{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T21:19:16Z","timestamp":1794431956144,"version":"4.9.1"},"reference-count":50,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2025,7,2]]},"abstract":"<jats:p>Palliative care is an approach for seriously ill patients. Illnesses and knowledge of limited life expectancy often limit self-determination among patients. Along with the concepts of patient autonomy and heteronomy, care is central to the everyday personal and institutional lives of the ill. However, the term \u2018care\u2019 has not yet been systematically examined. I argue for a clear distinction between care and paternalism in the discussion about the individual approach to a situation in everyday life, which are two different forms of action in which the patient\u2019s will is considered to varying degrees. The (at least ethical) evaluation, and thus the individual situational need for justification of an action, is different for both forms of action, even if both forms can promote the autonomy of the patient. However, not \u2018all\u2019 patient requests are fulfilled through palliative care. There are (justified and perhaps necessary) limitations in the fulfilment of the patient\u2019s goals on the part of those providing care. However, in the context of the discussion on care, these limitations also require a well-founded justification for each individual case.<\/jats:p>","DOI":"10.1136\/jme-2024-110247","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T21:40:53Z","timestamp":1752702053000},"page":"jme-2024-110247","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Care in palliative care: a challenging concept with normative issues"],"prefix":"10.1136","author":[{"given":"Michael","family":"Rechenmacher","sequence":"first","affiliation":[{"name":"Clinic and Polyclinic for Internal Medicine III, University Hospital Regensburg, Regensburg, Germany"},{"name":"Center for Palliative Care, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"2025071614401969000_jme-2024-110247v1.1","unstructured":"Allert G , Blasszauer B , Boyd K . The goals of medicine. Hastings Cent Rep 1996;1\u201327."},{"key":"2025071614401969000_jme-2024-110247v1.2","unstructured":"World Health Organization . Definition of palliative care: fact sheet n\u00b0402, 07\/2015 2015. Available: https:\/\/www.who.int\/cancer\/palliative\/definition\/en\/ [Accessed 4 Feb 2020]."},{"key":"2025071614401969000_jme-2024-110247v1.3","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.3390\/curroncol28030153","article-title":"Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care","volume":"28","author":"Seow","year":"2021","journal-title":"Curr Oncol"},{"key":"2025071614401969000_jme-2024-110247v1.4","unstructured":"Saunders C . Selected writings 1958-2004. Oxford University Press, 2006."},{"key":"2025071614401969000_jme-2024-110247v1.5","first-page":"278","article-title":"White paper on standards and norms for hospice and palliative care in Europe: Part 1","volume":"16","author":"Radbruch","year":"2009","journal-title":"EUROPEAN JOURNAL OF PALLIATIVE CARE"},{"key":"2025071614401969000_jme-2024-110247v1.6","unstructured":"Feinberg J . Harm to Self. New York: Oxford Univ. Press, 1986."},{"key":"2025071614401969000_jme-2024-110247v1.7","unstructured":"Beauchamp TL , Childress JF . Principles of Biomedical Ethics. 8th edn. Oxford University Press, 2019."},{"key":"2025071614401969000_jme-2024-110247v1.8","doi-asserted-by":"crossref","unstructured":"Berlin I . Two concepts of liberty. Oxford University Press, 2002.","DOI":"10.1093\/019924989X.003.0004"},{"key":"2025071614401969000_jme-2024-110247v1.9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1200\/CCI.18.00011","article-title":"Cognitive Bias: The Downside of Shared Decision Making","volume":"2","author":"Ozdemir","year":"2018","journal-title":"JCO Clin Cancer Inform"},{"key":"2025071614401969000_jme-2024-110247v1.10","doi-asserted-by":"publisher","DOI":"10.1353\/ken.0.0084"},{"key":"2025071614401969000_jme-2024-110247v1.11","unstructured":"Faden RR , Beauchamp TL . A history and theory of informed consent. New York: Oxford Univ. Press, 1986."},{"key":"2025071614401969000_jme-2024-110247v1.12","doi-asserted-by":"publisher","DOI":"10.1136\/jme.29.5.307"},{"key":"2025071614401969000_jme-2024-110247v1.13","doi-asserted-by":"publisher","DOI":"10.2307\/2940760"},{"key":"2025071614401969000_jme-2024-110247v1.14","unstructured":"Graumann S . Voraussetzungen von Patientenautonomie in der Gesundheitspolitik: Chancen und Fallstricke von Selbstbestimmung [prerequisites for patient autonomy in healthcare policy: opportunities and pitfalls of self-determination]. In: Bonde I , Gerhadt M , Kolb S , eds. Medizin und Gewissen: Im Streit zwischen Markt und Solidarit\u00e4t\u202f; Dokumentation des internationalen IPPNW-Kongresses in N\u00fcrnberg 20 - 22. Oktober 2006\u202f; [Kongressdokumentation. Frankfurt am Main: Mabuse-Verl. 2008: 415\u201327."