Teaching Doctors the 'End of Life Conversation'

I began to have visions in my mind’s eye of a doctor coming to my deathbed with a clipboard (or its electronic equivalent) and a checklist, bending over me and asking me pro-forma questions so that in the event of a clinical audit he would be able to prove that he had done all that he was supposed to have done. For, as everyone knows, there is for every human problem an equal and opposite checklist to solve it.

The essay quotes with approval the opinion of an intensivist that patient autonomy is not synonymous with endless choice. And a survey found that only 16 percent of seriously ill hospital patients wanted to make end of life decisions on their own. Certainly on the rare occasions when I have been very ill the last thing I wanted was to have to make choices: I wanted others to make them for me. I didn’t want to be involved in them at all, in fact.

But the essay does not dare to conclude that, perhaps, patient autonomy is not the summum bonum of medical ethics that it has sometimes been cracked up to be. This would be the modern equivalent of heresy.