Autonomous self-determination by competent adults is a cornerstone of medical law. We argue that the application of Kantian autonomy as the paramount model for self-determination at end of life is questionable as it fails to capture subtler nuances of decision-making in this context. We propose an alternative model which we term ‘holistic determination for oneself’ and posit this as a potential contender to the traditional Kantian construct. The paradigm of holistic determination is conceptualised on the basis of sub-determinations which coalesce to form the final determination. This paradigm offers a unique perspective that is multi-axial (based on the levels of decision-making) and multi-dimensional (based on an on-going temporal inter-relational and integrative synthesis of decisions at all levels). Holistic determination for oneself offers a paradigm that is tempered, universal and optimal for self-determination at end of life.