},{"key":"2025071614401969000_jme-2024-110247v1.15","unstructured":"Agich G . Autonomy and long-term care. New York: Oxford University Press, 1993."},{"key":"2025071614401969000_jme-2024-110247v1.16","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/NJH.0b013e318202425c","article-title":"The Autonomy Experience of Patients in Palliative Care","volume":"13","author":"Lavoie","year":"2011","journal-title":"Journal of Hospice & Palliative Nursing"},{"key":"2025071614401969000_jme-2024-110247v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.04.027"},{"key":"2025071614401969000_jme-2024-110247v1.18","unstructured":"Ruddick S . Care as labor and relationship. In: Haber JG , ed. Norms and values: Essays on the work of Virginia Held. Lanham: Rowman & Littlefield, 1998."},{"key":"2025071614401969000_jme-2024-110247v1.19","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1017\/hyp.2020.12","article-title":"Caring Actions","volume":"35","author":"Steyl","year":"2020","journal-title":"Hypatia"},{"key":"2025071614401969000_jme-2024-110247v1.20","unstructured":"Tronto JC . Moral boundaries: a political argument for an ethic of care. New York: Routledge, 2009."},{"key":"2025071614401969000_jme-2024-110247v1.21","unstructured":"Benedikt XVI . Deus caritas est 2005. Available: https:\/\/www.vatican.va\/content\/benedict-xvi\/de\/encyclicals\/documents\/hf_ben-xvi_enc_20051225_deus-caritas-est.html [Accessed 9 Sep 2021]."},{"key":"2025071614401969000_jme-2024-110247v1.22","unstructured":"Ric\u0153ur P . Das Selbst als ein Anderer [Oneself as Another]. 2nd edn. M\u00fcnchen: Wilhelm Fink Verlag, 1996."},{"key":"2025071614401969000_jme-2024-110247v1.23","doi-asserted-by":"crossref","unstructured":"Maio G . Eine Ph\u00e4nomenologie der Sorge [A phenomenology of care]. Zeitschrift f\u00fcr Palliativmedizin 2019;222\u20134. doi:10.1055\/a-0976-7874","DOI":"10.1055\/a-0976-7874"},{"key":"2025071614401969000_jme-2024-110247v1.24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03480160079038"},{"key":"2025071614401969000_jme-2024-110247v1.25","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1016\/j.pec.2016.07.026","article-title":"Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review","volume":"99","author":"Castro","year":"2016","journal-title":"Patient Educ Couns"},{"key":"2025071614401969000_jme-2024-110247v1.26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2147\/PPA.S55022","article-title":"Patient autonomy in chronic care: solving a paradox","volume":"8","author":"Reach","year":"2013","journal-title":"Patient Prefer Adherence"},{"key":"2025071614401969000_jme-2024-110247v1.27","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s11158-023-09580-9","article-title":"Care as a Thick Ethical Concept","volume":"29","author":"Chadha-Sridhar","year":"2023","journal-title":"Res Publica"},{"key":"2025071614401969000_jme-2024-110247v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(98)00441-9"},{"key":"2025071614401969000_jme-2024-110247v1.29","unstructured":"EAPC . Core competencies in palliative care: an EAPC White Paper on palliative care education \u2013 part 1. European journal of palliative care 2013."},{"key":"2025071614401969000_jme-2024-110247v1.30","doi-asserted-by":"crossref","unstructured":"Maio G . Sorgerationalit\u00e4t als identit\u00e4tsstiftendes Moment der Palliativmedizin [Rationality of care as an identity-forming moment in palliative care]. Zeitschrift f\u00fcr Palliativmedizin 2017;175\u20138. doi:10.1055\/s-0043-111612","DOI":"10.1055\/s-0043-111612"},{"key":"2025071614401969000_jme-2024-110247v1.31","doi-asserted-by":"crossref","unstructured":"Mackenzie C , Stoljar N , eds. Relational autonomy: feminist perspectives on autonomy, agency, and the social self. New York, NY: Oxford Univ. Press, 2000.","DOI":"10.1093\/oso\/9780195123333.001.0001"},{"key":"2025071614401969000_jme-2024-110247v1.32","doi-asserted-by":"crossref","unstructured":"Anderson J , Autonomy HA . Vulnerability, recognition, and justice. In: Christman J , Anderson J , eds. Autonomy and the challenges to liberalism. Cambridge: Cambridge Univ. Press, 2009: 127\u201349.","DOI":"10.1017\/CBO9780511610325.008"},{"key":"2025071614401969000_jme-2024-110247v1.33","unstructured":"Quante M . Dependenz und W\u00fcrde im Kontext der Pflege [Personal autonomy, dependency and dignity in the context of care]. Preprints and Working Papers of the Centre for Advanced Study in Bioethics 2017."