ethique_AMM_fin_vie

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 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 26. doi: 10.1007/s11673-024-10417-0. Online ahead of print.

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 Jun 14:100338. doi: 10.1016/j.clinme.2025.100338. Online ahead of print.

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 | 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

Anesthetic Considerations in Pregnancy Terminations, Miscarriages, Stillbirths, and Neonatal Palliative Care - Clinical Management and Ethical Challenges

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

Anasthesiol Intensivmed Notfallmed Schmerzther. 2025 Jun;60(6):357-370. doi: 10.1055/a-1727-8683. Epub 2025 Jun 13.

NO ABSTRACT

PMID:40513583 | DOI:10.1055/a-1727-8683

Ethical principles and challenges in end-of-life care for frail older adults

Mon, 09 Jun 2025 00:00:00 +0000

Br J Nurs. 2025 Jun 5;34(11):547-553. doi: 10.12968/bjon.2024.0413.

ABSTRACT

Providing end-of-life care to frail, older adults with multiple comorbidities can be ethically complex. As frailty differs from single terminal illness, end-of-life care requires a carefully considered, ethically informed approach. The four core ethical principles of autonomy, beneficence, nonmaleficence and justice need to be applied within this context; they involve challenges specific to frail patients, including fluctuating mental capacity, the risks of aggressive interventions and equitable access to resources. Key ethical issues include do not attempt cardiopulmonary resuscitation orders, confidentiality, mental capacity assessments and palliative sedation. Health professionals require a structured framework for decision-making. By balancing patient dignity, quality of life and legal considerations, practitioners can understand ethical obligations and practical decision-making strategies. For frail, older adults, a compassionate, patient-centred approach that prioritises comfort and dignity, especially as people approach the end of life, ensures care is provided in line with both ethical and legal standards.

PMID:40488561 | DOI:10.12968/bjon.2024.0413

Narrative review of the impact on physicians of administering euthanasia or physician-assisted suicide and its association with moral distress

Tue, 03 Jun 2025 00:00:00 +0000

Palliat Support Care. 2025 Jun 3;23:e115. doi: 10.1017/S1478951525000240.

ABSTRACT

BACKGROUND: Moral distress affects a significant proportion of clinicians who have received requests and participated in euthanasia or physician-assisted suicide (E/PAS) globally. It has been reported that personal and professional support needs are often unaddressed, with only a minority of those reporting adverse impacts seeking support.

OBJECTIVES: This study aimed to review studies from 2017 to 2023 for the perceived risks, harms, and benefits to doctors of administering E/PAS and the ethical implications for the profession of medicine resulting from this practice.

METHODS: The search explored original research papers published in peer-reviewed English language literature between June 2017 and December 2023 to extend prior reviews. This included both studies reporting quantitative and qualitative data, with a specific focus on the impact on, or response from, physicians to their participation in E/PAS. The quantitative review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The qualitative review used the Critical Appraisal Skills Programme to assess whether studies were valid, reliable, and trustworthy.

RESULTS: Thirty studies (quantitative n = 5, qualitative n = 22, mixed methods n = 3) were identified and fulfilled acceptable research assessment criteria. The following 5 themes arose from the synthesis of qualitative studies: (1) experience of the request prior to administration; (2) the doctor's role and agency in the death of a patient; (3) moral distress post-administration; (4) workload and burnout; and (5) professional guidance and support. Both quantitative and qualitative studies showed a significant proportion of clinicians (45.8-80%) have been adversely affected by their involvement in E/PAS, with only a minority of those reporting adverse impacts seeking support.

SIGNIFICANCE OF RESULTS: Participation in E/PAS can reward some and cause moral distress in others. For many clinicians, this can include significant adverse personal and professional consequences, thereby impacting the medical profession as a whole.

