Human dignity and autonomy in medicoethical decisions at the end of life

Abstract

Respect of human dignity is an unquestionable part of daily clinical routine as well as of evaluations in medical ethics. Some aspects of human dignity are asubject of transformation in the course of alifetime. If the ability to form a will is reduced, it might be difficult to satisfy the individual perception of adignified treatment, which is of particular interest in terminal care. As illustrated by the presented case report, moral problems can arise when the patient's present verbal or non-verbal expressions are opposed to what is documented or what is estimated by dependants to be the individual's will. In clinical decision-making processes, the determination of the will via an advance directive can be overstated, which can go so far that human dignity is reduced to autonomy. Aconcept of dignity reduced to autonomy misses the point not only of adignity-centered medical care but also of shared decision-making. In situations at the end of life other aspects, such as authenticity or self-actualization should be considered when respecting the individual's dignity. Medicine should as such not marginalize death but provide acare based on principles that focus on human interaction and respect for acomprehensive concept of dignity.