Historical and Contemporary Perspectives on End-of-Life Decision Making

Authored by: James L. Werth

Handbook of Thanatology

Print publication date:  May  2013
Online publication date:  July  2013

Print ISBN: 9781138430815
eBook ISBN: 9780203767306
Adobe ISBN: 9781136726507


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This chapter is intended to briefly review several areas that have implications for end-of-life decision making. To the degree possible, I have based the discussion on research and will provide both historical and contemporary perspectives on each area, although the length of time reviewed will vary by topic. I defined end-of-life decision making as choices made by dying individuals, their loved ones, or professional caregivers that take place during a person’s dying process and/or have an effect on the manner and timing of death. Examples of end-of-life decisions include whether to create advance directives (i.e., a living will, a durable power of attorney for health care) and, if so, determining the specifics related to them; whether to continue on, withhold, or withdraw life-sustaining treatment; whether to more actively hasten death such as by voluntarily stopping eating and drinking or requesting (or providing, in the case of personal and professional caregivers) assisted suicide or voluntary euthanasia (see also Kleespies, 2004). I will not deal with end-of-life decisions made and enforced by health care providers without the awareness of the dying person or loved ones (e.g., involuntary euthanasia) or over the protestations of the dying person/loved ones (e.g., futility determinations).

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