Autonomie zwischen Ideal und Realität

Abstract

The ethical principle of respect for patient autonomy is widely recognized in contemporary medical science. This undeniably positive development raises a number of questions. The answer to these questions determines whether autonomy should be regarded as a helpful or an overburdening principle. By drawing on the results from a qualitative study in which palliative and curative medical professionals where questioned about handling the breaking of bad news as well as about their perception, support, and the viability of patient autonomy, the thesis discusses the principle of autonomy’s feasibility against the backdrop of Palliative Care’s ideals and the complex bioethical debate about relational autonomy. The interviews (n=21) were based on a theme-centered interview guide, while the material of the interviews was analyzed using qualitative content analysis. The intention is not to draw another conflict issue, but rather, by analysing communication strategies as a practical instrument, to give insights into dealing and decision making in the context of end of life questions. Especially regarding doctor-patient-relationships and the principle of autonomy’s role as a corrective for the medical system. By examining the feasibility of the principle of autonomy in a qualitative study, the thesis acts on two levels. On its operational level it focusses on communication strategies and undergirds the methods of the study. On its ethical level the thesis deals with the bioethical debate about relational autonomy and the term of dignity. According to that two levels the practical relevance is given. The following 3-level-conclusion became apparent: First, considering the medical practice, it appears that ideals integrated from the outside can diverge from the inner logic of the practice. Secondly, the experts´ responsibility – for medical ethics and palliative care – seems to be of great relevance. Especially with regard to (medical) ethics playing a role as a corrective, it has to be the topic of the discourse whether normative images, like the principle of autonomy, should be regarded as helpful or overburdening. Furthermore, a discourse dealing with the professions´ internal tensions is needed. Thirdly, reflecting the principle of autonomy’s feasibility in the context of end of life questions, it should be considered, what is happening topically in public and whether the discourse has to be opened for another level. The reason for this is found in the fact that the public debate on dying is inflated and leeds to the problem that a „real death“ is partly put under taboo again. An aspect that can bring up conflicts in dealing with patient autonomy in end of life questions. Focussing that - thereof against the backdrop of Palliative Care’s ideals – the discussion leads to the reflection of the consequences of defining a universal ideal of a so-called “good death”. Overall, the study was valuable in putting the focus on new specific difficulties within the debate of the principle of autonomy’s feasibility and highlights the new aspect of the importance of different professions and the self-perception of medical professionals in dealing with patient autonomy in the context of end of life questions.