The patient's desire-an independent ethical factor contributing to therapeutic decision making?

Abstract

Definition of the problem Therapeutic decision making generally relies on a given underlying medical indication and the patient's informed consent. So far, the concept of medical indication has been analyzed and operationalized for clinical purposes by medical ethics, and the concept of the patient's informed consent is broadly secured by legislation and clinical and ethical guidelines. Informed consent implies thorough and appropriate delivery of information and an according treatment option communicated to the patient, who can accept or refuse this offer. Within this concept of medical decision making, it is under debate in medical ethics, to what extent the patient's (or the relatives') desire for certain treatment options should play a role, if at all. Arguments and conclusions This article discusses the significance of the patients' desire as an independent normative factor in medical decision making, besides ascertaining the underlying medical indication and the patient's informed consent. A case report illustrates the spectrum of concepts of autonomy, and points to the dilemma that might result on a diverging appraisal on medical usefulness and futility between patient and physician in cancer care and palliative care. The case report finally tries to incorporate the patient's desire as a relevant co-factor into conventional concepts of therapeutic decision making.