Literature Review

[Netherlands] A care ethical perspective on family caregiver burden and supportNursing Ethics; Maaike Haan, Jelle van Gurp, Marianne Boenink, Gert Olthuis; 3/25Family care-when partners, relatives, or other proxies care for each other in case of illness, disability, or frailty-is increasingly considered an important pillar for the sustainability of care systems. Especially in a palliative care context, however, family care can be challenging. Witnessing caregivers' challenges may prompt compassionate nurses to undertake actions to reduce burden by adjusting tasks or activities. The question is then whether self-sacrifice is a problem that nurses should immediately solve. Therefore, we suggest that caregiver experiences should always be interpreted in an explorative dialogue, focused on what caring means to a particular family caregiver. Nurses do not have to liberate family caregivers from the situation but should support them in whatever overwhelms or drives them in standing-by their loved ones until the end.

Why good palliative care clinicians get fired JAMA Network - Viewpoint; by Abby R. Rosenberg, MD, MS, MA; Elliot Rabinowitz, MD; and Robert M. Arnold; 4/14/25 Even the most seasoned palliative care clinician gets fired. In the past year, one of us was fired after asking whether a patient endorsing suicidal ideation had access to a gun; the patient requested not to see the palliative care team because we asked intrusive questions and documented the encounter. One of us was fired after supporting a family’s decision to discontinue life-sustaining therapies for their loved one with multisystem organ failure; the primary intensivist suggested palliative care overstepped in discussing options for which the family (and clinical teams) was not ready. And one of us was fired after sharing the impression that a patient with cancer was dying; the family suggested they preferred the oncologist’s version of a more hopeful future.

Brain activity before death: Do we see our lives flash? Time.News; interview with Dr. Eleanor Vance; 4/12/25 What flashes through our minds in the final moments of life? Could it be an intense reel of our most cherished memories or a profound sense of calm? Recent studies suggest that the brain may not simply shut down at death; instead, it could be engaged in a powerful replay of life’s most significant moments, offering a glimpse into the mysteries of consciousness and the human experience.

Bioethics Artificial Intelligence Advisory (BAIA): An Agentic Artificial Intelligence (AI) framework for bioethical clinical decision support Cureus; by Taposh P. Dutta Roy; 3/12/25 Healthcare professionals face complex ethical dilemmas in clinical settings in cases involving end-of-life care, informed consent, and surrogate decision-making. These nuanced situations often lead to moral distress among care providers. This paper introduces the Bioethics Artificial Intelligence Advisory (BAIA) framework, a novel and innovative approach that leverages artificial intelligence (AI) to support clinical ethical decision-making. The BAIA framework integrates multiple bioethical approaches, including principlism, casuistry, and narrative ethics, with advanced AI capabilities to provide comprehensive decision support. 

Moral agency in healthcare: What does it mean? Healthcare Business Today; by Editorial Team; 3/27/25 ... Moral agency, as defined by the American Association of Colleges of Nursing, is ”having the intent and then acting to pursue, achieve, and maintain optimal beneficial outcomes consistent with the moral/ethical principles of one’s practice.” ... A moral agent is a person who can tell right from wrong and is held accountable for his or her actions. Moral agents have a moral responsibility not to cause unjustified harm, which is especially important in a healthcare setting. ...

Pope Francis was so close to death that doctors considered ending treatment Reuters, Vatican City; by Joshua McElwee; 3/25/25 Pope Francis came so close to death at one point during his 38-day fight in hospital against pneumonia that his doctors considered ending treatment so he could die in peace, the head of the pope's medical team said. After a breathing crisis on February 28 ... "there was a real risk he might not make it," said Sergio Alfieri, a physician at Rome's Gemelli hospital. "We had to choose if we would stop there and let him go, or to go forward and push it with all the drugs and therapies possible, running the highest risk of damaging his other organs," Alfieri told Italy's Corriere della Sera in an interview published on Tuesday [3/25]. "In the end, we took this path," he said. [Continue reading ...]

Carolyn Hax: Does sibling love justify traveling to abusive mom’s deathbed?The Washington Post, Washington, DC; 3/24/25 Sister asks the letter writer to join her at their dying mom’s bedside — despite their PTSD-inducing childhoods. [The rest of this article may require a subscription to The Washington Post.]Editor's note: Even if you're not able to access the full article, what does this question stir in you? Be aware that many family caregivers (or simply family members) face complex, conflicted relationships with the persons they are tending--or in this case, even considering visiting or not. Be attuned to these common, everyday occurrences that your direct care interdisciplinary team members regularly navigate. What family systems' education and support do you provide for them?

