Autonomy, relational dynamics and professional mandates. A reflection on the choices of treatment in advanced stages of neurodegenerative diseases

The paper reflects upon some relevant issues observed in the context of a broader research aimed at investigating the mechanisms producing inequalities in the construction of care pathways. 51 semi-structured interviews with experts, health and social professionals, kin and ALS patients have been carried out. The analysis of empirical material outlined the definition of the opportunities and constraints for ALS patients care pathways from the players? point of view. The essay aims at highlighting some factors that may influence the decision-making processes about treatment choices. The emphasis on the autonomy of patients is likely to conceal the weight of social relations for the definition of individual preferences. Along the process leading to the treatment choices, divergent interests and approaches may be in conflict or create care practices whose results are unexpected.