ethique_AMM_fin_vie

Old problems in need of new (narrative) approaches? A young physician-bioethicist's search for ethical guidance in the practice of physician-assisted dying in the Netherlands

Sat, 18 Oct 2025 08:22:52 +0000

Author Names: Roest B.

Database Source: Embase Weekly Updates

Journal Title: Journal of medical ethics

Article Title: Old problems in need of new (narrative) approaches? A young physician-bioethicist's search for ethical guidance in the practice of physician-assisted dying in the Netherlands

Year: 2021

Issue: 4

Volume: 47

Abstract: The current empirical research and normative arguments on physician-assisted dying (PAD) in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and a certain view on ethics. Furthermore, the paper elaborates on how other approaches to empirical research in bioethics, such as found in the broad field of narrative research, could supplement the empirical and ethical evaluation of PAD in the Netherlands. This paper also addresses the challenging question of how empirical data-in this case narratives-relate to normativity. The paper is written in the form of a personal narrative of the author, a young Dutch general practitioner and researcher in bioethics. This style is intentionally chosen, to illustrate how work context and professional background influence the observations one makes and the questions one may ask about the topic of PAD. In addition, by using this style, this paper not only gives a different perspective on a much-contested bioethical issue, but also on the challenges faced when a physician-bioethicist has to navigate different disciplinary fields and (moral) epistemological paradigms, especially since the 'empirical turn' in bioethics.<br/>Copyright © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

End-of-life care in Moroccan ICUs: ethical challenges, practices, and perspectives of intensivists.

Wed, 15 Oct 2025 04:00:00 +0000

BMC Medical Ethics; 10/15/2025
(AN 188682909); ISSN: 14726939
CINAHL Complete

Moral Distress in Pediatric Palliative Care: A Cross-Sectional Study with Brazilian Professionals

Fri, 03 Oct 2025 00:00:00 +0000

Am J Hosp Palliat Care. 2025 Oct 3:10499091251384586. doi: 10.1177/10499091251384586. Online ahead of print.

ABSTRACT

IntroductionHealthcare professionals caring for children with life-threatening illnesses face frequent bioethical conflicts, often leading to moral distress. In pediatric palliative care (PPC), this can compromise both professional well-being and quality of care.ObjectiveTo analyze moral distress among professionals in PPC and identify associated factors.MethodCross-sectional study using the Measure of Moral Distress for Healthcare Professionals - Brazilian Version (MMD-HP BR) scale, applied online to PPC professionals.ResultsA total of 112 professionals participated, mean age 41 years (±9.1), predominantly female (90.2%) and from the Southeast region (49%). Average professional experience was 15 years (±9.2), with 6 years (±4.3) in PPC. Most participants were physicians (55.4%) and nurses (13.4%). The mean MMD-HP BR score was 104.2 (±74.8), significantly correlated with profession (P = 0.045). Nursing technicians had lower distress compared to nurses (P = 0.014), physiotherapists (P = 0.02), physicians (P = 0.002) and psychologists (P = 0.014). Higher scores were found among professionals who had considered leaving, had left, or were considering leaving their jobs. The most impactful items were: "I observe health professionals communicating 'false hopes' to the patient or family" and "I observe poor quality care due to lack of communication between team members".ConclusionMoral distress in PPC is strongly linked to communication difficulties, a critical factor in professionals' experiences. The scarcity of studies in pediatrics, especially in Brazil, highlights the need for further research to develop strategies that support team well-being and improve the quality of care provided to children and families.

PMID:41041944 | DOI:10.1177/10499091251384586

Digital Care and Human Death: Ethical Tensions at the End of Life

Fri, 03 Oct 2025 00:00:00 +0000

Stud Health Technol Inform. 2025 Oct 2;332:206-210. doi: 10.3233/SHTI251528.

ABSTRACT

The digitization of healthcare - through electronic health records, predictive algorithms, remote monitoring, and automated decision-making tools - has revolutionized clinical workflows and optimized patient management. However, these developments often carry unintended consequences when applied to the end-of-life context, where the subjective, relational, and existential dimensions of dying resist abstraction and quantification. This paper explores the tensions between digital efficiency and the human realities of death, arguing that the virtuality of digital health systems risks alienating patients, families, and clinicians at precisely the moments where care must be most embodied and relational. Drawing from a conceptual analysis informed by medical ethics and palliative care literature, we examine how virtual representations (data, dashboards, protocols) interact with real dying bodies and social relationships. Through case illustrations, we highlight how systems designed for efficiency can unintentionally marginalize suffering, flatten complex narratives, and displace the rituals and presence that define authentic death. Our findings suggest a pressing need to reorient digital health design to account for the limits of representation and the irreplaceability of human connection at the end of life. We argue that any future model of digital care must not only prioritize outcomes but also preserve dignity, ambiguity, and relational integrity in death.

PMID:41041775 | DOI:10.3233/SHTI251528

Ethics Roundtable State-Erected Barriers to End-of-Life Care.

Wed, 01 Oct 2025 04:00:00 +0000

American Journal of Hospice & Palliative Medicine; 10/01/2025
(AN 187457056); ISSN: 10499091
CINAHL Complete

Reflective Writing to Support Nursing Students' Ethical Understanding of End-of-Life Care: A Phenomenological Study.

Wed, 01 Oct 2025 04:00:00 +0000

Journal of Hospice & Palliative Nursing; 10/01/2025
End-of-life care requires nurses to integrate ethical sensitivity, emotional presence, and effective communication. Reflective writing, a key component of Narrative Medicine, offers nursing students a structured method to process complex emotional experiences and deepen their ethical understanding. This study investigated how third-year nursing students reflected on ethical issues and emotional responses related to end-of-life care through a structured reflective writing activity conducted after a film-based educational session. A qualitative phenomenological approach was applied to analyze 55 written reflections produced by Italian nursing students. The reflections were collected following a classroom screening of a film portraying terminal illness and decision-making at the end of life. Data were examined thematically using Braun and Clarke method. Four key themes emerged: emotional responses to death; relational and ethical dynamics; communication and connection; and temporal-spiritual meaning-making. Students' reflections revealed an emerging awareness of ethical dimensions such as patient autonomy, vulnerability, and the value of nonverbal communication. Through reflective writing, participants articulated emotions including fear, anger, and guilt and engaged in personal meaning-making related to self-determination and compassionate care. Overall, reflective writing facilitated the development of ethical awareness and emotional resilience among students preparing for palliative care practice. The integration of structured reflection into hospice and palliative nursing education may enhance students' readiness to deliver empathetic, person-centered care.
(AN 187860702); ISSN: 15222179
CINAHL Complete

Physicians Have Ethical Obligation to Provide Palliative Care: New Guidance.

Wed, 01 Oct 2025 04:00:00 +0000

Medical Ethics Advisor; 10/01/2025
(AN 188146321); ISSN: 08860653
CINAHL Complete

Ethics of disclosure in pediatric end-of-life care.

Wed, 01 Oct 2025 04:00:00 +0000

American Nurse Journal; 10/01/2025
(AN 188612102); ISSN: 26899272
CINAHL Complete

Ethical considerations and challenges associated with euthanasia in laboratory animal research

Mon, 29 Sep 2025 00:00:00 +0000

J Med Ethics Hist Med. 2024 Dec 22;17:11. doi: 10.18502/jmehm.v17i11.18663. eCollection 2024.

