Bioethical dimensions in the process of palliative care. Patient’s autonomy in the end-of-life decision-making
General Medicine, 2026, 28(1), 26-34.
A. Alakidi2, M. Lyochkova3, M. Nikolova1, I. Ivanova2, V. Mihaylova2,3
1Department of Еpidemiology and Hygiene, Faculty of Medicine, Medical University – Sofia
2Department of Physiotherapy, Faculty of Public Health „Prof. Tzecomir Vodenitcharov, MD, DSc”, Medical University – Sofia
3Department of Healthcare Management, Faculty of Public Health, Medical University – Plovdiv
Abstract. The analytical review on the topic is prompted by the global aging of the population accompanied by higher rates of chronic diseases and progressive conditions, raising end-of-life issues. Public and legislative debates concerning the moral, ethical and medico-legal dilemmas are discussed. Against this background, the neglect and silence on the issue in our country is strange and inexplicable. Emphasis is placed on the terminology, evolution and current legislative nature of the practices of assisted death. The difference between active euthanasia as an act of deliberate termination of life at the explicit request of the patient by a physician, and PAS – the provision or prescription of a medical remedy by a physician to a patient in case of incurable illness accompanied by severe suffering, ending their life by themselves, as an expression of their right to self-determination, is highlighted. A sensible and effective premise has been introduced for updating the content and jurisdictions of assisted dying, becoming a central issue of medical ethics, the regulation of the medical activity and the public health in general.
Key words: autonomy, self-determination, euthanasia, assisted dying, physician’s role
Address for correspondence: Dr. Adolf Alakidy, e-mail: a.alakidy@medfac.mu-sofia.bg