Values and goals at the end of life

Death is an unavoidable fact of life. However, the manner in which we each will die is a matter of great concern and conjecture, not least given the considerable advances presented to us by modern medicine. It is nowadays possible for us to delay death and, in many cases, to enable those who would previously have died prematurely to recover and to live full and healthy lives. Such techniques also allow us to exert a greater degree of control over the processes of dying, even when full recovery is not possible. This means that there are people who can now be kept alive by medical interventions but who will never recover sufficiently to live an independent, or in some cases even a conscious, life as a result. There are also patients for whom medical interventions make no (or no appreciable) difference to their suffering – and, sometimes, these patients insist that they would rather die than endure their current existence.

The occurrence of such requests, along with the opportunities and challenges that modern medical techniques simultaneously present, raise a host of important ethical questions. In this chapter we will explore various dilemmas that arise in end-of-life care.