PMID:40457758 | DOI:10.1017/S1478951525000240

Mapping ethical issues encompassing end-of-life care for persons experiencing severe and persistent mental illness: a qualitative study

Mon, 02 Jun 2025 00:00:00 +0000

BMC Med Ethics. 2025 Jun 2;26(1):71. doi: 10.1186/s12910-025-01234-0.

ABSTRACT

BACKGROUND: Persons experiencing severe and persistent mental illness (SPMI) represent a small but vulnerable group in mental health care and society. Research on this population is limited, despite significant ethical challenges in their care. These challenges include the severity of their illness, limited social networks, communication difficulties, impaired decision-making capacity, and, at times, disruptive behavior.

PURPOSE: This study aims to explore the ethical themes that emerge in the care of persons experiencing SPMI, both in general and at the end of life. Specifically, we examine which issues arise, how care teams address ethical dilemmas, who is involved in decision-making, and what ethical frameworks or practices are utilized.

METHODS: We conducted 73 in-depth qualitative interviews with care users, family members, caregivers, care managers, and experts from the Flemish region of Belgium. The data were analyzed through content analysis to identify recurring themes and reflect on ethical practices.

RESULTS: The findings reveal that while many facilities have ethical guidelines or advisory structures such as ethics committees, these are often not well known or not perceived as easily accessible to frontline staff. Ethical dilemmas are predominantly addressed at the team level, with some organizations employing a reference person ethics in the unit, "ethics pubs", or peer support mechanisms for challenging situations. The most frequently mentioned ethical issue was euthanasia, whereas others included neglect in home settings, prolonged delays in initiating palliative care, and maintaining autonomy for care users. Resource allocation, both at the organizational and societal levels, was also identified as an ethical concern. Caregivers described tensions between creative, individualized care and institutional policies, whereas families emphasized the shared responsibility in finding appropriate care.

CONCLUSION: Ethical care for persons experiencing SPMI demands attention to autonomy, collaboration, and resource distribution. Greater accessibility to ethical support systems and tailored approaches are needed to balance recovery-oriented care with a palliative care approach, ensuring dignity and respect for this vulnerable group.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40457393 | PMC:PMC12128549 | DOI:10.1186/s12910-025-01234-0

"Qualitative study on nursing students' perspective on ethical conflicts at the end of life: "We are not prepared".

Sun, 01 Jun 2025 04:00:00 +0000

Nurse Education Today; 06/01/2025
Nursing care for people at the end of life is a crucial aspect of health care that involves challenges and responsibilities. In this scenario, ethical conflicts often arise resulting in situations of great suffering and high-level emotional impact, for which nursing students do not feel sufficiently prepared. The aim of this study was to find out how nursing students perceive the ethical conflicts present at the end of life and their reflective and deliberative capacity in the face of these conflicts. Descriptive qualitative study. Between February and March 2023 with nursing students at the University of Huelva in Spain. Sixteen in-depth interviews were conducted. The data analysis was carried out using Giorgi's method and Atlas.ti 22 software as a support. The students reported that they had encountered ethical conflicts in the end-of-life phase during their internship care period. The main causes they mention are: the management of ethical conflicts, the position on euthanasia and conscientious objection, and the influence of values and beliefs about care. They highlight the lack of training in coping and emotion management in end-of-life care. Nursing students feel unprepared to deal with the suffering and ethical conflicts involved in end-of-life care, as well as the management of their own internal conflicts. There is therefore a need for the implementation of high-fidelity simulation-based training that generates the learning of the necessary competencies in bioethics and defensive palliative care through appropriate competencies. • Nursing students face ethical conflicts with end-of-life care. • In the management of ethical conflicts, the majority are in favour of euthanasia and against conscientious objection. • There is a lack of legislation that guarantees and supports human autonomy and dignity. • Need for training in ethical competencies through academic and clinical simulations.
(AN 184228160); ISSN: 02606917
CINAHL Complete

The ethical dimensions of utilizing Artificial Intelligence in palliative care.

