緩和ケアと医学

抽象的な

Paternalism and the Utilization of Advance Care Directives

Ekore Rabi Ilemona, Lanre-Abass Bolatito, Ekore John and Ajayi Ikeoluwapo

The End-of-life period requires attention to total care of persons suffering from life-limiting or terminal illnesses. Rendering this type of care can alter the quality of life, though it is not expected to cure the fundamental underlying diseases or to arrest their progression. Paternalism in medicine has become unpopular because it entails physicians telling patients what is, or is not good for them, without regards to the patient’s own needs and interests. There is increasing awareness of the fact that patients have right to self-determination over how they are treated and the principle of respect for self-autonomy imposes on the attending physician and other health workers a duty to respect this right. During the end-of-life period, however, a patient may be incompetent and unable to exercise this right. Thus, there may be a need to plan in advance, by the making and utilization of advance care directives. This article discusses patient care during the end-of-life period, the issue of advance care directives and paternalism in the light of some ethical theories and the role paternalism plays in its making and utilization of advance care directives.