Choosing between death at home or in the hospital: Respecting the principle of autonomy

摘要

Since time immemorial, the most likely place for humans to die has been in their homes amid the presence of loved ones. In this context, dying in a healthcare facility, and more specifically in an intensive care unit (ICU), is a recent development becoming more prevalent since the latter part of the 20th century. It can be argued that if death is inevitable, the choice of where to die should be determined by the patient or his or her surrogate decision-maker as required by the ethical principle of autonomy, a right to make decisions regarding one's health care. Yet, it is not uncommon that this right is not exercised, especially in ICU patients for a variety of reasons, which include dependence on life-sustaining therapies, lack of a protocol for safe transport from the ICU to home, and fear of medical malpractice and criminal prosecution. However, we find that the major reason is the lack of awareness on the part of both the patient and the physician that this right is attainable.