[Right of self-determination and the duty to treat--the conflict between the patients's right to self-determination and the physician's duty to treat in relation to living wills].

: The principle of autonomy requires competency. A competent patient is a patient who is capable of exercising his or her right to self-determination. However, in practical clinical work there is a continuum between competency and incompetency, and it is the doctor who has to decide whether the right to autonomy can be meaningfully upheld. When a patient rejects curative treatment, a conflict arises between the patient's right to autonomy and the doctor's duty to treat. While emphasizing the principle of autonomy is a guideline, the presence or absence of a living will is almost misguided. One may fear that the question of whether cure or relief is possible may altogether be neglected when a living will is in existence. The interpretation of when a living will should be used is dependent on the health staff's evaluation. There are widely divergent opinions of when a person is unavoidably dying or permanently incapable of taking care of themselves physically and mentally. If a treatment does not have a view to a cure, an improvement or a relief of symptoms it should in all circumstances be discontinued, independently of whether or not a living will is in existence.