Palliative Obstinacy: When Care Becomes a Constraint at the End of Life.

This paper develops the concept of "palliative obstinacy" to describe situations in which palliative care, rather than alleviating suffering in accordance with the patient's wishes and values, becomes a new form of clinical paternalism at the end of life. Drawing on a case narrated by Elyse Ona Singer and Norma Alicia Ordóñez-Vázquez of a patient with cancer requesting physician-assisted death, the paper argues that some models of palliative care unjustifiably pathologize the desire to die by treating it exclusively as a symptom of untreated suffering, depression, or inadequate care. Building on the analysis by Singer and Ordóñez-Vázquez, the paper examines the paradox whereby palliative care expands certain end-of-life choices while simultaneously rendering others-especially physician-assisted death-morally or conceptually unthinkable. It argues that denying the rationality of some requests for hastened death risks undermining patient autonomy and imposing a singular moral framework concerning suffering and dying. The paper concludes that palliative care and physician-assisted death should be understood as complementary rather than mutually exclusive options within end-of-life care.