do so, resulting in increased patients' satisfaction.
Copyright 2014 The Journal of Clinical Ethics. All rights reserved.
Repository Citation
White, M. T.
(2014). Uncharted Terrain: Preference Construction at the End of Life. Journal of Clinical Ethics, 25 (2), 120-130.
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