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Rawlsian reasoning about fairness at the end of life
Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden .
Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Science/Psychiatry.ORCID iD: 0000-0002-3227-2487
Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden.
2022 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, article id bmjspcare-2021-003500Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: The aim of this study was to discuss end-of-life care in the context of Rawls' and Daniels' philosophy of justice. The study is based on an empirical survey of Swedish physicians who were asked whether they would want the option of physician-assisted suicide (PAS) for themselves (hereafter called own preferences), what are their attitudes towards PAS in general and whether they were prepared to prescribe PAS drugs to eligible patients. The question is to what extent the physicians' answers are impartial and consistent in a Rawlsian sense.

METHODS: The underlying indicator was the physicians' own preferences. Kappa score inter-rater agreement was measured between that response and that same physician's general attitude towards allowing PAS and preparedness to prescribe PAS drugs. The coherence of provided comments and arguments were analysed using content analysis.

RESULTS: Palliative care physicians are the least willing to offer PAS, and surgeons and psychiatrist the most willing. There is a discrepancy between physicians' general attitudes about allowing PAS, their own wishes to be offered PAS at the end of life and the concrete action of prescribing PAS drugs. Arguments given for not prescribing PAS by those in favour of PAS are seemingly but not truly inconsistent.

CONCLUSIONS: Those supporting PAS provided impartial and consistent arguments for their stances in a Rawlsian sense, while those against PAS provided partial arguments. Two specialties, psychiatrists and palliative care physicians, were coherent in their reasoning about PAS for themselves and their willingness to prescribe the needed drugs.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022. article id bmjspcare-2021-003500
Keywords [en]
End of life care, ethics, hospice care, methodological research, terminal care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-99874DOI: 10.1136/spcare-2021-003500ISI: 000819490200001PubMedID: 35768205Scopus ID: 2-s2.0-85134584254OAI: oai:DiVA.org:oru-99874DiVA, id: diva2:1678878
Available from: 2022-06-30 Created: 2022-06-30 Last updated: 2023-12-08Bibliographically approved

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