NO ABSTRACT

PMID:41017948 | PMC:PMC12464455 | DOI:10.18502/jmehm.v17i11.18663

End-of-life decisions and ethics on the big screen: reflecting narratives of 'a life fully lived'

Fri, 26 Sep 2025 00:00:00 +0000

Med Health Care Philos. 2025 Sep 26. doi: 10.1007/s11019-025-10296-1. Online ahead of print.

ABSTRACT

The question of what constitutes a good life, whether a human existence is considered fulfilling and how to respond to a life perceived as no longer worth living has long been one of the great inquiries of medical ethics. With the increasing liberalization of various forms of assisted dying worldwide, these fundamental questions are gaining renewed relevance. An emerging field of interest explores films as sociocultural laboratories, offering an intriguing approach to a more nuanced perspective on personal narratives. Applied to the subject of end-of-life decisions this practice turns abstract constructs such as the quest for a meaningful life into tangible plotlines and vivid case studies. Far more than conceptual discussions about morally right or wrong, the storyline on screen enables the viewer to gain a deep and unique insight into the personal life and contextual embeddedness of protagonists struggling with end-of-life decisions. This paper aims to explore the idea and narrative of 'a life fully lived' in the movies focussing on end-of-life decisions. It focuses on the implications, demands, and influences on choices concerning death and dying using the example of ten of the most impactful and most debated movies featuring end-of-life decisions. Using film analysis, commonly held assumptions and value judgments that influence public discourse about end-of-life decisions are to be revealed and made accessible for ethical reflection.

PMID:41004030 | DOI:10.1007/s11019-025-10296-1

The Mediating Role of Moral Resilience in the Relationship Between Moral Distress and End-of-Life Care Attitudes and Behaviours Among Intensive Care Nurses

Mon, 15 Sep 2025 00:00:00 +0000

Nurs Crit Care. 2025 Sep;30(5):e70171. doi: 10.1111/nicc.70171.

ABSTRACT

BACKGROUND: Intensive care nurses experience moral distress due to moral conflicts, which negatively impact their attitudes and behaviours towards end-of-life care. Moral resilience is considered a potential factor in mitigating these negative effects.

AIM: This study aims to examine the mediating role of moral resilience in the relationship between moral distress and intensive care nurses' attitudes and behaviours towards end-of-life care.

STUDY DESIGN: A descriptive and cross-sectional study was conducted in accordance with the guidelines for observational studies (STROBE). The study was conducted with 228 intensive care nurses between December 2024 and February 2025. Data were collected using the 'Personal Information Form', 'Moral Distress Scale', 'Moral Resilience Scale' and 'Scale of Attitudes and Behaviours of Intensive Care Nurses Towards End-of-Life Care'. Statistical analyses were performed using SPSS 26.0 and AMOS V 24.0.

RESULTS: The moral distress levels of female nurses were higher and significantly higher than male nurses (OR 0.245; 95% CI 0.074-0.598; p = 0.011). Nurses with 11 years or more of work experience had a higher and significant level of moral distress compared to other nurses (OR 0.053; 95% CI 0.080-0.115; p = 0.012). The moral resilience level of nurses with 3-6 years of work experience was higher and significantly higher than other nurses (OR 0.067; 95% CI 0.048-0.107; p = 0.023). Moral distress negatively affects nurses' attitudes and behaviours towards end-of-life care. Moral resilience has a significant and positive effect on attitudes and behaviours. Moreover, moral resilience mediated the relationship between moral distress and attitudes and behaviours towards end-of-life care (β;-0.266, CI 95% -0.301-0.197).

CONCLUSIONS: Moral distress negatively influences intensive care nurses' attitudes and behaviours in end-of-life care. Enhancing moral resilience can help mitigate these effects. The findings highlight the need for nursing education programmes and workplace interventions to strengthen nurses' moral resilience and improve their ability to manage moral distress.

RELEVANCE TO CLINICAL PRACTICE: While moral distress damages intensive care nurses' attitudes towards end-of-life care, moral resilience may help to reduce its negative effects. Supporting nurses is thought to improve the quality of adverse end-of-life care.

PMID:40947520 | DOI:10.1111/nicc.70171

Veterinary Ethics in Practice: Euthanasia Decision Making for Companion and Street Dogs in Istanbul

Sat, 13 Sep 2025 00:00:00 +0000

Animals (Basel). 2025 Sep 3;15(17):2585. doi: 10.3390/ani15172585.

ABSTRACT

This article examines how veterinarians in Istanbul experience and navigate the ethical, emotional, and institutional complexities of performing euthanasia on dogs, with particular attention to the differences between companion and street dogs. Drawing on 29 in-depth interviews with private practice veterinarians in Istanbul, this study employs qualitative analysis using the NVivo 12 Plus software and reflexive thematic analysis to identify key patterns in moral reasoning, emotional labor, and clinical decision making. The findings indicate that euthanasia of companion dogs is often framed through shared decision making with guardians, emotional preparation, and post-procedural grief rituals. While still emotionally taxing, these cases are supported by relational presence and mutual acknowledgment. In contrast, euthanasia of street dogs frequently occurs in the absence of legal ownership, institutional accountability, or consistent caregiving, leaving veterinarians to bear the full moral and emotional weight of the decision. Participants described these cases as ethically distinct, marked by relational solitude, clinical ambiguity, and heightened moral distress. Six key themes that reveal how euthanasia becomes a site of both care and conflict when structural support is lacking are identified in this study, including emotional burden, ethical strain, and resistance to routinized killing. By foregrounding the roles of institutional absence and relational asymmetry in shaping end-of-life decisions, this study contributes to empirical veterinary ethics and calls for more contextually attuned ethical frameworks, particularly in urban settings with large populations of street dogs and culturally entrenched practices of collective guardianship and caregiving.

PMID:40941380 | PMC:PMC12427213 | DOI:10.3390/ani15172585

Mediating effect of moral resilience between good-death perception and coping with death competence of ICU nurses: a cross-sectional study.

Wed, 03 Sep 2025 04:00:00 +0000

BMC Nursing; 09/03/2025
Background: Moral resilience can help Intensive Care Unit (ICU) nurses overcome moral dilemmas caused by the death of patients, while enhancing their competence to cope with death. Death-coping competence is also related to the cognitive level of nurses about good death. However, few studies have focused on the relationships among between moral resilience, perception of good death, and death-coping competence. Research aim: To explore the focused on the relationships among ICU nurses' moral resilience, good-death perception and death-coping competence, and to examine the mediating role of moral resilience between good-death perception and death-coping competence. Research design: This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey in which moral resilience, perception of good death and coping with death competence using the Rushton Moral Resilience Scale for nurses, Chinese version of Good Death Inventory and coping with death scale-short version, respectively. Participants and research context: A total of 254 ICU nurses were recruited from five tertiary general hospitals in Shandong province of China to participate in the survey. Ethical considerations: This study was approved by the ethics committee of Zibo Central Hospital. Informed consent was obtained from all the nurses. Results: Good-death perception positively affects death-coping competence (r = 0.565, p < 0.01). The mediation analysis revealed that the direct effect of good-death perception on death-coping competence in the presence of the mediator was significant. Hence, moral resilience partially mediated the relationship between good-death perception and death-coping competence. And the mediating effect is 0.099. Conclusions: ICU nurses' good-death perceptions can directly predict their death-coping competence, and they can also indirectly affect their death-coping competence through the mediating effect of moral resilience. Clinical trial number: not applicable.
(AN 187724029); ISSN: 14726955
CINAHL Complete

Mediating effect of moral resilience between good-death perception and coping with death competence of ICU nurses: a cross-sectional study

Wed, 03 Sep 2025 00:00:00 +0000

BMC Nurs. 2025 Sep 3;24(1):1162. doi: 10.1186/s12912-025-03836-w.

