title: Uncharted terrain: preference construction at the end of life.
abstract: Respect for patients' self-determination has long been considered central to efforts to improve end-of-life care, yet efforts to promote advance directives or engage patients in end-of-life discussions are often unsuccessful. In this article, I contend that this is because the shared decision-making approach typically used in healthcare assumes patients' capacity to make rational choices, which is not always possible in end-of-life decisions. Drawing on decision theory, behavioral psychology, and related studies of end-of-life care, I present a growing body of evidence that suggests the novelty, complexity, and uncertainty of end-of-life circumstances make rational and stable preferences difficult to establish. I argue that an effective decision-making approach for the terminally ill must recognize and respond to the unique characteristics of end-of-life choices, including their nonrational dimensions. I conclude with a description of an initiative that appears to do so, resulting in increased patients' satisfaction.
authors: Division of Medical Humanities, Boonshoft School of Medicine, Wright State University, 290H white Hall, 3640 Col. Glenn Hwy, Dayton, OH USA. mary.t.white@wright.edu.
authors: Mary T
authors: MT
authors: White
mesh_terms: D032722:Advance Care Planning / Q000941:ethics / Q000592:standards / Q000639:trends; D016223:Advance Directives; D002755:Choice Behavior / Q000941:ethics; D003071:Cognition; D003657:Decision Making / Q000941:ethics*; D004644:Emotions; D006801:Humans; D019545:Intuition; D026684:Personal Autonomy; D013727:Terminal Care / Q000379:methods / Q000639:trends; D013850:Thinking