Summary
Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. The main objective in an end-of-life (EOL) situation is to maintain the autonomy and the dignity of the patient as much as possible. Due to the severity of progressive diseases and as a result of the poor general condition of the patient, their autonomy is often endangered. This case report presents a 70-year-old woman who suffered from hepatic and bone metastases from cancer of unknown primary (CUP) in a palliative setting and discusses the supportive treatment opportunities as well as the ethical thoughts about her autonomy.
References
World Health Organization. National cancer control programmes: policies and managerial guidelines. 2nd ed. Geneva: World Health Organization; 2002.
Hui D, Bruera E. Models of palliative care delivery for patients with cancer. J Clin Oncol. 2020;38(9):852–65. https://doi.org/10.1200/JCO.18.02123. PMID: 32023157; PMCID: PMC7082156.
Swami M, Case AA. Effective palliative care: what is involved? Oncology. 2018;32(4):180–4.
Rangachari D, Smith TJ. Integrating palliative care in oncology: the oncologist as a primary palliative care provider. Cancer J. 2013;19:373–8.
Rodríguez-Prat A, Monforte-Royo C, Porta-Sales J, Escribano X, Balaguer A. Patient perspectives of dignity, autonomy and control at the end of life: systematic review and meta-ethnography. PLoS ONE. 2016;11(3):e151435. https://doi.org/10.1371/journal.pone.0151435. PMID: 27010323; PMCID: PMC4806874.
Childress JF. The place of autonomy in bioethics. Hastings Cent Rep. 1990;20(1):12–77.
Dworkin G. The theory and practice of autonomy. : Cambridge University Press; 1988.
Schneider CE. The practice of autonomy: patients, doctors, and medical decisions. Oxford: Oxford University Press; 1998.
Gómez-Vírseda C, de Maeseneer Y, Gastmans C. Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities. BMC Med Ethics. 2020;21(1):50. https://doi.org/10.1186/s12910-020-00495-1.
Kanai Y, Ishiki H, Maeda I, Iwase S. A survey of practice in management of malignancy-related ascites in Japan. PLoS ONE. 2019;14(8):e220869. https://doi.org/10.1371/journal.pone.0220869.
Gerbes AL, Labenz J, et al. Aktualisierung der S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“ . AWMF-Nr.: 021-017 Version November 2018. https://www.awmf.org/uploads/tx_szleitlinien/021-017l_S2k_Komplikationen-der-Leberzirrhose_2019-04.pdf. Accessed 20.10.2021.
Sharma S, Walsh D. Management of symptomatic malignant ascites with diuretics: two case reports and a review of the literature. J Pain Symptom Manag. 1995;10(3):237–42. https://doi.org/10.1016/0885-3924(94)00129-9.
Ramazzotti D, Clardy P, Celi LA, Stone DJ, Rudin RS. Withholding or withdrawing invasive interventions may not accelerate time to death among dying ICU patients. PLoS ONE. 2019;14(2):e212439. https://doi.org/10.1371/journal.pone.0212439.
Houska A, Loučka M. Patients’ autonomy at the end of life: a critical review. J Pain Symptom Manag. 2019;57(4):835–45. https://doi.org/10.1016/j.jpainsymman.2018.12.339.
Bakitas MA. Self-determination: analysis of the concept and implications for research in palliative care. Can J Nurs Res. 2005;37(2):22–49.
Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES—A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302–11. https://doi.org/10.1634/theoncologist.5-4-302.
Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267(16):2221–6.
Reach G. Patient autonomy in chronic care: solving a paradox. Patient Prefer Adher. 2014;8:15–24.
Roeland E, Cain J, Onderdonk C, Kerr K, Mitchell W, Thornberry K. When open-ended questions don’t work: the role of palliative paternalism in difficult medical decisions. J Palliat Med. 2014;17(4):415–20. https://doi.org/10.1089/jpm.2013.0408.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
B. Engelhardt declares that he has no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Engelhardt, B. Palliative care: patient’s autonomy in the end-of-life situation. memo 15, 76–78 (2022). https://doi.org/10.1007/s12254-021-00783-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12254-021-00783-5