ABSTRACT

BACKGROUND: Moral resilience can help Intensive Care Unit (ICU) nurses overcome moral dilemmas caused by the death of patients, while enhancing their competence to cope with death. Death-coping competence is also related to the cognitive level of nurses about good death. However, few studies have focused on the relationships among between moral resilience, perception of good death, and death-coping competence.

RESEARCH AIM: To explore the focused on the relationships among ICU nurses’ moral resilience, good-death perception and death-coping competence, and to examine the mediating role of moral resilience between good-death perception and death-coping competence.

RESEARCH DESIGN: This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey in which moral resilience, perception of good death and coping with death competence using the Rushton Moral Resilience Scale for nurses, Chinese version of Good Death Inventory and coping with death scale-short version, respectively.

PARTICIPANTS AND RESEARCH CONTEXT: A total of 254 ICU nurses were recruited from five tertiary general hospitals in Shandong province of China to participate in the survey.

ETHICAL CONSIDERATIONS: This study was approved by the ethics committee of Zibo Central Hospital. Informed consent was obtained from all the nurses.

RESULTS: Good-death perception positively affects death-coping competence (r = 0.565, p < 0.01). The mediation analysis revealed that the direct effect of good-death perception on death-coping competence in the presence of the mediator was significant. Hence, moral resilience partially mediated the relationship between good-death perception and death-coping competence. And the mediating effect is 0.099.

CONCLUSIONS: ICU nurses’ good-death perceptions can directly predict their death-coping competence, and they can also indirectly affect their death-coping competence through the mediating effect of moral resilience.

CLINICAL TRIAL NUMBER: not applicable.

PMID:40903717 | PMC:PMC12406356 | DOI:10.1186/s12912-025-03836-w

Quality improvement in palliative care: A review of the ethics.

Mon, 01 Sep 2025 04:00:00 +0000

Nursing Ethics; 09/01/2025
Introduction: Quality improvement is the systematic seeking of improvements in care and experience. This discussion paper will explore how the principles of good clinical care and the established ethical frameworks for research can help guide its practice, using examples from palliative care. Quality improvement in palliative care: Palliative care is well positioned to be at the vanguard of quality improvement in healthcare. But it holds ethical particularities which require specific considerations, that are helpful for other specialities. The experiences of two improvement activities in palliative care, the Liverpool Care Pathway and Do Not Attempt Resuscitation status reviews, illustrate potential dangers of QI. Implications for ethical practice: Recommendations for ethically sound quality improvement projects in palliative care include paying attention to the burden of time, viewing informed consent as a tool, monitoring for vulnerability and coercion and transparency in the use of data. The ethics and practices in clinical encounters provide a framework for approaching consent and protecting those with palliative care needs who are deemed as vulnerable. It is explicit in palliative care that time and energy are precious and finite resources. These must be valued and respected in any quality improvement projects. Respect for beneficence and autonomy is essential to avoid coercion and for any project to be ethically sound. Conclusion: Quality improvement processes are an integral part of good healthcare practices. High ethical standards, a supportive culture, transparency and candour are needed for the promotion and sustainability of quality improvement in palliative care.
(AN 187593297); ISSN: 09697330
Health Business Elite

The Ethical Standard for End-of-Life Decisions for Unrepresented Patients.

Mon, 01 Sep 2025 04:00:00 +0000

American Journal of Bioethics; 09/01/2025
There has been increasing awareness of the medical and moral challenges in the care of unrepresented patients: those who cannot make their own medical decisions, do not have any surrogate decision maker, and have not indicated their treatment preferences. Most discussions have focused on procedural questions such as who should make decisions for these patients. An issue that has not gotten enough attention is the ethical standard that should govern medical decision making. I explore the question of which ethical standard provides better justification for end-of-life decisions for unrepresented patients. Two options are considered: the conventional and less demanding best interest standard, and the novel and more demanding medical futility standard. I explain the similarities and differences between these two standards, examine arguments for and against each one, and suggest that the medical futility standard is ethically superior and should replace the established best interest standard.
(AN 187408458); ISSN: 15265161
CINAHL Complete

The Representation Paradox: Rethinking Ethical Standards Through Anticipatory Autonomy...Shea M. The Ethical Standard for End-of-Life Decisions for Unrepresented Patients. American Journal of Bioethics. 2025;25(9):74-85.

Mon, 01 Sep 2025 04:00:00 +0000

American Journal of Bioethics; 09/01/2025
(AN 187408487); ISSN: 15265161
CINAHL Complete

The Mediating Role of Moral Resilience in the Relationship Between Moral Distress and End‐of‐Life Care Attitudes and Behaviours Among Intensive Care Nurses.

Mon, 01 Sep 2025 04:00:00 +0000

Nursing in Critical Care; 09/01/2025
Background: Intensive care nurses experience moral distress due to moral conflicts, which negatively impact their attitudes and behaviours towards end‐of‐life care. Moral resilience is considered a potential factor in mitigating these negative effects. Aim: This study aims to examine the mediating role of moral resilience in the relationship between moral distress and intensive care nurses' attitudes and behaviours towards end‐of‐life care. Study Design: A descriptive and cross‐sectional study was conducted in accordance with the guidelines for observational studies (STROBE). The study was conducted with 228 intensive care nurses between December 2024 and February 2025. Data were collected using the 'Personal Information Form', 'Moral Distress Scale', 'Moral Resilience Scale' and 'Scale of Attitudes and Behaviours of Intensive Care Nurses Towards End‐of‐Life Care'. Statistical analyses were performed using SPSS 26.0 and AMOS V 24.0. Results: The moral distress levels of female nurses were higher and significantly higher than male nurses (OR 0.245; 95% CI 0.074–0.598; p = 0.011). Nurses with 11 years or more of work experience had a higher and significant level of moral distress compared to other nurses (OR 0.053; 95% CI 0.080–0.115; p = 0.012). The moral resilience level of nurses with 3–6 years of work experience was higher and significantly higher than other nurses (OR 0.067; 95% CI 0.048–0.107; p = 0.023). Moral distress negatively affects nurses' attitudes and behaviours towards end‐of‐life care. Moral resilience has a significant and positive effect on attitudes and behaviours. Moreover, moral resilience mediated the relationship between moral distress and attitudes and behaviours towards end‐of‐life care (β;‐0.266, CI 95% −0.301–0.197). Conclusions: Moral distress negatively influences intensive care nurses' attitudes and behaviours in end‐of‐life care. Enhancing moral resilience can help mitigate these effects. The findings highlight the need for nursing education programmes and workplace interventions to strengthen nurses' moral resilience and improve their ability to manage moral distress. Relevance to Clinical Practice: While moral distress damages intensive care nurses' attitudes towards end‐of‐life care, moral resilience may help to reduce its negative effects. Supporting nurses is thought to improve the quality of adverse end‐of‐life care.
(AN 188363469); ISSN: 13621017
CINAHL Complete

Treatment and support for adults at the end of life in intensive care. A recommendation by the Ethics Section of DIVI and the German Society for Palliative Medicine. : Part 2: Therapeutic measures and support at the end of life in intensive care

Fri, 29 Aug 2025 00:00:00 +0000

Med Klin Intensivmed Notfmed. 2025 Aug 29. doi: 10.1007/s00063-025-01330-4. Online ahead of print.

