Phenomenology
Is planning your end-of-life care really a matter of choice?
Open access · cc by · source: Europe PMC
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.
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.
Key findings
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.
Methodology
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.
Limitations
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.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
Deciding is embodied and partly passive, not only a cognitive calculation.
English capacity law's cognitive test is argued to be too thin: bodily and affective engagement belong to autonomous deciding. A Ricoeurian reading of one widow's end-of-life choices adds that choosing has a passive side, hesitation can be wisdom, and responsibility is shared when another person must act on a directive — suggesting 'wishes' rather than 'directives'.
Evidence for the claim as stated.
Deciding is embodied and partly passive, not only a cognitive calculation.
English capacity law's cognitive test is argued to be too thin: bodily and affective engagement belong to autonomous deciding. A Ricoeurian reading of one widow's end-of-life choices adds that choosing has a passive side, hesitation can be wisdom, and responsibility is shared when another person must act on a directive — suggesting 'wishes' rather than 'directives'.
Scope note — Built on a single, deliberately atypical case; it does not test whether changing advance-care language improves care.
Limits the claim's scope: a different population, assay, or outcome.
The capacity paper wants bodily engagement built into assessments of autonomous decisions, while the Ricoeurian paper cautions that anticipatory choices are inherently ambivalent and partly passive — which sits uneasily with any test demanding a settled, clear decision.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.
The capacity paper wants bodily engagement built into assessments of autonomous decisions, while the Ricoeurian paper cautions that anticipatory choices are inherently ambivalent and partly passive — which sits uneasily with any test demanding a settled, clear decision.
- Supports · Is autonomy only a cognitive capacity test?
History
When this study was placed
Dated entries from the concept change log — when this paper was added or removed as support, challenge, or qualifier on a claim.
Placed as supporting evidence on Phenomenology
English capacity law's cognitive test is argued to be too thin: bodily and affective engagement belong to autonomous deciding. A Ricoeurian reading of one widow's end-of-life choices adds that choosing has a passive side, hesitation can be wisdom, and responsibility is shared when another person must act on a directive — suggesting 'wishes' rather than 'directives'.
Placed as a scope qualifier on Phenomenology
English capacity law's cognitive test is argued to be too thin: bodily and affective engagement belong to autonomous deciding. A Ricoeurian reading of one widow's end-of-life choices adds that choosing has a passive side, hesitation can be wisdom, and responsibility is shared when another person must act on a directive — suggesting 'wishes' rather than 'directives'.
Placed as supporting evidence on Phenomenology
The capacity paper wants bodily engagement built into assessments of autonomous decisions, while the Ricoeurian paper cautions that anticipatory choices are inherently ambivalent and partly passive — which sits uneasily with any test demanding a settled, clear decision.
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Same topic cluster — not a recommendation engine.