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Patient autonomy and professional expertise in decisions near the end of life: commentary on Francis Kamm
  1. Robert D Truog
  1. Correspondence to Dr Robert D Truog, Boston Children's Hospital, Harvard Medical School, Bader 633, 300 Longwood Ave., Boston, MA 02115, USA; Robert.Truog{at}childrens.harvard.edu

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In her essay, Francis Kamm discusses a broad range of issues surrounding care near the end of life, as examined through the lens of three position papers and two studies.i Her comments remind me of the value that good philosophical analysis brings to the work of clinicians; Kamm accurately and perceptively uncovers areas of ambiguity and outright inconsistency that are very relevant to how we approach the many challenges that arise in providing care to those who are near the end of their lives.

This being said, position papers and research studies provide only a narrow window into understanding what actually happens during the care of patients. My goal in this commentary is to build some clinical context around Kamm's observations. In particular, I will focus on a recurrent theme in Kamm's essay, which she summarises as follows: ‘While professionals… typically begin with calls to attend to preferences of a person…, they seem to have aims beyond guiding care according to those preferences and view these aims as having objective value. In particular, while a ground given for attending to patients’ preferences is that views on what constitutes a good death vary, many professionals have a particular view of what a good death is and hope to promote it for what they see as patients’ own good.’

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