ABSTRACT

Life in an intensive care unit (ICU) involves the successful use of life-sustaining treatment and patients dying. In intensive care medicine, allowing a patient to die often means discontinuing life-sustaining measures. Together with the severity of the illness, this has a significant impact on the course of the dying process. End of life treatment and support focus on alleviating symptoms. The interprofessional team's task in the ICU is to anticipate, plan and implement palliative measures. A family-centered approach to palliative care requires providing human resources for psychosocial support and spiritual care for those affected. Implementing internal recommendations for action improves the quality of care. Training in the necessary skills to support people at the end of life is an integral component of education and ongoing professional development. This training includes basic knowledge of palliative care as well as specific knowledge about terminating life-sustaining measures.

PMID:40879752 | DOI:10.1007/s00063-025-01330-4

Treatment and Support for Adults at the End of Life in Intensive Care : A Recommendation by the Ethics Section of DIVI and the German Society for Palliative Medicine. Part 1: Key Aspects of End-of-Life Care and Dying in Intensive Care. Part 2: Therapeutic

Fri, 29 Aug 2025 00:00:00 +0000

Med Klin Intensivmed Notfmed. 2025 Aug 29. doi: 10.1007/s00063-025-01327-z. Online ahead of print.

ABSTRACT

The primary goal of intensive care medicine is to overcome a critical phase of illness using all available means and to enable patients to survive and return to an independent life without intensive care. However, this therapeutic goal cannot always be achieved. The possibility of death, the need to alleviate suffering, and respect for the end of life make it necessary to integrate palliative approaches into intensive care medicine. Supporting seriously ill and dying patients and their relatives in intensive care units requires an attitude that holistically recognizes and respects their individuality and is shared by the entire team. In addition to recognizing life and death, reliable structures, clear agreements, and palliative care skills among the respective professional groups are necessary. When implementing these approaches, it is important to remain within the framework of legal requirements and to take the wishes of those affected into account. In addition to the relevant professional expertise, the most important tool is respectful and clear communication with all those involved and affected. Help should be available at all times in cases of uncertainty regarding ethical and palliative issues, as well as in cases of psychological stress.

PMID:40879751 | DOI:10.1007/s00063-025-01327-z

Euthanasia in Mental Disorders: Clinical and Ethical Issues in the Cases of Two Women Suffering from Depression

Thu, 28 Aug 2025 00:00:00 +0000

Healthcare (Basel). 2025 Aug 16;13(16):2019. doi: 10.3390/healthcare13162019.

ABSTRACT

Background/Objectives: The extension of euthanasia and physician-assisted suicide to individuals with mental disorders presents a profound ethical, clinical, and legal challenge. While increasingly accepted in some jurisdictions, their application in psychiatric contexts-particularly in cases of depression-raises concerns about diagnostic precision, therapeutic adequacy, and the validity of informed consent. This study examines two controversial Belgian cases to explore the complexities of euthanasia for psychological suffering. Methods: A qualitative case analysis was conducted through a qualitative analysis of publicly available media sources. The cases were examined through clinical, psychoanalytic, and medico-legal lenses to assess diagnostic clarity, treatment history, and ethical considerations. No access to official medical records was available. Case Presentation: The first case involved a young woman whose depressive symptoms were reportedly linked to trauma from a terrorist attack. The second concerned a middle-aged woman convicted of infanticide and later diagnosed with Major Depression. Discussion: In both cases, euthanasia was granted on the grounds of "irreversible psychological suffering." However, the absence of detailed clinical documentation, potential unresolved trauma, and lack of psychodynamic assessment raised doubts about the robustness of the evaluations and the validity of informed consent. Conclusions: These findings highlight the need for a more rigorous, multidisciplinary, and ethically grounded approach to psychiatric euthanasia. This study underscores the importance of precise diagnostic criteria, comprehensive treatment histories, and deeper exploration of unconscious and existential motivations. Safeguarding clinical integrity and ethical standards is essential in end-of-life decisions involving mental illness.

PMID:40868634 | PMC:PMC12385801 | DOI:10.3390/healthcare13162019

Moral distress among family caregivers of people with cancer in palliative care: A qualitative study

Thu, 28 Aug 2025 00:00:00 +0000

Can Oncol Nurs J. 2025 Mar 1;35(2):361-375. doi: 10.5737/23688076352361. eCollection 2025 Spring.

ABSTRACT

The study aimed to understand the triggering events of moral distress according to the family caregivers of people with cancer in palliative care. This is a longitudinal qualitative approach study, using the concept of moral distress as an interpretative reference. Ten family caregivers participated in in-depth interviews. The data were analyzed according to the inductive thematic analysis technique, and two themes were identified. In the first theme, entitled "The repercussions following diagnosis," participants reported the uncertainties they experienced following their family member's cancer diagnosis. In the second theme, entitled "The transformation of daily life", participants expressed how providing care for the family member with cancer changed their daily lives. While experiencing the role of a caregiver, they faced dilemmas and uncertainties that led them to feel moral distress, since this situation will follow them continuously until the outcome of the disease.

PMID:40873897 | PMC:PMC12379905 | DOI:10.5737/23688076352361

Motivations, acceptability and ethical considerations for interventional HIV cure research at the end of life: perspectives from long-term survivors of HIV in the United States.

Sat, 23 Aug 2025 04:00:00 +0000

BMC Medical Ethics; 08/23/2025
(AN 187496479); ISSN: 14726939
CINAHL Complete

Motivations, acceptability and ethical considerations for interventional HIV cure research at the end of life: perspectives from long-term survivors of HIV in the United States

Sat, 23 Aug 2025 00:00:00 +0000

BMC Med Ethics. 2025 Aug 23;26(1):112. doi: 10.1186/s12910-025-01253-x.

ABSTRACT

INTRODUCTION: Despite progress in antiretroviral therapy (ART), an effective cure for HIV remains out of reach. End-of-life (EOL) research studies involving individuals with a prognosis of six months or less offers an opportunity to advance cure science but has so far been limited to observational designs focused on HIV reservoirs. As interventional approaches at the EOL are now being considered, it is essential to assess their acceptability before moving forward. Understanding how long-term survivors (LTS) of HIV perceive these potential interventions, along with their motivations and ethical considerations, is critical to guiding the design of future EOL-HIV interventional research.

METHODS: We conducted in-depth qualitative interviews with 16 LTS of HIV from across regions in United States to examine their views on hypothetical interventional HIV cure research at the EOL. To ensure representation, we recruited participants through community-based organizations and HIV cure collaboratories using purposive-sampling. We conducted interviews via secure teleconferencing, transcribed the recordings, and used inductive thematic analysis to identify key themes related to motivations, acceptability, and ethical considerations surrounding interventional EOL HIV cure research.

RESULTS: Participants viewed hypothetical interventional HIV cure research at the EOL as a way to contribute to science, despite expecting no personal benefit. They prioritized autonomy and informed-choice in ethical participation. Many supported latency-reversing agents but raised safety concerns; in contrast, they viewed block-and-lock strategies as promising and less risky. Participants generally welcomed immune-based approaches, though some questioned their suitability for older adults near the EOL. LTS found cell and gene-based interventions innovative but expressed caution about safety and feasibility. While they valued the scientific potential of combination strategies, they noted their complexity and burden. Opinions on analytical treatment interruptions were mixed and depended on ethical safeguards, including medical oversight and reversibility. Willingness to participate in hypothetical HIV cure research at the EOL reflected individual health status, perceived burden, and personal values.

CONCLUSIONS: LTS are willing to engage in interventional EOL HIV cure research but emphasize the importance of ethical safeguards and participant autonomy. As HIV cure research progresses, integrating LTS perspectives is critical to designing feasible, ethical, and scientifically impactful interventional studies at EOL.

