Care in palliative care: a challenging concept with normative issues.

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 'care' 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's 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 'all' patient requests are fulfilled through palliative care. There are (justified and perhaps necessary) limitations in the fulfilment of the patient's 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.