A Comprehensive Examination of End-of-Life Decision-Making

Abstract

Background: End-of-life decision-making presents a critical ethical and clinical challenge in modern healthcare. With medical technologies enabling prolonged life even in advanced illness, families and physicians often face conflicts between respecting patient autonomy, cultural values, and medical judgments. This study explores who should hold the final authority in end-of-life decisions and how ethical frameworks, cultural influences, and family dynamics shape these processes .

Methods and Materials: A mixed-methods approach was employed, including an extensive literature review of bioethical frameworks and clinical guidelines, expert interviews with physicians and bioethicists, and surveys distributed to healthcare professionals and families with lived end-of-life care experiences. The data were analyzed to identify communication gaps, ethical tensions, and practical barriers in decision-making. A shared decision-making (SDM) framework was developed, integrating ethical principles, cultural considerations, and emotional support strategies .

Results: Findings revealed a persistent tension between medical recommendations and family preferences, with 68% of surveyed families reporting feelings of exclusion from decisions and 75% of physicians expressing frustration over demands for non-beneficial treatments. Cultural values strongly influenced preferences, with Western norms prioritizing individual autonomy and many non-Western contexts emphasizing family consensus. The proposed SDM framework—centering on communication, informed consent, cultural competence, and emotional support—was positively received by both families and healthcare providers as a tool to bridge ethical and relational divides .

Conclusion: End-of-life decision-making must balance autonomy, beneficence, non-maleficence, and justice while respecting cultural and familial contexts. Implementing a shared decision-making model enhances collaboration, reduces conflict, and promotes dignity for patients. The study underscores the need for cultural competency, emotional support systems, and legal tools such as advance directives to guide ethical, patient-centered end-of-life care .