Literature Review

Medical aid in dying: Bridging ethical guidance and bedside communication in nursing practiceJournal of Hospice & Palliative Nursing; by Jeanna Ford, Phyllis Whitehead; 7/26As MAiD [Medical aid in dying] becomes more integrated into serious illness care, nurses, particularly those in hospice and palliative care, are increasingly the first clinicians to receive patient questions about this option. These inquiries are often embedded in broader concerns related to suffering, loss of autonomy, fear of prolonged dying, and desire for control rather than solely requests for hastened death. The Hospice and Palliative Nurses Association’s recent position statement on medical aid in dying emphasizes compassionate, nonjudgmental care, respect for autonomy, professional integrity, and the ethical obligation of nonabandonment while recognizing the complexities of conscientious objection. This manuscript examines the evolving legal and ethical landscape of MAiD, explores the professional implications for nursing practice, and introduces the EXPLORE (Elicit, Explore, Probe Suffering, Learn Values, Observe Pressures, Review Support, Evaluate Next Steps) communication framework, a practice-based model developed to provide nurses with a structured, evidence-informed approach for responding to patient-initiated MAiD discussions. 

Where hospice fails us: A qualitative study of facilitators and barriers in transitions to hospice according to palliative care cliniciansJournal of Palliative Medicine; by Morgan M Nakatani, Julia G Cohn, Kris W Herring, Thomas W LeBlanc; 7/26Transitions to hospice are challenging for patients, caregivers, and health care teams, yet few studies have examined gaps in care from the perspectives of referring palliative care (PC) clinicians. PC clinicians identify substantial barriers to hospice transitions, underscoring the need to improve access to comprehensive end-of-life care. Clinicians emphasized the value of hospice and the Medicare benefit, while identifying barriers to hospice transitions [including] ... inadequate caregiving support, limited reimbursement, uncertainty around eligibility and prognostication, and differences between for-profit and non-profit hospice agencies. These barriers contributed to inequitable access to hospice and gaps in care.

Ethical implementation of organ donation following medical assistance in dying: Recommendations of the ethics committee of the Transplantation SocietyTransplantation; by Kristof Van Assche, Johannes Mulder, Curie Ahn, Richard D M Allen, Jan Bollen, Katrina A Bramstedt, Patrizia Burra, Patrick Cras, Kumud Dhital, Ian Dittmer, Beatriz Domínguez-Gil, James Downar, Riadh A S Fadhil, Patrick Ferdinande, John L R Forsythe, Marie-Chantal Fortin, Michael A Freeman, Rik T Gerritsen, Kim E Grayson, Andrew Healey, Alex Kazemi, Vivek B Kute, Dominique E Martin, Diethard Monbaliu, Elmi Muller, Alejandro Nino-Murcia, Gert Olthuis, Helen I Opdam, Brendan Parent, Alicia Pérez Blanco, Sam D Shemie, Marion Siebelink, Amina Silva, Vanessa Silva E Silva, Hans P Sonneveld, Peter G Stock, Rankie Ten Hoopen, Carrie Thiessen, Walther van Mook, Dirk Van Raemdonck, Anji E Wall, Matthew J Weiss, Larna Woodyatt, Dirk Ysebaert, David Thomson; 7/26Medical assistance in dying (MAiD) is legally permitted in a growing number of jurisdictions ... Organ donation following MAiD offers patients an opportunity to address transplant needs as a final act of altruism, but it also raises complex ethical questions that require strong safeguards to protect patients, professionals, and public trust.We identified key ethical issues and safeguards by analyzing guidelines and protocols from the 6 countries where organ donation following MAiD is performed: Australia, Belgium, Canada, the Netherlands, New Zealand, and Spain. Three domains of ethical concern emerged: (1) safeguarding the integrity of patients' decision-making (voluntariness, informed consent, and how and when information is presented); (2) ethical governance of donation following MAiD (adherence to the Dead Donor Rule, death determination, and consent for premortem interventions); and (3) implications for care relationships and professional practice (end-of-life impacts, recipient information and donor anonymity, and professional support, including conscientious objection). Key recommendations include clear and consistent policies; a patient-centered, nondirective approach; rigorous eligibility and voluntariness assessments; and strict separation between MAiD and donation/transplantation teams.

Mandatory mortality surprise question screening in the ED: Identification and associations with end-of-life care outcomesJournal of Palliative Medicine; by Nancy Kim, Karen Jubanyik, Peiyuan Liu, Giselle O'Connor, Ling Han, Rohit B Sangal, R Lynn Fiellin, Jennifer Kapo, Elizabeth Prsic, Shelli Feder; 7/26Early identification of patients with serious illness remains challenging in the emergency department (ED), where clinical decisions are made under time constraints. The mortality surprise question (MSQ) is a brief prognostic screen that may help identify patients needing end-of-life services. Results: Among 113,397 admissions (74,816 patients), MSQ completion was 100%; 7.8% received a "No" response. A "No" response was strongly associated with increased palliative care consultation ... , ACP documentation ... , hospice referral ... , comfort-measures-only orders ... , hospice disposition ... , higher inpatient mortality ... , and increased 30-day readmission ... Palliative care consultation occurred earlier among MSQ "No" than MSQ "Yes" encounters.

Private equity ownership in hospice care:  a systematic review (2012-2026) American Journal of Hospice and Palliative Medicine; by Denise D. Quigley, PhD, MA, Shannon Walsh, MPP, Cordt T. Kassner, PhD, Lara Dhingra, PhD, and Andrew W. Dick, PhD; 7/28/26 Hospice care is associated with improved end-of-life outcomes. Recent shifts in hospice utilization highlight several key trends. Alzheimer’s disease and related dementias (ADRD) (25%) have surpassed cancer (23%) as the leading primary diagnosis. Concurrently, industry ownership has transitioned from predominantly nonprofit to for-profit (70%) and private equity (PE) ownership has grown dramatically from 3% to 15%. To date, no study has synthesized evidence on PE ownership in hospice care.  We conducted a systematic review of English-language, peer-reviewed studies published 2012-2026, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Quality domains in home-based pediatric hospice and palliative care: Adolescent and young adult perspectivesBMC Palliative Care; by Daniel H Grossoehme, Claire A Crawford, Jhansi Chandra Ellakula, Toluwalase Ajayi, Justin N Baker, Sarah Friebert, Lisa Humphrey, JillAnn Jarrell, Rachel Thienprayoon, Pamela S Hinds; 7/26Previous research with pediatric providers and caregivers concluded that pediatric hospice and palliative care have unique attributes. Not known is how adolescent hospice and palliative care patients understand quality palliative care. Methods: Semi-structured interviews with 10-26 year-olds who received home-based hospice and/or palliative care visits in the prior three years at six diverse sites in the United States. The results address an important gap by including adolescent/young adult patients' voices regarding delivery of home-based hospice and palliative care. Clinical implications include prioritizing and making time to build trusting relationships directly with the AYA, empowering them to participate in their care to the extent appropriate and prepare for transition to adult care when needed, providing support for family members, and training for all providers in generalist spiritual care.