Sun, 01 Jun 2025 04:00:00 +0000

Nursing Ethics; 06/01/2025
Palliative care aims to improve the quality of life for seriously ill individuals and their caregivers by addressing their holistic care needs through a person- and family-centered approach. While there have been growing efforts to integrate Artificial Intelligence (AI) into palliative care practice and research, it remains unclear whether the use of AI can facilitate the goals of palliative care. In this paper, we present three hypothetical case examples of using AI in the palliative care context, covering machine learning algorithms that predict patient mortality, natural language processing models that detect psychological symptoms, and AI chatbots addressing caregivers' unmet needs. Using these cases, we examine the ethical dimensions of utilizing AI in palliative care by applying five widely accepted moral principles that guide ethical deliberations in AI: beneficence, nonmaleficence, autonomy, justice, and explicability. We address key ethical questions arising from these five core moral principles and analyze the potential impact the use of AI can have on palliative care stakeholders. Applying a critical lens, we assess whether AI can facilitate the primary aim of palliative care to support seriously ill individuals and their families. We conclude by discussing the gaps that need to be further addressed in order to promote ethical and responsible AI usage in palliative care.
(AN 185986000); ISSN: 09697330
Health Business Elite

"I Used to Feel my Child Was...the Property of the Hospital": An Examination of an Ethic of Care for Pediatric Home-Based Hospice and Palliative Care.

Sun, 01 Jun 2025 04:00:00 +0000

Journal of Palliative Medicine; 06/01/2025
Background: Home-based hospice and/or palliative care (HBHPC) is an important pediatric care modality offering continuity of care and a deeper understanding of patient and family needs. There is limited guidance to address multi-faceted approaches to care in home-based settings through a care ethics model. Objectives: Qualitatively examine patient and family home-based care experiences to formalize care ethics guidance for HBHPC. Design: Secondary thematic analysis of semi-structured, transcribed interviews (n = 14) of 18 participants. Setting/Subjects: A group of 17 family caregivers and one adolescent/young adult patient receiving HBHPC provided by two regional pediatric health systems in the United States. Measurements: Three stages of thematic analysis were conducted: line-by-line coding of text, descriptive theme development, and analytic theme generation. Results: Transcripts from 18 participants (88% female; 12% male) were analyzed. Four descriptive themes were generated through deductive analysis: relationships; home health environment; ways of caring; and values. Several analytic themes (n = 22) and sub-themes (n = 90) emerged and provided contextual meaning centered on a care ethic. Conclusion: A care ethic model is present in HBHPC experiences and, with validation, can offer guidance in the acknowledgment and delivery of care among professional and family caregivers.
(AN 186113973); ISSN: 10966218
CINAHL Complete

Ethics and moral empathy in end-of-life palliative care

Fri, 30 May 2025 00:00:00 +0000

Palliat Support Care. 2025 May 30;23:e108. doi: 10.1017/S1478951525000458.

ABSTRACT

OBJECTIVES: End-of-life care poses significant ethical challenges for nurses, requiring a deep understanding of moral empathy and ethical decision-making. This study examines the impact of these factors on end-of-life decision-making among nurses in oncology and pain management units in Egypt.

METHODS: A cross-sectional design was employed to gather data from participants at a single point in time, facilitating an analysis of the relationships among ethical principles, moral empathy, and nursing practice. The study involved 246 registered nurses with at least 6 months of experience, selected through stratified random sampling from oncology and pain management units in Damietta, Egypt. These settings were chosen due to their central role in palliative care, as Damietta serves as a regional healthcare hub with specialized units addressing chronic and end-of-life conditions. This selection allows for an in-depth exploration of the ethical dimensions involved in providing palliative care. Informed consent was acquired from all participants, ensuring confidentiality and the right to withdraw from the study at any time.

