Autonomy as a bioethical principle in end of life decisions for institucionalized older adults

Abstract

This paper offers a necessary reflection on the distinction between capacity and possibility in relation to end-of-life care decisions. This phenomenon entails a series of conflicts —medical, legal, religious, and social—that reveal a persistent confusion between concepts such as “vulnerability” and “autonomy,” which, in turn, may cast doubt on a person’s ability to make informed decisions. Evidence shows that institutionalization tends to diminish personal autonomy. Even when individuals retain decision-making capacity, they are often unable to choose basic matters such as food, clothing, or daily schedules. In the case of older adults, this makes it even more difficult to uphold their right to make decisions about their own end-of-life care. It is
therefore essential to develop specific protocols that ensure respect for their rights and promote their active participation in decision-making processes regarding their desires and preferences at the end of life.