Lois Shepherd: Autonomy and Responsibility at the End of Life

"This essay identifies four situations in which limits to patient choices about life-sustaining treatment should be recognized, even when those choices are clearly expressed and carefully documented. The four situations are (1) the refusal of medical treatment in a suicide attempt, (2) the request for futile treatment, narrowly defined, (3) the refusal of hand feeding by surrogate or advance directive, and (4) the refusal of non-burdensome treatment for people who become profoundly disabled but are neither permanently unconscious nor terminally ill or injured. In each of these situations, patient demands (by proxy or otherwise) are unreasonable because they ask people to deny their basic impulses to treat others humanely. The author argues that not only do individuals have no right to make such demands, they have a responsibility not to make them."