Introduction In nursing practice the concept of autonomy plays a significant role, in particular in end-oflife care. Wilkinson (1997) has defined autonomy as “the power to shape one’s own life, to be self-governing, and to act on one’s decisions” (p. 262). In the NPR podcast, “If You Have Dementia, Can You Hasten Death As You Wished?”, a case is presented that highlights the complexities of autonomy in end-of-life care, particularly in cases where patients may lose their decision-making capacity. This paper will analyze the case using Wilkinson’s defining attributes of autonomy and describe how the case fits into the definition of a borderline case. The case as presented as well as as a “model case” will also be examined in terms of the ethical questions it raises.
Borderline Case of Autonomy Wilkinson’s (1997) defining attributes of autonomy include the power to shape one’s own life, self-governance, and the ability to act on one’s decisions. In the NPR Podcast, the case is a borderline one. The patient wants to die before the dementia gets to a point that she can no longer make decisions. Although the patient can make her decisions, she is restricted by dementia. It makes it challenging for her to follow through on the decision. This case highlights the difficulty of balancing the patient’s desire for autonomy with the healthcare provider’s duty to provide care and prevent harm.
Ethical Issues Raised The case raises several ethical issues, including the patient’s right to autonomy, the healthcare provider’s duty to provide care and prevent harm, and the legal implications of assisted suicide. Although the patient is entitled to her autonomy, and the ability to decide about her own future, her decision to take her life brings into question the responsibility of the healthcare provider to protect her. The legal and ethical consequences of assisted suicide should also be taken into consideration, especially in situations where the patient may lack the capacity to make an informed decision about her care.
Model Case Ethics If the case was changed to match criteria for a’model case,’ the ethical issues could be resolved more easily. The patient in a “model case” would have the full capacity to make decisions and would choose how they wanted to die. This would meet all legal and ethical requirements. The ethical issues would center on the duty of healthcare providers to provide care and prevent harm, particularly in cases where they may disagree with the patient’s decision to end their life.
Conclusion The NPR podcast, “If You Have Dementia, Can You Hasten Death As You Wished?”, presents a complex case that highlights the challenges of autonomy in end-of-life care. Using Wilkinson’s (1997) defining attributes of autonomy, the case can be identified as a borderline case, as the patient has the desire to end her life before losing her decision-making capacity. The case raises several ethical issues, including the tension between the patient’s right to autonomy and the healthcare provider’s duty to provide care and prevent harm, as well as the legal and ethical implications of assisted suicide. The ethical questions would become more clear if the case was changed to fit the criteria of a “model case” and the focus would be on the healthcare provider’s duty to prevent harm and provide care. The case highlights the need for clear communication, shared decisions, and patient-centered care at the end of life.