We would like to thank you for the opportunity to respond to the issues raised in Dr. Rodríguez-Prat et al.'s letter concerning our critical review on patients' autonomy at the end of life
1and to offer an explanation of our comment to their systematic review.
- Houska A.
- Loucka M.
Patients' autonomy at the end of life: a critical review.
J Pain Symptom Manage. 2019; 57: 835-845
2We would also like to thank Dr. Rodríguez-Prat and her colleagues for their interest in our paper and for taking the time to express their concerns. In their letter to the editor, Dr. Rodríguez-Prat et al. argue that their results show autonomy as a determining factor of dignity only at one particular context and not in general and also highlighted their understanding of dignity as a “fundamentally intrinsic feature of the human individual.”
- Rodríguez-Prat A.
- Monforte-Royo C.
- Porta-Sales J.
- Escribano X.
- Balaguer A.
Patient perspectives of dignity, autonomy and control at the end of life: systematic review and meta-ethnography.
PLoS One. 2016; 11: e0151435
It would be mistake to interpret the results of Dr. Rodríguez-Prat et al.'s review in a reductive way and to generalize the determining role of autonomy for perceived dignity. The aim of our review was to develop a structural model of patients' autonomy that extends the traditional understanding of autonomy as a capacity to make an independent rational choice and so our perspective was specifically orientated on autonomy. Dr. Rodríguez-Prat et al.'s review highlights the relation between perceived dignity, autonomy, and control in patients at the end of life. If we understood the results of their analysis correctly, Rodríguez-Prat et al. argue in their review that autonomy plays an important role at the end of life, although it is mostly described in a negative way—for example, how “loss of autonomy” can influence dignity. In their review, autonomy is defined positively only in patients whose sense of dignity was based on autonomy and predominantly in the context of the control over the dying process, self-determination, and the right to decide. The results of our review highlight the need for broader positive definition of autonomy with emphasis on “patients' engagement in daily activities, in contributing to others, and in active preparation for dying.”
We would like to point out that the objective of our comment was not to criticize the explanatory model of dignity presented by the authors of the cited paper. On the contrary, we appraise the methodological robustness and the empirical background of the model which present important contribution to the discussion about patients' perspectives on dignity.
- Patients' autonomy at the end of life: a critical review.J Pain Symptom Manage. 2019; 57: 835-845
- Patient perspectives of dignity, autonomy and control at the end of life: systematic review and meta-ethnography.PLoS One. 2016; 11: e0151435
Published online: April 15, 2019
© 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc.
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- Response to: “Patients' Autonomy at the End of Life: A Critical Review”Journal of Pain and Symptom ManagementVol. 58Issue 1
- PreviewDr. Houska et al. carried out a critical review about patients' autonomy at the end of life1 in which they compare their results to a previous systematic review conducted by our research group.2 We appreciate the comments of Dr. Houska et al. regarding our review. As the authors highlight, our conclusions about the relationship between dignity and autonomy are similar to their autonomy model among patients at the end of life.