PMID:40849625 | PMC:PMC12374411 | DOI:10.1186/s12910-025-01253-x

Reflective Writing to Support Nursing Students' Ethical Understanding of End-of-Life Care: A Phenomenological Study

Fri, 22 Aug 2025 00:00:00 +0000

J Hosp Palliat Nurs. 2025 Oct 1;27(5):245-252. doi: 10.1097/NJH.0000000000001145. Epub 2025 Aug 21.

ABSTRACT

End-of-life care requires nurses to integrate ethical sensitivity, emotional presence, and effective communication. Reflective writing, a key component of Narrative Medicine, offers nursing students a structured method to process complex emotional experiences and deepen their ethical understanding. This study investigated how third-year nursing students reflected on ethical issues and emotional responses related to end-of-life care through a structured reflective writing activity conducted after a film-based educational session. A qualitative phenomenological approach was applied to analyze 55 written reflections produced by Italian nursing students. The reflections were collected following a classroom screening of a film portraying terminal illness and decision-making at the end of life. Data were examined thematically using Braun and Clarke method. Four key themes emerged: emotional responses to death; relational and ethical dynamics; communication and connection; and temporal-spiritual meaning-making. Students' reflections revealed an emerging awareness of ethical dimensions such as patient autonomy, vulnerability, and the value of nonverbal communication. Through reflective writing, participants articulated emotions including fear, anger, and guilt and engaged in personal meaning-making related to self-determination and compassionate care. Overall, reflective writing facilitated the development of ethical awareness and emotional resilience among students preparing for palliative care practice. The integration of structured reflection into hospice and palliative nursing education may enhance students' readiness to deliver empathetic, person-centered care.

PMID:40845283 | DOI:10.1097/NJH.0000000000001145

Telehealth in palliative care settings: A systematic review of argument-based ethics literature

Fri, 22 Aug 2025 00:00:00 +0000

Palliat Med. 2025 Aug 22:2692163251360115. doi: 10.1177/02692163251360115. Online ahead of print.

ABSTRACT

BACKGROUND: The need for palliative care is rising rapidly, but meeting global demand is falling behind. Telepalliative care offers a potential solution, though its implementation requires careful ethical evaluation.

AIM: To provide an overview of the ethical concepts and arguments related to telepalliative care as presented in the argument-based literature.

DESIGN: We conducted a systematic review of argument-based literature following PRISMA-guidelines (PROSPERO: CRD42024533732). Data extraction and synthesis followed the Qualitative Analysis Guide of Leuven.

DATA SOURCES: We searched 12 databases covering medical, ethical, and technological disciplines using broad, unfiltered terms. Publications in English, French, German, or Dutch on telehealth, palliative care, and ethics were considered. Two researchers independently screened publications, using peer review as a quality proxy due to the lack of standards for argument-based literature.

RESULTS: Twenty-six publications were included. Two main ethical approaches emerged: one related to the four principles of biomedical ethics and the other to care. Regarding respect for autonomy, telepalliative care may both promote and limit autonomy, with concerns raised about informed consent, privacy, and confidentiality. Regarding beneficence, potential improvements in symptom management and quality of life were identified. Regarding non-maleficence, risks such as replacing in-person care and medicalizing the home environment were highlighted. Regarding justice, issues of access, equity, distributive justice, and environmental issues were addressed. Concerns about the patient-provider relationship and holistic care were central to care-related arguments.

CONCLUSIONS: Telehealth's benefits challenge its incompatibility with palliative care, however, significant risks threaten core palliative care values. Thus, careful implementation must prioritize ethical considerations.

PMID:40842413 | DOI:10.1177/02692163251360115

Euthanasia in Mental Disorders: Clinical and Ethical Issues in the Cases of Two Women Suffering from Depression.

Fri, 15 Aug 2025 04:00:00 +0000

Healthcare (2227-9032); 08/15/2025
(AN 187555832); ISSN: 22279032
CINAHL Complete

Correction: The heart of palliative care is relational: a scoping review of the ethics of care in palliative medicine

Sat, 02 Aug 2025 00:00:00 +0000

BMC Palliat Care. 2025 Aug 1;24(1):217. doi: 10.1186/s12904-025-01818-y.

NO ABSTRACT

PMID:40751237 | PMC:PMC12315293 | DOI:10.1186/s12904-025-01818-y

Challenges and Ethical Considerations of Palliative Care in Indian Prisons.

Fri, 01 Aug 2025 04:00:00 +0000

Journal of Pain & Symptom Management; 08/01/2025
(AN 186451771); ISSN: 08853924
CINAHL Complete

Correction: The heart of palliative care is relational: a scoping review of the ethics of care in palliative medicine...Bertaud S, Wilkinson D, Kelley M. BMC PALLIAT CARE. 2025;24(1):1-12.(12p)

Fri, 01 Aug 2025 04:00:00 +0000

BMC Palliative Care; 08/01/2025
(AN 187121443); ISSN: 1472684X
CINAHL Complete

The Morality of Assisted Dying Open Access.

Fri, 01 Aug 2025 04:00:00 +0000

Journal of Medicine & Philosophy; 08/01/2025
(AN 188155269); ISSN: 03605310
CINAHL Complete

"Screening" for End of Life Using Artificial Intelligence: A Qualitative Study of Palliative Care Team Members' Perspectives on Ethical Use

Wed, 30 Jul 2025 00:00:00 +0000

J Palliat Med. 2025 Jul 30. doi: 10.1177/10966218251363753. Online ahead of print.

ABSTRACT

Background: Artificial intelligence (AI) tools for health care applications are rapidly emerging. Some AI-based prognostic tools can predict patient mortality automatically and with accuracy that outperforms clinicians and other available tools. In palliative care (PC), these tools may change practice in ways we do not fully understand and raise important ethical and implementation questions. Objective: Identify the ethical challenges that could shape the implementation of AI-based prognostication in PC. Design: We conducted a qualitative study using semistructured interviews and a modified grounded theory approach. Setting/Subjects: We interviewed 45 PC team members (physicians, nurses, social workers, spiritual care providers, psychologists) from four U.S. academic medical centers. Results: PC team members viewed AI-based prognostication as a form of "screening" for end of life (EOL) and believed it could help identify patients with PC or other EOL needs. By drawing on an established model of screening ethics as a framework for our analysis, we identified four principles to guide the implementation of AI-based prognostication as screening: (i) screening for EOL should be evidence-based, (ii) screening for EOL should take opportunity cost into account, (iii) screening for EOL should distribute costs and benefits fairly, and (iv) screening for EOL should offer respect for persons. Conclusions: Our findings help us understand how PC team members view AI-based prognostic tools and offer guidance for their implementation. In the future, it will be important to define more precisely the role of screening in this context and understand how it affects decision making for patients, families, and care teams.

PMID:40737233 | DOI:10.1177/10966218251363753

Supervision, Moral Distress and Moral Injury Within Palliative Care-A Qualitative Study

Tue, 29 Jul 2025 00:00:00 +0000

Int J Environ Res Public Health. 2025 Jul 21;22(7):1156. doi: 10.3390/ijerph22071156.

