Patient autonomy and 'death with dignity'. Some clinical caveats

The issues of patient autonomy and the right to die with dignity are without question important ones that require further discussion and clarification by our society as a whole. However, there is a danger that in certain cases, preoccupation with these dramatic and popular issues may lead physicians and patients to make clinically inappropriate decisions - precisely because sound clinical evaluation and judgement are suspended. This article attempts to illustrate this concept by use of clinical examples from a medical intensive-care unit. Each case demonstrates a specific clinical situation where concerns about patient autonomy and the right to die with dignity posed a potential threat to sound decision making and the total clinical (medical, social and ethical) basis for the 'optimal' decision. The cases presented in this article preoccupation with the issues of patient autonomy and death with dignity could have led to inappropriate clinical and ethical decisions. They suggest a checklist that may aid the clinician in evaluating such difficult situations.