},{"key":"2025071614401969000_jme-2024-110247v1.34","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/1363459308090052","article-title":"Conceptualizing autonomy in the context of chronic physical illness: relating philosophical theories to social scientific perspectives","volume":"12","author":"Mars","year":"2008","journal-title":"Health (London)"},{"key":"2025071614401969000_jme-2024-110247v1.35","unstructured":"Agich G . Dependence and autonomy in old age. Cambridge University Press, 2009."},{"key":"2025071614401969000_jme-2024-110247v1.36","doi-asserted-by":"crossref","unstructured":"Dworkin G . The theory and practice of autonomy. Cambridge University Press, 1988.","DOI":"10.1017\/CBO9780511625206"},{"key":"2025071614401969000_jme-2024-110247v1.37","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1080\/00455091.1971.10716012","article-title":"Legal Paternalism","volume":"1","author":"Feinberg","year":"1971","journal-title":"Can J of Philosophy"},{"key":"2025071614401969000_jme-2024-110247v1.38","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/phc3.12111","article-title":"Medical Paternalism \u2013 Part 1","volume":"9","author":"Groll","year":"2014","journal-title":"Philos Compass"},{"key":"2025071614401969000_jme-2024-110247v1.39","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-134-12-200106190-00012"},{"key":"2025071614401969000_jme-2024-110247v1.40","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-020-00576-3","article-title":"Systematic symptom and problem assessment at admission to the palliative care ward - perspectives and prognostic impacts","volume":"19","author":"Coym","year":"2020","journal-title":"BMC Palliat Care"},{"key":"2025071614401969000_jme-2024-110247v1.41","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2010.0139"},{"key":"2025071614401969000_jme-2024-110247v1.42","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-011-1335-1"},{"key":"2025071614401969000_jme-2024-110247v1.43","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1111\/bioe.13091","article-title":"Nudges and hard choices","volume":"36","author":"Raskoff","year":"2022","journal-title":"Bioethics"},{"key":"2025071614401969000_jme-2024-110247v1.44","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1080\/23294515.2018.1462273","article-title":"How acceptable is paternalism? A survey-based study of clinician and nonclinician opinions on paternalistic decision making","volume":"9","author":"Bailoor","year":"2018","journal-title":"AJOB Empir Bioeth"},{"key":"2025071614401969000_jme-2024-110247v1.45","doi-asserted-by":"crossref","DOI":"10.1186\/s12910-021-00739-8","article-title":"How to reveal disguised paternalism: version 2.0","volume":"22","author":"Lyn\u00f8e","year":"2021","journal-title":"BMC Med Ethics"},{"key":"2025071614401969000_jme-2024-110247v1.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.04.010"},{"key":"2025071614401969000_jme-2024-110247v1.47","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18189575","article-title":"A Qualitative Study on Nudging and Palliative Care: \u201cAn Attractive but Misleading Concept\u201d","volume":"18","author":"De Panfilis","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025071614401969000_jme-2024-110247v1.48","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.2147\/PPA.S205819","article-title":"Patient Preferences as Guidance for Information Framing in a Medical Shared Decision-Making Approach: The Bridge Between Nudging and Patient Preferences","volume":"13","author":"Bailo","year":"2019","journal-title":"Patient Prefer Adherence"},{"key":"2025071614401969000_jme-2024-110247v1.49","doi-asserted-by":"crossref","unstructured":"Ekstrom LW . Autonomy and personal integration. In: Taylor JS , ed. Personal autonomy: New essays on personal autonomy and its role in contemporary moral philosophy. Cambridge u. a: Cambridge Univ. Press, 2005: 143\u201361.","DOI":"10.1017\/CBO9780511614194.007"},{"key":"2025071614401969000_jme-2024-110247v1.50","doi-asserted-by":"crossref","unstructured":"Schechtman M . Staying alive: personal identity, practical concerns, and the unity of a life. 1st edn. Oxford: Oxford University Press, 2014.","DOI":"10.1093\/acprof:oso\/9780199684878.003.0001"}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jme-2024-110247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T21:41:09Z","timestamp":1752702069000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/jme-2024-110247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":50,"alternative-id":["10.1136\/jme-2024-110247"],"URL":"https:\/\/doi.org\/10.1136\/jme-2024-110247","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"value":"0306-6800","type":"print"},{"value":"1473-4257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,16]]}}}