Concepts of personhood and autonomy as they apply to end-of-life decisions in intensive care

Abstract

Amongst traditionally-available frameworks within which end-of-life decisions in Intensive Care Units (ICU) are situated, we favour Ordinary versus Extra-ordinary care distinctions as the most helpful. Predicated on this framework, we revisit the concepts of personhood and autonomy. We argue that a full account of personhood locates its foundation in relationships with others, rather than merely in "rationality". A full account of autonomy also recognises relationships with others, as well as the actual reality of the patient's situation-in-the-world. The fact that, when critically ill, the patient may no longer be able to take an active role in decision-making does not bring about the end of their personhood, or of their autonomy. Because the patient's autonomy is intimately linked to their relationships with others, once critical illness supervenes, respect for their autonomy devolves to those others with whom the patient is in relationship. In practical application, this means that there must be a dialogue, as the end-of-life of the critically-ill patient in ICU comes into view. Such dialogue should be grounded on this understanding in order to conform best to moral philosophical principles. Ideally the dialogue will involve all those with whom the patient is in relationship and, practical difficulties within an ICU notwithstanding, will aim to be inclusive, non-coercive and reflective as it seeks to maximise the good of the patient in their unique context.

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

“…The philosophical origins of individual autonomy are temporally situated in the Modern era, in a thread that links the ideas of René Descartes [25–27], John Locke [28, 29], Immanuel Kant [25, 26, 29–35], and John Stuart Mill [26, 30, 31, 33, 36]. In contemporary bioethics, this line of thought finds expression in the notion of ‘respect for autonomy’, one of the four basic principles coined by Beauchamp and Childress in their monograph, Principles of Biomedical Ethics [2].…”

“…In contemporary bioethics, this line of thought finds expression in the notion of ‘respect for autonomy’, one of the four basic principles coined by Beauchamp and Childress in their monograph, Principles of Biomedical Ethics [2]. This classic book was referenced by 26 of the included publications [25, 26, 30–35, 37–54].…”

Recognizing Dementia: Constructing Deconstruction in a Danish Memory Clinic

“…If the prophecies of a dementia boom looming large in the public media turn out to come true, these conditions constitute our common future. To meet one's own and others’ disability we suggest that we reconsider the imagination that “things can exist in themselves” (Strathern , 135), an imagination that manifests autonomy and independence as the central values around which the self is constituted (Chatterji ; Lamb ; Walker and Lovat ). Instead of insisting on our independence or resisting to recognize our loved ones when they show signs of dependence, we might practice personhood by “blurring the boundaries of self and other” (Leibing , 260) and think of ourselves as always already being a part of multiple common‐yous.…”

The role of ICU nurses in the spiritual aspects of end‐of‐life care in the ICU: an explorative study

“…Building relationships between patient, family and professionals has been studied before and was called care triad . In addition, Walker and Lovat described that a patient who may no longer be able to take a role in the decision‐making process still has a personhood and autonomy. Because autonomy is linked to their relationship with others, respect for the autonomy of the patient transfers to those others to whom the patient is related.…”