Patient Autonomy Research Articles

Misaligned hope and conviction in health care.

It is often said that it is important for patients to possess hope that their treatment will be successful. We agree, but a widely appealed to type of hope-hope based on conviction (religious or otherwise), renders this assertion problematic. If conviction-based hope influences patient decisions to undergo medical procedures, then questions are raised about the scope of patient autonomy. Libertarians permit patients to make decisions to undergo medical procedures on the basis of any considerations, including conviction-based hopes, on grounds of respect for freedom of choice. Rational interventionists want to restrict choices made on the basis of conviction-based hope on the grounds that choices based on hope incorporate irrationality of a sort incompatible with autonomous decision-making. In this article, we navigate a middle path between these extremes, arguing that patient decision-making based on conviction-based hope ought to be acceptable and permitted in health care when it conforms to norms of practical rationality. These norms allow patients some room to make decisions to consent to undergo medical procedures informed by conviction-based hope.

Exploring the unconventional: health professionals' experiences into medication-free treatment for patients with severe mental illness.

In January 2017, the Norwegian government mandated the establishment of an inpatient unit for "medication-free treatment" for patients with severe mental illness at the University Hospital of North Norway in Tromsø. This study aims to explore the employees' experiences with this unit. Focus group interviews were conducted October 2021 - February 2022. For analysis, the participants were divided into three groups; S (staff working at the medication-free unit), M (people involved in management at the unit) and T (therapists working elsewhere in the hospital). The analysis followed the Systematic Text Condensation and interviews were recorded, transcribed and analysed using NVivo software. Health professionals described their experiences with medication-free treatment through five main concepts: 1) Employees' motivation; 2) Frames; 3) Network; 4) Relations; and 5) Patients' motivation. Staff and management expressed strong motivation for an alternative to "treatment as usual," focusing more on recovery and relationships than on the absence of medication. Therapists from other hospital areas highlighted resource allocation concerns and expressed a desire to learn from the unit. Challenges were acknowledged by all groups. The term "medication-free treatment'' might be misleadning. While patiens at the unit can use medications, there is a strong emphasis on patient autonomy and the option to taper off medication and live a life without them. The study adds valuable knowledge about the the experiences of employees working at a medication-free unit, and provides insights into the complexity of treating severe mental illness, both with and without medication. It highlights the importance of sufficient time, stability and resources to focus on each patient's strengths and challenges. All employees agree that tailored measures in long-term treatment and a clear focus on recovery should be integral, even without an emphasis on "medication-free treatment".

Should we restrict food intake during labor? A randomized controlled trial.

To evaluate whether consuming food during labor influences its outcomes. This randomized controlled study included healthy, laboring patients at 37-41weeks of gestation. After epidural anesthesia, patients were randomized into groups of eating at will versus drinking clear fluids only. The primary composite outcome included unplanned cesarean delivery, the need for general anesthesia, asphyxia, postpartum fever, and prolonged postpartum admission (more than 5days). Secondary outcomes included the need for oxytocin, length of the second stage of labor, postpartum analgesia requirements, and early maternal and neonatal outcomes. Sample size analysis indicated that 126 patients needed to be randomized to detect a statistically significance difference between the groups. A total of 129 patients were randomized: 58 to the fluids-only group and 71 to the food group. The groups had similar basic characteristics. The composite outcome of complications attributed to eating during labor and delivery was comparable between groups. Labor progression and the need for oxytocin augmentation were similar in both groups. The groups had comparable fetal heart rate tracings, modes of delivery, maternal and neonatal outcomes, and complications. None of the patients in the study experienced aspiration or an indication for general anesthesia. While our data suggest that eating during labor does not adversely affect labor progression or outcomes, we recommend a cautious approach, allowing patients autonomy while considering individual risk factors. The study has been registered in the primary clinical trial registry on 02/12/2023. ISRCTN trial number ISRCTN11794106, registration number 44513. https://www.isrctn.com/ISRCTN11794106 .

Patients' preferences for virtual outpatient consultations and health care professionals' assessment of suitability for their patients: A single-centre survey.

To explore patients' preferences regarding virtual consultations (via telephone or video) and to explore healthcare professionals' assessment of whether virtual consultations can maintain the same clinical quality as in-person consultations for outpatient care. A cross-sectional survey was conducted among patients with an in-person consultation at the outpatient clinic for internal medicine and among healthcare professionals who treated the patients. The prevalence of preference was determined using descriptive statistics based on cross-tabulated frequencies. Percentages are presented with 95% confidence intervals (95%CI). In total, 218 patients (response rate 67%) completed the questionnaire; 79 patients (36%) preferred a virtual consultation (95%CI: 30%-43%); telephones were the most popular and preferred by 72 patients (33%; 95%CI: 27%-39%) followed by video preferred by 54 patients (25%; 95%CI: 19%-31%). Regarding contextual factors, male gender and previous experiences with telephone or video consultations were statistically significant predictors in favour of virtual consultations. Healthcare professionals estimated that 58 consultations (21%; 95%CI: 17%-26%) could have been conducted virtually with the same professional and clinical quality as the current in-person consultations. Current practice does not fully align with patient preferences for virtual visits in internal medicine outpatient clinics. Patients should be given the choice of virtual consultations whenever they are deemed professionally and clinically possible to enhance patient autonomy and satisfaction, while being mindful of speciality-specific considerations.

