‘Moral luck’ and the question of autonomy, choice, and control in end-of-life decision making

Johnstone,M-J 2015, ‘Moral luck’ and the question of autonomy, choice, and control in end-of-life decision making, Progress in Palliative Care, vol. 23, no. 3, pp. 126-132, doi: 10.1179/1743291X14Y.0000000101.

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Title ‘Moral luck’ and the question of autonomy, choice, and control in end-of-life decision making
Author(s) Johnstone,M-J
Journal name Progress in Palliative Care
Volume number 23
Issue number 3
Start page 126
End page 132
Total pages 7
Publisher W S Maney & Son Ltd
Publication date 2015
ISSN 0969-9260
1743-291X
Keyword(s) Moral luck, Ethics, Bioethics, Patient autonomy, End-of-life care, Medical ethics, Ethical decision making
Summary It is commonly assumed that, in the realm of ethical decision making at the end-of-life, ‘luck’ and ‘risk’ do not intrude. Nonetheless ‘moral luck’ (where happenstance makes a moral difference) does intrude and can have an unanticipated impact on the ultimate moral outcomes of end-of-life care. In the interests of upholding the ethical standards of end-of-life care, healthcare providers have increasingly relied on ethical principlism as a rational decision-guiding frame in the sincere belief that such an approach will enable patient selfdetermination and control over treatment decisions when needing end-of-life care. Due to contextual variables and associated uncertainties in end-of-life care, however, the intended moral outcomes of appeals to commonly accepted ethical principles (in particular the principle of autonomy) are not always realized. What is not always appreciated is that whether ‘good’ or ‘bad’ moral outcomes are achieved can be as much a matter of chance as of choice. This essay explores the relevance and possible implications of moral luck in end-of-life decision making and care. A key conclusion of the paper is that the notion of moral luck needs to be taken seriously in end-of-life care contexts since it can have an unanticipated impact on the outcomes of the decisions that are made and thereby on the moral interests of patients facing the end of their lives.
DOI 10.1179/1743291X14Y.0000000101
Field of Research 111099 Nursing not elsewhere classified
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2015, Maney Publishing
Persistent URL http://hdl.handle.net/10536/DRO/DU:30073696

Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
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