ABSTRACT

The number of people requiring palliative care is increasing. This can result in moral and ethical conflicts that may lead to psychological distress and moral injury. (MI). Solutions are needed to counteract career abandonment-supervision (SV) could be one solution. This study examines the extent to which palliative care nurses link MI to their everyday experiences and whether SV can contribute to the identification and prevention of moral distress and MI. In addition, factors that influence the implementation of, participation in, and perception of SV are analyzed. A qualitative study design was chosen for the investigation, consisting of guided interviews, narrative-generating questions with seven participants working in palliative care, and participant observation with audio recording during two supervisions of two palliative care teams with 16 participants in total. The data was analyzed using qualitative content analysis according to Mayring. The results show differences in workload between acute and palliative care wards. Time pressure and hierarchical structures promote distress and MI and are particularly evident on acute wards. The interviewees described specific experiences of MI. In addition, factors were identified that influence participation in SV. The analysis of SV showed that workload is a key cause of moral distress and can have an impact on health. SV can be used for sensitization and exchange. Implementation and acceptance of SV depend on individual and structural factors. In palliative care, signs of moral distress are present and are specifically addressed in SV, which means that SV can be a tool for dealing with stressful situations.

PMID:40724221 | PMC:PMC12295009 | DOI:10.3390/ijerph22071156

Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectives

Mon, 21 Jul 2025 00:00:00 +0000

Interv Pain Med. 2025 Jul 2;4(3):100610. doi: 10.1016/j.inpm.2025.100610. eCollection 2025 Sep.

ABSTRACT

Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.

PMID:40688011 | PMC:PMC12271779 | DOI:10.1016/j.inpm.2025.100610

Cultural and ethical barriers to implementing end-of-life advance care planning among oncology nursing professionals: a content analysis of open-ended questions.

Fri, 11 Jul 2025 04:00:00 +0000

BMC Medical Ethics; 07/11/2025
(AN 186621581); ISSN: 14726939
CINAHL Complete

Cultural and ethical barriers to implementing end-of-life advance care planning among oncology nursing professionals: a content analysis of open-ended questions

Fri, 11 Jul 2025 00:00:00 +0000

BMC Med Ethics. 2025 Jul 11;26(1):96. doi: 10.1186/s12910-025-01261-x.

ABSTRACT

BACKGROUND: Advance care planning (ACP), a cornerstone of ethical end-of-life care, upholds patient autonomy. However, its practice in Confucian-influenced societies, like China, is significantly shaped by cultural norms where family preferences often precede individual choice. This study explored cultural and ethical barriers to ACP implementation among oncology nursing professionals, focusing on tensions between patient-centered care and deeply rooted social norms.

METHODS: A qualitative thematic analysis was conducted on open-ended responses from oncology hospitals across 22 provinces, 4 municipal cities, and 5 autonomous regions in China. Data were collected via a cross-sectional online survey and analyzed using Braun and Clarke's framework to identify patterns in cultural, ethical, and communicative challenges.

RESULTS: A total of 838 oncology nursing professionals participated in the study. Three main interdependent barriers emerged: (1) Cultural norms, including filial piety (15.6% of codes) and death-related taboos (11.0%), often led to family-mediated decision-making (33.1%) over patient autonomy; (2) Ethical dilemmas involved neglecting patient preferences (24.3%) and conflicts between life-prolonging treatments and quality-of-life considerations (8.1%); (3) Communication challenges arose from information asymmetry (7.9%) and power imbalances, which often silenced patient voices. These factors collectively created systemic obstacles to ACP implementation.

CONCLUSIONS: Context-specific ACP strategies in China should integrate Confucian ethics into nursing education, support ethics consultation, and develop culturally sensitive communication models. Future research must assess these interventions' impact on balancing cultural values and patient autonomy, advancing equitable end-of-life care in culturally diverse healthcare systems.

TRIAL REGISTRATION: Not applicable.

PMID:40646488 | PMC:PMC12247472 | DOI:10.1186/s12910-025-01261-x

The "gray zone" in pediatric end-of-life care: bioethical and medico-legal reflections

Thu, 10 Jul 2025 00:00:00 +0000

Front Pediatr. 2025 Jun 25;13:1599837. doi: 10.3389/fped.2025.1599837. eCollection 2025.

ABSTRACT

Palliative care for children with incurable diseases represents one of the most complex challenges in pediatric medicine. It requires a delicate balance between continuing potentially ineffective therapies and ensuring comfort and dignity during the terminal phase. Decisions involve both the family and the medical team, with a particular focus on the "gray zone," where prognostic uncertainty makes it difficult to determine the most ethical course of action. According to the WHO, palliative care aims to improve the quality of life for both the child and their family, addressing not only physical pain but also psychological and social issues. This article explores the bioethical and medico-legal implications surrounding end-of-life care, parental decision-making autonomy, and the need to always prioritize the child's best interests, while respecting their dignity and values.

PMID:40636513 | PMC:PMC12237892 | DOI:10.3389/fped.2025.1599837

Ethical reflection: The palliative care ethos and patients who refuse information

Mon, 07 Jul 2025 00:00:00 +0000

Palliat Care Soc Pract. 2025 Jul 3;19:26323524251355287. doi: 10.1177/26323524251355287. eCollection 2025.

ABSTRACT

Situations wherein a patient refuses potentially important information present tricky ethical challenges for palliative care staff. This critical essay looks to both mainstream bioethics and the palliative care ethos for recommendations on whether or not to provide information in such situations. Such cases highlight controversies surrounding autonomy within mainstream bioethics, making the latter an unlikely source of clear and coherent guidance on this specific topic. The palliative care ethos, as presented by authors within the palliative care community claiming to (re)present such an ethos, may be a more promising source for practical and ethical recommendations. Eleven aspects of the palliative care ethos that may be relevant for such situations are presented, and their implications, individually and collectively, are summarised. Taken as a whole, the palliative care ethos seems to recommend a strategy of using communication skills and time to try to get information across to the patient without forcing things. The recommendation is nuanced and highly contextualised, which increases its validity for clinical practice. Some meta-ethical questions are discussed regarding the use of the palliative care ethos as a source of guidance in ethically challenging clinical situations. All in all, probing the palliative care ethos for practical guidance is an interesting possibility that deserves further ethical and practical reflection.

PMID:40620337 | PMC:PMC12227911 | DOI:10.1177/26323524251355287

Ethical reflection: The palliative care ethos and patients who refuse information.

Thu, 03 Jul 2025 04:00:00 +0000

Palliative Care & Social Practice; 07/03/2025
Situations wherein a patient refuses potentially important information present tricky ethical challenges for palliative care staff. This critical essay looks to both mainstream bioethics and the palliative care ethos for recommendations on whether or not to provide information in such situations. Such cases highlight controversies surrounding autonomy within mainstream bioethics, making the latter an unlikely source of clear and coherent guidance on this specific topic. The palliative care ethos, as presented by authors within the palliative care community claiming to (re)present such an ethos, may be a more promising source for practical and ethical recommendations. Eleven aspects of the palliative care ethos that may be relevant for such situations are presented, and their implications, individually and collectively, are summarised. Taken as a whole, the palliative care ethos seems to recommend a strategy of using communication skills and time to try to get information across to the patient without forcing things. The recommendation is nuanced and highly contextualised, which increases its validity for clinical practice. Some meta-ethical questions are discussed regarding the use of the palliative care ethos as a source of guidance in ethically challenging clinical situations. All in all, probing the palliative care ethos for practical guidance is an interesting possibility that deserves further ethical and practical reflection.
(AN 186418150); ISSN: 26323524
CINAHL Complete

Ethical aspects of limiting end-of-Life treatment of adult patients at the primary healthcare level in family and emergency medicine: a systematic review

Wed, 02 Jul 2025 00:00:00 +0000

BMC Palliat Care. 2025 Jul 1;24(1):169. doi: 10.1186/s12904-025-01807-1.

ABSTRACT

BACKGROUND: Decisions to limit treatment near the end of life are challenging and common in primary healthcare, especially in family and emergency medicine.

