'Choice is a small word with a huge meaning': Autonomy and decision making at the end of life

The United Kingdom (UK) End-of-Life Care Strategy, published in June 2008, recommends the identification, documentation and review of people's preferences for care and highlights the importance of choice at an individual level. Drawing on data from a qualitative research study, this article reflects on the complex range of interconnected factors impacting on older people's preferences and decision-making processes at the end of life. As older people consider not only themselves but also the impact on loved ones when making decisions, the pertinence of a relational conceptualisation of autonomy is considered. The impact of structural issues on the realisation of preferences is also explored.