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O-53 Between autonomy and paternalism – self-determination in end of life care
  1. Katharina Leitner1,
  2. Sigrid Beyer2 and
  3. Maria Kletečka-Pulke1
  1. 1Institue for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
  2. 2Dachverband Hospiz Österreich, Vienna, Austria


Background In Austria, as in Germany as well, the patient’s right to self-determination includes the right to freely refuse any proposed medical treatment, even if it is linked to vital consequences. A patient, who has the capacity to consent, can articulate a refusal at any time.

For situations when the patient doesn’t have the capacity to consent anymore, he/she can make an advance health care directive or a health care proxy since 2006. The Institute for Ethics and Law in Medicine conducted a study to evaluate these instruments for self-determination. The findings of this study shall be presented at the ACPEL 2015.

Aim The aim of the study was the evaluation of the advance health care directive and the health care proxy.

Methods Quantitative (representative telephone poll among the Austrian population) and qualitative (qualitative interviews and focus group discussions with doctors, nurses, psychologists, lawyers and patients) methods.

Results Most of the people living in Austria, have already heard of the instruments for self-determination, but only 4.1% have made an advance health care directive and only 2% a health care proxy. People don’t want to be confronted with their end-of-life, they lack necessary information about the formation procedure and the costs are too high.

Discussion Are the existing instruments for self-determination fulfilling the needs of the patients and the doctors and if not, how can the instruments for self-determination be improved?

Conclusion The study shows that the health care directive and the health care proxy can’t be seen in isolation but have to be embedded in a larger context of advance care planning.

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