“No todo lo que alarga, cuida”: Narrativas de disentimiento terapéutico motivadas por dignidad en cuidados paliativos

Abstract

“Not Everything That Prolongs, Cares”: Therapeutic Dissent Narratives Motivated by Dignity in Palliative Care

Introduction: In palliative care, some patients with advanced illness choose to reject medical treatments. This form of therapeutic dissent, often misinterpreted as denial or hopelessness, may instead reflect an ethical affirmation of dignity, meaning, and autonomy. Despite its relevance, few studies have explored how patients themselves understand and justify these decisions. This study aimed to explore, through patient narratives, the motivations underlying therapeutic dissent.

Methods: Qualitative study with an interpretative phenomenological approach. Five semi-structured interviews were conducted with patients A high-complexity hospital in Bogotá, and one publicly available narrative was included. Coding and thematic analysis were performed using NVivo v15.

Results: The word cloud highlighted terms such as dignity, life, meaning, say, God, and health. The most frequent categories were dignity, autonomy, suffering, spirituality, and critique of biomedical logic. Dignity was described as a relational and vulnerable experience, affected by the care received, lack of recognition, and a diminished sense of control over decision-making. Autonomy emerged both as the ability to make choices and as something exercised in relation to others. Suffering was portrayed as a threat to existential meaning, and spirituality as a source of re-signification.

Conclusion: Therapeutic dissent may constitute an ethical act aimed at preserving personal coherence. These findings call for a model of care that listens to and legitimizes the patient’s voice as a central element of clinical practice.