Living Up to a Good Death: Complexities and Constraints in End of Life Choices

The concept of choice has gained favour with politicians and policymakers over the past two decades as a means of driving down costs, driving improvements in healthcare and empowering patients in decisions about their care. It is a concept equally taken up by patients and families and now appears to have secured its place as a moral imperative in the public imagination. In the UK NHS, as with other high-income healthcare systems, choice has become a key principle guiding the way that healthcare is organised and delivered. Recently, attempts have made been to apply the logic of choice to the context of care at the end of life. This chapter considers two central accounts of choice: the market version of choice and the civic version of choice. It introduces the ideas that underpin each version of choice and discusses the ways in which patients are implicated and defined in relation to them. It then discusses how each version becomes complicated in the context of end of life, taking the ideal of a “good death” as the central point of reference. The aim is to outline tensions in the choice agenda and to highlight the complexities inherent in the application of choice to care at the end of life.