RESULTS: The findings indicated that 72% of participants reported high levels of moral empathy, which positively correlated with ethical decision-making scores (r = 0.65, p < 0.01). However, 58% of the nurses also reported experiencing moderate to high levels of moral distress in various clinical scenarios. Additionally, nurses in supportive ethical climates experienced significantly lower moral distress than those in less supportive settings (p < 0.05).

SIGNIFICANCE OF RESULTS: This study highlights the importance of integrating ethical training and moral empathy into nursing education and practice. The findings underscore the need for policy reforms to embed ethics and empathy training in nursing curricula and professional development programs, fostering ethical competence and enhancing patient care quality.

PMID:40442997 | DOI:10.1017/S1478951525000458

Nursing ethical dimensions of euthanasia and medically assisted suicide for older people in need of long-term care

Thu, 29 May 2025 00:00:00 +0000

Front Psychiatry. 2025 May 14;16:1589487. doi: 10.3389/fpsyt.2025.1589487. eCollection 2025.

ABSTRACT

Euthanasia and medically assisted suicide (E/MAS) are (healthcare-)practices intended to cause a patient's death according to their wish and will. This article addresses the specific ethical questions that arise in the context of E/MAS regarding older adults in need of long-term care (LTC) from a nursing ethics perspective. Older people in need of LTC are particularly vulnerable due to a combination of health-related, social, and economic factors. Multiple chronic diseases, age-related frailty and the subsequent need for LTC, for example, may contribute to an increased risk of social isolation, loneliness and hopelessness. The boundaries between "normal" age-related changes and changes that are deemed to be pathological also become blurred. The complex interplay of these factors results in the particular needs of older adults who rely on nursing care. Consequently, specific ethical issues arise that are unique in terms of their quality and quantity - also regarding E/MAS. We present a common scenario: a fall with a subsequent fracture, as a turning point in the LTC arrangement. The consequences of such an adverse event (limited mobility, risk of further falls) compromise the security of care at home, raising the (potential) need for transfer to a LTC facility. This (potential) move represents a major disruption, is experienced as a crisis, and marks a transition for the older adult in need of LTC. We highlight the complex interplay between aging, health-care dependency, personal values and the resulting wish/request for E/MAS. We discuss how the professional self-perception and ethical values of the nursing profession in the home care setting determine the treatment pathway for older peoples' request for E/MAS.

PMID:40438333 | PMC:PMC12116641 | DOI:10.3389/fpsyt.2025.1589487

Palliative care competencies: a bioethical analysis of medical students' education

Tue, 27 May 2025 08:26:42 +0000

Author Names: Truiti M.T.,Perini C.C.,Guirro UB.D.P.

Database Source: Embase Daily Updates

Journal Title: BMC medical education

Article Title: Palliative care competencies: a bioethical analysis of medical students' education

Year: 2025

Issue: 1

Volume: 25

Abstract: BACKGROUND: With technological advancements, health education has predominantly focused on technical aspects, neglecting human values. Palliative care (PC), seeking holistic care, becomes crucial in this context, and for its development, the World Health Organization has defined its education and teaching as one of the essential pillars. PC emphasizes patient dignity, autonomy, and holistic well-being, reflecting Thomasma and Pellegrino's beneficence-in-trust model, fostering trust and ethical care.The aim of this research was to analyze, through the bioethics perspective, the acquisition of PC competencies among medical students. <br/>METHOD(S): This cross-sectional, quantitative study assessed 360 medical students from a public university in Parana, using the Pallicomp tool questionnaire to evaluate PC competencies. Data were analyzed using statistical methods, comparing scores across academic cycles and prior PC coursework. Findings were interpreted through bioethical principles and Pellegrino and Thomasma's beneficence-in-trust model. <br/>RESULT(S): Basic cycle students presented a higher overall score than those in the internship, with statistical difference, and the individual analysis of competencies did not reveal an increase throughout the course. When considering the overall score between students who took PC courses and those who did not, there was no statistically significant difference. Deficiencies were observed in key areas involving bioethical principles, including symptom management, compassionate communication, spirituality, and interdisciplinary teamwork. <br/>CONCLUSION(S): This study revealed gaps in PC education among medical students, with scores below 70% across academic cycles and a decline from basic to internship levels. The findings highlight deficiencies in holistic, patient-centered competencies, including psychological and spiritual care, interdisciplinary teamwork, and communication. Addressing these gaps requires integrating bioethical principles and practical training throughout medical education to foster ethical, humanized, and comprehensive care, aligning with the beneficence-in-trust model. CLINICAL TRIAL NUMBER: Not applicable.<br/>Copyright © 2025. The Author(s).

