Planning for an (un)certain future: Choice within English end-of-life care

Neoliberal policies are shaping the healthcare landscape by emphasising individual choice. End-of-life care is a case in point as patient choice, through advance care planning, is a key conceptual framework for motivating service development and provision. Based on qualitative ethnographic research in England, this paper describes what choice is and how it is enacted in the context of end-of-life care. Within policy, choice represents individual autonomy and is a goal to strive towards. In order to enable choice, healthcare professionals are to openly discuss dying with patients and in turn, patients are expected to express their preferences. However, by focusing on two case studies, the paper demonstrates how people struggle to articulate choice in these ways and the preferences expressed represent the complex contexts in which care is performed. Although death is certain, the possibility of control alluded to by choice rhetoric is not realised in practice.