OBJECTIVES: This review aimed to [1] examine the evidence on the decision-making process regarding treatment limitation in end-of-life care in family and emergency medicine [2], identify associated ethical considerations, and [3] compare the evidence between family and emergency medicine.

METHODS: A systematic search of PubMed and Embase was conducted for studies published between 2004 and 2024. Eligible studies focused on ethical aspects of limiting treatment in end-of-life care in family and emergency medicine, such as decision-making processes, influencing factors, and ethical considerations. Quality was assessed using adapted Critical Appraisal Skills Programme checklists.

RESULTS: Of the 477 identified studies, 12 met the inclusion criteria. Eight papers reported research on treatment limitations in emergency medical care, two in family/general medicine, one on medication discontinuation in end-of-life care, and one on goals-of-care conversations in emergency departments. Patients, families and colleagues were involved to varying degrees. Family physicians were rarely included in emergency care decisions, despite their potential to align care with patient preferences. Decision-making in emergency medicine was characterized by rapid, protocol-driven processes, often constrained by time and workload, while decisions in family medicine relied on longitudinal patient relationships and clinical judgment, though lacking formalized guidelines. Key factors influencing decisions on limiting treatment included patient and family wishes and values, illness severity, prognosis, previous functional limitation, age, poor predicted quality of life and cultural and religious contexts.

CONCLUSION: Our review showed that decisions regarding treatment limitations in primary care settings remain underexplored, particularly in family medicine. More research and development of clearer guidelines, as well as enhanced collaboration between family and emergency physicians, could improve primary end-of-life care.

PMID:40597127 | PMC:PMC12210583 | DOI:10.1186/s12904-025-01807-1

Moral courage of palliative care nurses and affecting factors

Wed, 02 Jul 2025 00:00:00 +0000

BMC Palliat Care. 2025 Jul 1;24(1):179. doi: 10.1186/s12904-025-01829-9.

ABSTRACT

BACKGROUND: Moral courage among palliative care nurses plays a critical role in ensuring high-quality care for patients in the final stages of life. This study aimed to assess the level of moral courage among palliative care nurses and identify the factors that influence it.

METHODS: This descriptive, cross-sectional study was conducted between September 2023 and September 2024, involving 181 palliative care nurses. Data were collected through an online survey distributed to nurses who voluntarily agreed to participate. The survey included a "Personal Information Form" and the "Nurses' Moral Courage Scale (NMCS)."

RESULTS: The mean age of participants was 31.82 ± 7.92 years, and their average professional experience was 9.33 ± 9.32 years. Of the nurses, 62.4% were female. The average NMCS score was 82.25 ± 12.21. Nurses with a master's degree scored significantly higher on the NMCS compared to those with lower educational levels (p < 0.001). Additionally, nurses who had chosen their current unit voluntarily (p = 0.046), and those who rated their knowledge of healthcare ethics as "excellent" (p < 0.001), demonstrated significantly higher moral courage scores. A positive correlation was found between moral courage and age (r = 0.153, p = 0.040), whereas a negative correlation was observed between moral courage and the average number of night shifts per month (r = -0.253, p = 0.001).

CONCLUSION: The findings suggest that palliative care nurses generally exhibit high levels of moral courage. Educational attainment, voluntary selection of the work unit, and perceived competence in healthcare ethics were positively associated with moral courage. Conversely, challenging working conditions-such as high workloads, frequent night shifts, and insufficient institutional support-may hinder nurses' ethical decision-making by fostering caution and hesitation.

PMID:40597076 | PMC:PMC12220342 | DOI:10.1186/s12904-025-01829-9

Homelessness Raises Unique Ethical Concerns on End-of-Life Care.

Tue, 01 Jul 2025 04:00:00 +0000

Medical Ethics Advisor; 07/01/2025
(AN 186051688); ISSN: 08860653
CINAHL Complete

Navigating autonomy and decision-making capacity: Legal and ethical considerations in Medical Assistance in Dying for individuals with mental disorders in Portugal.

Tue, 01 Jul 2025 04:00:00 +0000

Death Studies; 07/01/2025
Portugal has recently amended its absolute prohibition on euthanasia and assisted suicide that now permits it conditionally and exonerates those providing this practice. People with a mental disorder or medical condition that affects their decision-making capacity (DMC), regardless of the mental disorder, its contemporaneity, or its connection to the decision itself are expressly excluded from this service unless they are assessed and deemed capacitous. In the absence of any statute concerning capacity or assisted decision-making, this legislation raises concerns about potential discrimination, conflicting with the presumption of capacity principle. A shift toward a DMC model is proposed. This model allows for the assessment of capacity for specific decisions, addressing the ethical implications of respecting or overriding a terminally ill person's autonomous will for medical assistance in dying. This review paper examines the challenges of assessing DMC in depression and examines several questions of ethical and legislative nature for future consideration.
(AN 186130022); ISSN: 07481187
Health Business Elite

Ethical aspects of limiting end-of-Life treatment of adult patients at the primary healthcare level in family and emergency medicine: a systematic review.

Tue, 01 Jul 2025 04:00:00 +0000

BMC Palliative Care; 07/01/2025
Background: Decisions to limit treatment near the end of life are challenging and common in primary healthcare, especially in family and emergency medicine. Objectives: This review aimed to [1] examine the evidence on the decision-making process regarding treatment limitation in end-of-life care in family and emergency medicine [2], identify associated ethical considerations, and [3] compare the evidence between family and emergency medicine. Methods: A systematic search of PubMed and Embase was conducted for studies published between 2004 and 2024. Eligible studies focused on ethical aspects of limiting treatment in end-of-life care in family and emergency medicine, such as decision-making processes, influencing factors, and ethical considerations. Quality was assessed using adapted Critical Appraisal Skills Programme checklists. Results: Of the 477 identified studies, 12 met the inclusion criteria. Eight papers reported research on treatment limitations in emergency medical care, two in family/general medicine, one on medication discontinuation in end-of-life care, and one on goals-of-care conversations in emergency departments. Patients, families and colleagues were involved to varying degrees. Family physicians were rarely included in emergency care decisions, despite their potential to align care with patient preferences. Decision-making in emergency medicine was characterized by rapid, protocol-driven processes, often constrained by time and workload, while decisions in family medicine relied on longitudinal patient relationships and clinical judgment, though lacking formalized guidelines. Key factors influencing decisions on limiting treatment included patient and family wishes and values, illness severity, prognosis, previous functional limitation, age, poor predicted quality of life and cultural and religious contexts. Conclusion: Our review showed that decisions regarding treatment limitations in primary care settings remain underexplored, particularly in family medicine. More research and development of clearer guidelines, as well as enhanced collaboration between family and emergency physicians, could improve primary end-of-life care.
(AN 186338125); ISSN: 1472684X
CINAHL Complete

Moral courage of palliative care nurses and affecting factors.