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

Mon, 26 May 2025 04:00:00 +0000

BMC Palliative Care; 05/26/2025
Background: Palliative care, perhaps more than any subspecialty in healthcare, is deeply relational and engages patients and families at times of great vulnerability. Ethics of care, or relational ethics, developed through contributions from feminist ethics, offers conceptual tools and ways of thinking that seem especially suited to palliative care practice. Aim: To identify and describe studies and theoretical analyses applying the ethics of care to palliative care (both adult and paediatric), specifically, its use to guide and improve practice and education for palliative care practitioners. Design: We conducted a scoping review of six databases covering clinical, social science and normative ethics scholarship and conducted a thematic analysis of the findings and ethical discussions or arguments. Data sources: Databases searched included PubMed, CINAHL, PsychINFO, EMBASE, Web of Science and Philosopher's Index from 1982 to November 2024. Results: 30 publications meeting our inclusion criteria were identified. Major themes reflected the relational obligations, attributes and character traits ideally developed in palliative care providers in their work and relationships with patients and families, including responsiveness, connectedness and hope, as well as in caring for ourselves and each other on palliative care teams. An emerging literature recognises the special guidance for palliative care for children. Conclusions: Clinical and ethical scholarship in palliative care reveals a valuable but still underexplored connection between the ethical commitments within the ethics of care tradition and palliative care training and practice. Ethics of care addresses important gaps in training, particularly having to do with practitioners' relationships and ways of being with patients, families, colleagues and themselves.
(AN 185423729); ISSN: 1472684X
CINAHL Complete

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

Mon, 26 May 2025 00:00:00 +0000

BMC Palliat Care. 2025 May 26;24(1):150. doi: 10.1186/s12904-025-01784-5.

ABSTRACT

BACKGROUND: Palliative care, perhaps more than any subspecialty in healthcare, is deeply relational and engages patients and families at times of great vulnerability. Ethics of care, or relational ethics, developed through contributions from feminist ethics, offers conceptual tools and ways of thinking that seem especially suited to palliative care practice.

AIM: To identify and describe studies and theoretical analyses applying the ethics of care to palliative care (both adult and paediatric), specifically, its use to guide and improve practice and education for palliative care practitioners.

DESIGN: We conducted a scoping review of six databases covering clinical, social science and normative ethics scholarship and conducted a thematic analysis of the findings and ethical discussions or arguments.

DATA SOURCES: Databases searched included PubMed, CINAHL, PsychINFO, EMBASE, Web of Science and Philosopher's Index from 1982 to November 2024.

RESULTS: 30 publications meeting our inclusion criteria were identified. Major themes reflected the relational obligations, attributes and character traits ideally developed in palliative care providers in their work and relationships with patients and families, including responsiveness, connectedness and hope, as well as in caring for ourselves and each other on palliative care teams. An emerging literature recognises the special guidance for palliative care for children.

CONCLUSIONS: Clinical and ethical scholarship in palliative care reveals a valuable but still underexplored connection between the ethical commitments within the ethics of care tradition and palliative care training and practice. Ethics of care addresses important gaps in training, particularly having to do with practitioners' relationships and ways of being with patients, families, colleagues and themselves.

PMID:40420093 | PMC:PMC12105298 | DOI:10.1186/s12904-025-01784-5

Ethical, legal, and social aspects of health technologies for home-based paediatric palliative care – a systematic review.

