Within bioethics, Kant’s conception of autonomy is often portrayed as excessively rationalistic, abstract, and individualistic, and, therefore, far removed from the reality of patients’ needs. Drawing on recent contributions in Kantian philosophy, we argue that specific features of Kantian autonomy remain relevant for medical ethics and for patient experience. We use contemporary end-of-life illness narratives—a resource that has not been analyzed with respect to autonomy—and show how they illustrate important Kantian themes, namely, the duty to know oneself, the interest in (...) elaborating universalizable principles, and the emphasis on ideals as points of orientation that guide behavior without ever being fully realized. As Kant does, the patient-authors discussed here perceive the end of life as a moment to reflect on the constitutive principles which have governed that life, thereby offering a privileged moment to pursue self-knowledge. We argue that bioethical conceptions of autonomy stand to gain if they revise their conception of Kantian moral philosophy as too formal, abstract, and detached from emotions and personal relationships to be helpfully applied. (shrink)

Ethical issues raised by the outbreak of COVID-19 have predominantly been addressed through a public health ethics lens. This article proposes that the rising COVID-19 fatalities and the World Health Organization’s failure to include palliative care as part of its guidance on how to maintain essential health services during the pandemic have exposed palliative care as an underlying global crisis. It therefore calls for a different ethical framework that includes a care ethics perspective and thereby addresses the ways in which (...) the pandemic has triggered new difficulties in ensuring the delivery of appropriate end-of-life care for the dying. The article analyses the structural weaknesses of palliative care accentuated by the pandemic and proposes solutions that could set in motion lasting changes in the way it is delivered beyond COVID-19. (shrink)