Trust, intent, authenticity, and good dying: Beyond the autonomy debates and towards a philosophy of palliative care

Abstract

At a time when death-and-dying are increasingly thought of as medical events, even to the point where professionals traditionally oriented towards healing are sometimes thought to be responsible for intentionally ending the lives of patients, it is becoming increasingly clear that palliative care is both unique and critically important. In this paper I show the need for clear articulation of the philosophy of this distinctive practice that properly acts with intent towards neither health in a narrowly medical sense nor patient death. I propose four lenses through which a rigorous philosophy of palliative care may be approached: trust, intent, authenticity, and the foundational question of good dying – literally euthanasia. I contend that proper palliative care seeks to cloak (palliare) pain within the context of trusting relationships both as a good in itself and as way of de-cloaking the things that form important components of most people’s narratives of good dying: opportunities to authentically engage with trusted others with the aim of finding some kind of meaning in life and community, even during the process of dying. Furthermore, palliative care is characterized by a non-paternalistic willingness to point outside of itself in order to help patients authentically engage the important existential questions of human mortality via lenses that extend beyond those offered by scientific medicine.

Keywords:

• Palliative care
• Palliation
• Euthanasia
• Bioethics
• Medical ethics
• Autonomy
• Trust
• Double effect

Acknowledgments

The author wishes to thank Dr Brendan Leier for the conversations that inspired this little work; and Kalyn and Lila Christine, as always.

Disclaimer statements

Contributors None.

Funding None.

Conflicts of interest The authors report no conflict of interest.

Ethics approval None.