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

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.