The Role of PMHNPs in Palliative Psychiatry: An Ethical Framework for Care When Remission Is Unattainable.

Patients with serious and persistent mental illness may experience intractable suffering despite exhaustive treatment, challenging the dominant curative paradigm in psychiatry. Palliative psychiatry offers an emerging alternative-prioritizing comfort, dignity, and quality of life when remission is no longer attainable. This article presents a comprehensive ethical and clinical framework for integrating palliative psychiatry into psychiatric-mental health nurse practitioner (PMHNP) practice. Drawing parallels with somatic palliative care, the author explores the theoretical foundations, diagnostic complexities, and ethical imperatives guiding palliative psychiatry. The article delineates PMHNP competencies in prognostic assessment, symptom management, advance-care planning, and interprofessional collaboration. Legal challenges, such as hospice eligibility criteria and involuntary treatment statutes, are also examined, with recommendations for practice and policy reform. Through this synthesis, the author argues that PMHNPs are ideally positioned to lead a paradigm shift that upholds the humanity of patients at the limits of recovery.