Is planning your end-of-life care really a matter of choice?
The author argues that advance care planning overstates choice and control, and should make room for hesitation, acceptance and responsibility shared with the people who must act.
Source
Embracing ambivalence and hesitation: a Ricoeurian perspective on anticipatory choice processes at the end of life
Study at a glance
- Design
- Qualitative / archival — Philosophical analysis (Ricoeur's Freedom and Nature) applied to one case narrative from an earlier phenomenological interview study
- N
- The argument rests on a single case (one older woman and her family) drawn from a prior study of 30 participants in 10 triads; no new data
- Population
- Older adults anticipating end-of-life choices and their close ones, in advance care planning
- Outcome
- Thesis: end-of-life 'choices' should be reconceived to include passivity, hesitation, consent and shared responsibility, perhaps as 'wishes' rather than directives
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
The author presents the case of Anne, a widow who stopped her husband's resuscitation in line with his earlier wishes and later wrote her own list of end-of-life wishes. She then lays out Paul Ricoeur's phenomenology of the will, in which choosing is always bound up with the involuntary (body, birth, character, society), and uses it to reinterpret Anne's experience.
What they found
Five underrated elements are identified: choice has a passive side, as when Anne felt she had nothing real to choose; hesitation is a sign of wisdom, not weakness; anticipated suffering is felt as real now; agency may lie in consenting and surrendering rather than controlling; and when another person must act on a directive, responsibility is shared. The author suggests speaking of advance care 'wishes' or 'aspirations' rather than directives and decisions.
The limits
What it doesn't show
The empirical basis is a single, deliberately rich case that the author says is not typical, so it cannot show how common these experiences are. The argument is mainly descriptive and interpretive; it does not test whether changing ACP language would improve care or reduce family distress. It also underplays evidence, which the author acknowledges, that advance directives help protect against unwanted treatment.
Key terms
- Advance directive
- A document recording a person's wishes about future medical treatment in case they cannot communicate.
- Advance care planning
- The process of discussing and recording values and preferences for future care, often with family and clinicians.
- Voluntary and involuntary
- Ricoeur's pair: what we will and do, versus what is given to us, such as our body, birth and history; he holds them in tension.
- Consent (Ricoeur)
- Actively saying yes to a situation one did not choose, making it one's own; treated as a form of agency.
- Hesitation
- Holding choice in suspension while weighing conflicting values; for Ricoeur a recognition of life's ambiguity, not a flaw.
Flashcards
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Quiz yourself
Whose philosophy frames this paper's analysis?
Common questions
Is the author against advance directives?
No. Anne still values writing hers, and the author sees the process as affirming agency; she argues the language should better reflect uncertainty and shared responsibility.
Why does it matter who carries out a directive?
For Ricoeur a decision is completed in action; if someone else must act, they also decide and bear responsibility, so it may be more honest to call it a wish.
How can giving in count as agency?
Ricoeur treats consent as an active acceptance of what cannot be changed, turning an imposed situation into one's own.
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