Fri, 16 May 2025 04:00:00 +0000

BMC Palliative Care; 05/16/2025
Background: Home-based health technologies for paediatric palliative care have great potential to improve care for children, caregivers, healthcare professionals, and health systems. However, no systematic reviews have directly addressed the intersections among the ethical, legal, and social aspects of these technologies for paediatric palliative care. The objective of this systematic review was to identify and analyse the ethical, legal, and social aspects of health technologies for home-based paediatric palliative care. Methods: We have conducted a systematic review, inspired by the framework suggested by McCullough. We registered the review protocol in PROSPERO (CRD42024496034) and conducted a systematic search in six databases (ASSIA, Cinahl, Embase, Medline, PsycInfo, and Web of Science) on 27 November 2023 to identify relevant studies. Pairs of authors independently assessed the eligibility of the studies and extracted data. The eligible studies employed a range of different methods from randomised controlled trials to usability studies. We then synthesised the data according to the ethical, legal and social aspects of the technologies. Results: Overall, our search resulted in 9,545 reports, which were screened after deduplication. The quality of the reports was assessed according to being published in peer reviewed journals. Fifteen reports were included, which showed that the main ethical issues are harm reduction, improved services, agency and autonomy, trust and empowerment. The main legal aspects are privacy equal access to care, participation in decisions and standardisation. The main social issues are cost reduction, transformation of family relations and novel modes of communication. Health technologies have the potential to alleviate burdens and improve the quality of care for children in paediatric palliative care and their families, but they also create novel burdens through constant reporting requirements and the vulnerability of some health technologies to technological malfunction. Nevertheless, they can increase family inclusion and children's autonomy and participation, thus empowering children, particularly through co-development of solutions. Furthermore, studies have indicated that health technologies themselves may have positive effects on children's health. The legal aspects of health technologies pertain to privacy and control over one's health information and equitable access to care and participation in care, while social issues can potentially reduce costs for health systems but also involve novel costs. Conclusion: The reviewed studies concerning the co-development of health technologies reported increased benefits in terms of health, agency, well-being, and strengthened children's rights in home-based paediatric palliative care. However, the social dimensions of such technologies can lead to both public savings and reconfiguration of family constellations. We recommend that future researchers consider privacy, the formal dimensions of apps and smartphones, and their impacts on families. PROSPERO reference: CRD42024496034.
(AN 185240515); ISSN: 1472684X
CINAHL Complete

Ethical, legal, and social aspects of health technologies for home-based paediatric palliative care - a systematic review

Fri, 16 May 2025 00:00:00 +0000

BMC Palliat Care. 2025 May 16;24(1):139. doi: 10.1186/s12904-025-01774-7.

ABSTRACT

BACKGROUND: Home-based health technologies for paediatric palliative care have great potential to improve care for children, caregivers, healthcare professionals, and health systems. However, no systematic reviews have directly addressed the intersections among the ethical, legal, and social aspects of these technologies for paediatric palliative care. The objective of this systematic review was to identify and analyse the ethical, legal, and social aspects of health technologies for home-based paediatric palliative care.

METHODS: We have conducted a systematic review, inspired by the framework suggested by McCullough. We registered the review protocol in PROSPERO (CRD42024496034) and conducted a systematic search in six databases (ASSIA, Cinahl, Embase, Medline, PsycInfo, and Web of Science) on 27 November 2023 to identify relevant studies. Pairs of authors independently assessed the eligibility of the studies and extracted data. The eligible studies employed a range of different methods from randomised controlled trials to usability studies. We then synthesised the data according to the ethical, legal and social aspects of the technologies.

