What we found is that (a) prognostication at the EOL is problematic and resisted (b) shared decision making is illusory, patients often resist advance care planning and hold other values more important than autonomy, and system characteristics are more determinative of EOL care than patient preferences and (c) the incommensurability of medical and lay knowledge and values and the multifaceted and processual nature of patient and family decision making are at odds with the current EOL approach toward advance care planning. Results: There is little or no empirical evidence to support the autonomy paradigm of patient "choice" in EOL decision making. In addition we will provide a brief review of our own ethnographic, longitudinal study of the decision-making experience of dying patients, their families, and their health care providers. Design and Methods:Our critique is based on a comprehensive review of empirical research exploring bioethics practices at the EOL. Research on the ethical dimensions of EOL decision making has focused on an idealized discourse of patient "choice" that requires patients to embrace their dying to receive excellent palliative care. We argue that researchers have rarely questioned the normative power of autonomy-based bioethics practices. I’d tell you to go f*ck yourself, but you’d be disappointed.Purpose: The contribution of bioethics to clinical care at the end of life (EOL) deserves critical scrutiny. No, I won’t be giving you a 5-star rating. Yup, I did wait an extra 10 minutes for my 20 nuggets thanks.I’d love to have a house, Dad, but you did such a good job on the economy that I’ll have to wait a little longer.I’m not married because the world is full of people like you.My rule is: if it has an asshole, don’t eat it. Did I offend you with my opinion? That was nothing, you should hear the things I keep to myself. I may not have any savings, but you don’t have any hair, Uncle Pete.Still watching Netflix all day? Why yes Celine I am.Just like you chose to ignore the mirror today. No, you can’t have a bite of my cheeseburger. I think it’s a bit rich you’re judging me for eating a large chips, when that pork is the only thing you’ve pulled in the past six months, Josh.You’re just jealous you aren’t as #blessed as I am. And I’m jealous of the people that don’t know you.
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