‘Early discussions on what to expect can lessen the strain’ Nursing Times; by Kylie Chaffin; 3/19/25 The article explains the pros and cons of nutrition and hydration at end of life and the several types of artificial nutrition and hydration that can be used, written in a way patients and families can understand. Resources and educational articles, like this one, can also be a great way to introduce new or even more effective ways nurses and care team members can support patients and families when pursuing a palliative approach to their health and wellbeing. My question for readers is, “Should the conversation of end-of-life, hospice and palliative care, and nutritional changes, be initiated sooner rather than later in patients with a terminal diagnosis?”

Impacting end-of-life care with new healthcare legislation: Patient-Directed Medical Orders (PDMO) in advance care planningAmerican Nurse - State Nurses Associations - Florida News Journal; by Meredith Fischer, BSN, RN, CHPN; 3/19/25 Over the summer, a friend’s elderly father underwent resuscitation and intubation because his nursing facility could not locate his Do Not Resuscitate Order (DNRO) or Advanced Directive (AD). ... New legislation is being filed for a Patient-Directed Medical Order (PDMO) document designed to address the shortcomings of the ADs and DNRO forms—currently the primary tools for addressing end-of-life care preferences in Florida. The PDMO form originates from the POLST paradigm, which has been adopted by most states since its inception in Oregon in the early 1990s (National POLST, 2022). Healthcare professionals recognized that many individuals were not receiving the end-of-life care outlined in their ADs and DNROs due to accessibility, clarity, and practicality (National POLST, 2022).

[International] Healthcare on the brink: Palliative Care Unit and Late Shift The 75th Berlin International Film Festival - Part 7, wsws.org; by Martin Nowak and Bernd Reinhardt; 3/16/25 Two films, the drama Late Shift (Heldin) and the documentary Palliative Care Unit (Palliativstation), featured at this year's Berlin International Film Festival, addressed the current situation in German and Swiss hospitals. The sold-out festival screenings reflected the burning public interest in this topic. This is particularly remarkable bearing in mind that Palliative Care Unit has a running time of more than four hours. ... [In the] documentary Palliative Care Unit by Philipp Döring, shot at the Franziskus Hospital in Berlin, ... [the] camera quietly observes the daily routine, staff consultations and the constant empathy of the head of the ward towards employees and seriously ill patients, who usually spend their last weeks here. The very calm, always discreet images emphasise the necessity of sufficient time for care and reflection when making life-critical decisions. ... How can the highest possible quality of life be achieved? The high ethical standard of treating incurable patients as active human beings ... is admirable and makes a lasting impression throughout the film.

How Houston Methodist’s ACO reduced its end-of-life spending by nearly 20% MedCity News - Hospitals; by Katie Adams; March 10, 2025 Houston Methodist Coordinate Care is reducing costs through a partnership with Koda Health, a digital platform that guides patients through their end-of-life choices. Preliminary findings show the technology resulted in a 19% reduction in the total cost of care for patients at the end of their life, which equals nearly $9,000 in savings per patient. ... The ACO has been working with Koda Health for more than three years — and it is saving money by getting patients more involved in their end-of-life care plan.

Understanding a patient’s AI medical journey The Hastings Center; by Ian Stevens, Erin William, Jean-Christophe Bélisle-Pion, and Vardit Ravitsky; 3/5/25As artificial intelligence becomes increasingly integrated into U.S. health care, patients should know the ways in which AI is being used in their care, concludes a new paper, “Bring a ‘Patient’s Medical AI Journey’ to the Hill.” Transparency is crucial for interactions between health care providers and individual patients, as well as for systemic level uses of AI, including:

Exploring the role of AI in palliative care and decision-making Penn Today; by Erica Moser; 2/28/25 Oonjee Oh [nursing Ph.D studen] was the lead author on the paper “The ethical dimensions of utilizing Artificial Intelligence in palliative care,” which published in the journal Nursing Ethics in November. ... The paper applies the moral principles of beneficence, nonmaleficence, autonomy, justice, and explicability to examine the ethical dimensions of three hypothetical use cases: machine learning algorithms that predict patient mortality, natural language processing models that capture the signals of psychological distress from clinical notes, and chatbots that provide informational and emotional support to caregivers.