RESULTS: Overall, our search resulted in 9,545 reports, which were screened after deduplication. The quality of the reports was assessed according to being published in peer reviewed journals. Fifteen reports were included, which showed that the main ethical issues are harm reduction, improved services, agency and autonomy, trust and empowerment. The main legal aspects are privacy equal access to care, participation in decisions and standardisation. The main social issues are cost reduction, transformation of family relations and novel modes of communication. Health technologies have the potential to alleviate burdens and improve the quality of care for children in paediatric palliative care and their families, but they also create novel burdens through constant reporting requirements and the vulnerability of some health technologies to technological malfunction. Nevertheless, they can increase family inclusion and children's autonomy and participation, thus empowering children, particularly through co-development of solutions. Furthermore, studies have indicated that health technologies themselves may have positive effects on children's health. The legal aspects of health technologies pertain to privacy and control over one's health information and equitable access to care and participation in care, while social issues can potentially reduce costs for health systems but also involve novel costs.

CONCLUSION: The reviewed studies concerning the co-development of health technologies reported increased benefits in terms of health, agency, well-being, and strengthened children's rights in home-based paediatric palliative care. However, the social dimensions of such technologies can lead to both public savings and reconfiguration of family constellations. We recommend that future researchers consider privacy, the formal dimensions of apps and smartphones, and their impacts on families.

PROSPERO REFERENCE: CRD42024496034.

PMID:40380108 | PMC:PMC12082856 | DOI:10.1186/s12904-025-01774-7

Ethical and clinical concerns surrounding euthanasia for mental illness: Upholding hope and healing in psychiatric practice

Fri, 16 May 2025 00:00:00 +0000

Ind Psychiatry J. 2025 Jan-Apr;34(1):138-139. doi: 10.4103/ipj.ipj_279_24. Epub 2025 Jan 15.

NO ABSTRACT

PMID:40376651 | PMC:PMC12077621 | DOI:10.4103/ipj.ipj_279_24

Challenges and Ethical Considerations of Palliative Care in Indian Prisons

Wed, 14 May 2025 00:00:00 +0000

J Pain Symptom Manage. 2025 May 12:S0885-3924(25)00634-7. doi: 10.1016/j.jpainsymman.2025.05.003. Online ahead of print.

NO ABSTRACT

PMID:40368288 | DOI:10.1016/j.jpainsymman.2025.05.003

Moral psychological exploration of the asymmetry effect in AI-assisted euthanasia decisions

Wed, 14 May 2025 00:00:00 +0000

Cognition. 2025 Sep;262:106177. doi: 10.1016/j.cognition.2025.106177. Epub 2025 May 13.

ABSTRACT

A recurring discrepancy in attitudes toward decisions made by human versus artificial agents, termed the Human-Robot moral judgment asymmetry, has been documented in moral psychology of AI. Across a wide range of contexts, AI agents are subject to greater moral scrutiny than humans for the same actions and decisions. In eight experiments (total N = 5837), we investigated whether the asymmetry effect arises in end-of-life care contexts and explored the mechanisms underlying this effect. Our studies documented reduced approval of an AI doctor's decision to withdraw life support relative to a human doctor (Studies 1a and 1b). This effect persisted regardless of whether the AI assumed a recommender role or made the final medical decision (Studies 2a and 2b and 3), but, importantly, disappeared under two conditions: when doctors kept on rather than withdraw life support (Studies 1a, 1b and 3), and when they carried out active euthanasia (e.g., providing a lethal injection or removing a respirator on the patient's demand) rather than passive euthanasia (Study 4). These findings highlight two contextual factors-the level of automation and the patient's autonomy-that influence the presence of the asymmetry effect, neither of which is not predicted by existing theories. Finally, we found that the asymmetry effect was partly explained by perceptions of AI incompetence (Study 5) and limited explainability (Study 6). As the role of AI in medicine continues to expand, our findings help to outline the conditions under which stakeholders disfavor AI over human doctors in clinical settings.

PMID:40367579 | DOI:10.1016/j.cognition.2025.106177

Truth-telling, and ethical considerations in terminal care: an Eastern perspective.