title: 'Ambivalence' at the end of life: how to understand patients' wishes ethically.
abstract: Health-care professionals in end-of-life care are frequently confronted with patients who seem to be 'ambivalent' about treatment decisions, especially if they express a wish to die. This article investigates this phenomenon by analysing two case stories based on narrative interviews with two patients and their caregivers. First, we argue that a respectful approach to patients requires acknowledging that coexistence of opposing wishes can be part of authentic, multi-layered experiences and moral understandings at the end of life. Second, caregivers need to understand when contradictory statements point to tensions in a patient's moral experience that require support. Third, caregivers should be careful not to negatively label or even pathologize seemingly contradictory patient statements.
authors.affiliation: Institute for Biomedical Ethics, University of Basel, Switzerland. kathrin.ohnsorge@unibas
authors.forename: Kathrin
authors.initials: K
authors.lastname: Ohnsorge
authors.forename: Heike R Gudat
authors.initials: HR
authors.lastname: Keller
authors.forename: Guy A M
authors.initials: GA
authors.lastname: Widdershoven
authors.forename: Christoph
authors.initials: C
authors.lastname: Rehmann-Sutter
mesh_terms: D001293:Attitude to Death; D017028:Caregivers / Q000941:ethics*; D005065:Euthanasia; D006801:Humans; D016224:Living Wills; D028681:Moral Obligations; D033262:Narration; D009369:Neoplasms; D019982:Organizational Case Studies; D005791:Patient Care / Q000941:ethics*; D057240:Patient Preference; D026684:Personal Autonomy; D012928:Social Desirability; D013727:Terminal Care; D019452:Terminally Ill