Tue, 01 Jul 2025 04:00:00 +0000

BMC Palliative Care; 07/01/2025
Background: Moral courage among palliative care nurses plays a critical role in ensuring high-quality care for patients in the final stages of life. This study aimed to assess the level of moral courage among palliative care nurses and identify the factors that influence it. Methods: This descriptive, cross-sectional study was conducted between September 2023 and September 2024, involving 181 palliative care nurses. Data were collected through an online survey distributed to nurses who voluntarily agreed to participate. The survey included a "Personal Information Form" and the "Nurses' Moral Courage Scale (NMCS)." Results: The mean age of participants was 31.82 ± 7.92 years, and their average professional experience was 9.33 ± 9.32 years. Of the nurses, 62.4% were female. The average NMCS score was 82.25 ± 12.21. Nurses with a master's degree scored significantly higher on the NMCS compared to those with lower educational levels (p < 0.001). Additionally, nurses who had chosen their current unit voluntarily (p = 0.046), and those who rated their knowledge of healthcare ethics as "excellent" (p < 0.001), demonstrated significantly higher moral courage scores. A positive correlation was found between moral courage and age (r = 0.153, p = 0.040), whereas a negative correlation was observed between moral courage and the average number of night shifts per month (r = -0.253, p = 0.001). Conclusion: The findings suggest that palliative care nurses generally exhibit high levels of moral courage. Educational attainment, voluntary selection of the work unit, and perceived competence in healthcare ethics were positively associated with moral courage. Conversely, challenging working conditions—such as high workloads, frequent night shifts, and insufficient institutional support—may hinder nurses' ethical decision-making by fostering caution and hesitation.
(AN 186338134); ISSN: 1472684X
CINAHL Complete

Ethical Expertise Before and After Medically Assisted Dying: The Informal and Formal Role of the Ethicist in the Netherlands

Mon, 30 Jun 2025 00:00:00 +0000

Bioethics. 2025 Jun 29. doi: 10.1111/bioe.13437. Online ahead of print.

ABSTRACT

Although we have a long-standing and well-institutionalized practice of medical aid in dying (MAID) in the Netherlands, it is insufficiently clarified which goals ethicists should pursue in the context of assisted dying, and which competencies they need to fulfil their role(s). We sought to contribute to this clarification. We argue that both in anticipation and in evaluation of MAID, ethicists fulfil a role that is highly valuable to good MAID practice, and complementary to that of other professionals. Whereas the involvement of the ethicist preceding MAID, for instance, to provide ethics support in the case of complex decision-making, is elective in the Netherlands, the participation of ethicists in evaluating performed MAID cases is obligatory, as they are required members of the interdisciplinary regional review committees that judge every case of MAID. We discuss some misconceptions and less-than-optimal performances of both these roles of the ethicist, then focus on how these roles should be perceived, and which kinds of ethics expertise are necessary for ethicists to make a valuable contribution to good MAID practice.

PMID:40583307 | DOI:10.1111/bioe.13437

Parental Authority and the Weight of Assent: Navigating Moral Dilemmas in Adolescent End of Life Care

Thu, 26 Jun 2025 00:00:00 +0000

J Bioeth Inq. 2025 Jun;22(2):235-241. doi: 10.1007/s11673-024-10417-0. Epub 2025 Jun 26.

ABSTRACT

Though the idea of assent emerged in the 1980s and adaptation in paediatrics has become more common practice, adolescent end-of-life care adds a multi-faceted layer of increased complexity to the assent process. In the current era of moral pluralism, medical decisions must account for much more than clinical considerations: they must abide by legal standards of decision-making which usually prioritize parental preferences. In the case of an adolescent at the end of life, there remains much room for improvement when disagreements arise. Conflict abounds between the parent or other legal decision-maker and healthcare team in situations where the parent prefers not to disclose the severity of the adolescent's illness or the healthcare team believes continuing lifesaving therapies are not in the adolescent's best interest. These dilemmas challenge how we solicit adolescents' preferences (assent) and their options for refusal (dissent). Disagreements create tension and weaken communication between the family and providers. Healthcare workers struggle to fulfil their professional obligations and retain their professional identities when values collide. We explore the moral distress healthcare workers face navigating conflict amongst various stakeholders involved in the adolescent's end-of-life care. Strategies to minimize moral distress are also provided.

PMID:40569538 | DOI:10.1007/s11673-024-10417-0

Palliative sedation at the end of life: Practical and ethical considerations

Mon, 16 Jun 2025 00:00:00 +0000

Clin Med (Lond). 2025 Jul;25(4):100338. doi: 10.1016/j.clinme.2025.100338. Epub 2025 Jun 14.

ABSTRACT

Sedation is commonly used at the end of life; however, there are several practical and ethical considerations for its use. It is important to identify any treatable causes for agitation prior to initiating medication. The drug, dose and route of administration may vary according to the indication for treatment, and specialist advice or supervision may be required. There are a number of ethical and cultural considerations relevant to the use of palliative sedation, which must also be understood to ensure best practice in this area.

PMID:40523526 | PMC:PMC12269621 | DOI:10.1016/j.clinme.2025.100338

End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe

Mon, 16 Jun 2025 00:00:00 +0000

Open Med (Wars). 2025 Jun 10;20(1):20251218. doi: 10.1515/med-2025-1218. eCollection 2025.

ABSTRACT

INTRODUCTION: This study explores the complexities and distinctive traits of end-of-life (EOL) care and assisted suicide in cancer patients across Europe, and the challenges they entail. It analyzes various countries in the Southern, Central, and Northern regions. Legal, ethical, and cultural dimensions of euthanasia are examined. Differences in practices across Europe are highlighted.

MATERIALS AND METHODS: The aim of this study is to provide an overview of EOL care policies in Europe by delving into the legislative/policy-making approaches of three selected nations, and implications thereof.

RESULTS: Disparities between regions are identified, to figure out margins for improvement. This includes advocating for a balanced approach that both upholds legal frameworks and respects patient autonomy. By doing so, the ultimate objective is to foster a culture of ethical and empathetic EOL care for cancer patients throughout Europe, ensuring that their needs and preferences are prioritized till the end. Advocacy for a balanced approach is recommended.

CONCLUSION: Ultimately, the findings herein presented point to the need for a collaborative effort among policymakers, healthcare providers, and communities to build a more holistic approach to end-of-life care that harmonizes legal regulations with the ethical imperative of respecting individual choice in an environment marked by sensitivity and compassion.

PMID:40520343 | PMC:PMC12163574 | DOI:10.1515/med-2025-1218

Rethinking end-of-life decisions through the ethics of care

Fri, 13 Jun 2025 00:00:00 +0000

Nurs Ethics. 2025 Jun 13:9697330251350388. doi: 10.1177/09697330251350388. Online ahead of print.

ABSTRACT

Although principles-based approaches have long been a cornerstone of bioethics and remain well-suited to many aspects of medical ethics, their reliance on deductive reasoning and emphasis on individualistic interpretations of autonomy often fall short in addressing the nuanced complexities of end-of-life (EOL) issues. The Ethics of Care (EoC) provides a comprehensive anthropological and ethical framework that is well-suited for EOL decision-making, including treatment limitations. This article explores the application of EoC to EOL care, proposing that decisions should prioritize care, compassion, relational networks, and context-sensitive judgements rather than the deduction of abstract principles. The inherent tension between EoC as a theoretical framework and its strong orientation toward concrete, relational practice is also discussed. While EoC cannot provide prescriptive steps, it offers valuable insights to complement traditional approaches to ethics. Following it, we propose eight practical guides for improving EOL decision-making. They represent an interpretation of EoC's core elements, interpreted for the specific challenges of treatment limitation. The practical guides are as follows: (1) building a trusting relationship with the patient, (2) identification of the patient's needs and values, (3) respect for the patient's relational part of autonomy, (4) identifying good treatment for the patient, (5) recognition of HCP's own inclinations and interests, (6) weighing different responsibilities, (7) shared decision-making towards best care, and (8) ensuring continuity of care and openness to change. Integrating the EoC perspective into clinical practice can enhance healthcare professionals' ability to navigate the ethical challenges at the EOL.

PMID:40514350 | DOI:10.1177/09697330251350388