A Re-examination of the Issue of Patients' Autonomy in End-of-Life Medical Decision-Making in China

This study analyzes the dilemmas of end-of-life medical decision-making autonomy among Chinese patients through a "relation–power" framework. The root of these dilemmas lies in the disconnection between a rights-centered institutional design and relational medical practice. The challenges in implementing living wills illustrate how autonomy in end-of-life care is constrained within relational networks: the static nature of texts conflicts with the dynamic realities of clinical practice, and the realization of rights is affected by structural social barriers. A deeper issue is the power imbalance among the "physician–patient–family" triad, resulting in suspended patient wishes, pressured family decision-making, and physicians' risk-averse withdrawal. Addressing these issues requires moving beyond a purely rights-based approach by legislatively clarifying responsibilities, establishing shared decision-making mechanisms, and fostering a supportive social culture, thereby enhancing substantive autonomy through dynamic power coordination.