Relationship between characteristics of health professionals and the respect for the autonomy of cancer patients at the end of life.

This study investigated whether providers respected patient's autonomy, investigating providers' pattern of decisions and their associated characteristics. Cross-sectional study, conducted through anonymous questionnaire with hypothetical clinical cases, presented to providers at one oncology center. Decision-making patterns were pre-stablished accordingly to the response´s pattern. Of 151 responses, decisions patterns were paternalistic in 38%, shared in 38%, obstinate in 10.6% and consumerist in 13.2%. The consumerist providers reported never having participated in an EOL class in 35% and 30% had never trained in palliative care. Among providers with paternalistic pattern, 35.1% had never attended ethic lectures. In the obstinate group, 31.2% had no training in palliative care. When asked how subjects saw themselves about their pattern of decision, 100% of obstinate, 95% of consumerist and 89% of paternalistic patterns exhibited cognitive dissonance. Significative differences between decisions and how the providers judge themselves were observed.

Study protocol of an exercise and nutrition intervention for ovarian cancer patients during and after first-line chemotherapy (BENITA) - a randomized controlled trial.

In ovarian cancer frequently reported side effects are muscle wasting and malnutrition, leading to frailty, decreased health-related quality of life (HRQoL), and cancer-related fatigue (CRF). Both often begin during first-line chemotherapy and develop progressively into a refractory state, if left untreated. Primary objective is to evaluate effectiveness of a newly developed app-based exercise and nutrition program under non-standardized conditions of clinical routine. We hypothize that patients who receive an individually tailored exercise and nutrition program for six months will have improved physical performance compared to patients who receive usual care. This is a multicenter randomized controlled open-label trial comparing an intervention group receiving a six-month exercise and nutrition intervention and a control group receiving usual care. Primary endpoint is the change in 6-Minute Walk Test (6MWT) from baseline to T2 (26 weeks after baseline) as a measure of physical functioning. Secondary endpoints include patients' utilization and adherence to the nutrition program (MEDAS), their malnutrition risk (NRS2002), as well as patients' HRQoL (see Table1). Using the two-sample t-test with a two-sided type I error of 5% and 80% power, a medium effect size of Cohen's d = 0.50 can be demonstrated with a minimum of 128 participants (64 per group). With a conservatively estimated dropout rate of 30%, 182 patients will be recruited. Patients who are included must be over 18 years of age, be diagnosed with ovarian cancer, cancer of fallopian tubes, or peritoneal cancer, FIGO stages II-IV, receive surgery and chemotherapy (adjuvant or neoadjuvant). Exclusion criteria are an ECOG status greater than 2, inadequate proficiency in German, or physical or mental impairments hindering the implementation of the program or execution of study procedures. In case of success, the project contributes in the long term to (i) improving medical care (diagnosis, psychoeducation, patient orientation, and empowerment), (ii) reducing the burden of disease and promoting physical autonomy for patients, and (iii) being incorporated into relevant guidelines. The study was registered at ClinicalTrials.gov (NCT06250686).

Navigating Voluntarily Stopping Eating and Drinking in Hospice Settings: A Multidisciplinary Approach.

This article explores current global research on voluntarily stopping eating and drinking (VSED) and presents a detailed, deidentified case study of a patient who elected VSED in a hospice setting in the Southeastern United States. It highlights the collaborative efforts of health care professionals in effectively supporting the patient and family, sharing multiple perspectives from various health care team members who cared for the patient and family. It offers evidence-based recommendations to guide health care teams through the ethical, medical, and emotional challenges of VSED, ensuring compassionate and competent care. The article emphasizes the importance of structured protocols and empathetic care in hospice settings, advocating for the education and preparation of health care teams and families to address the complex challenges associated with VSED. By promoting open communication, interdisciplinary collaboration, and comprehensive support, hospices can respect the autonomy of patients and families choosing VSED, ensuring a compassionate and dignified end-of-life experience.

QLTI-19. PEDIATRIC NEURO-ONCOLOGISTS NAVIGATING AN ADULT WORLD: A TALE OF TWO CENTERS

Abstract BACKGROUND Adolescent and Young Adult Neuro-Oncology(AYA-NO) patients are a distinct cohort with an overlap of tumors found in childhood and adulthood. For adult patients with pediatric-type Central Nervous System tumors, optimal work-flow to manage these patients is unclear. METHODS We examine the work-flow of pediatric neuro-oncologists starting AYA-NO clinics within two high volume adult institutions: the University of Miami(Florida, USA) and the Princess Margaret Cancer Centre(Toronto, Canada). RESULTS Over 18 months, the AYA-NO clinics managed 167 patients total with several key differences emerging in both institutions between the pediatric and adult work-flows. Adult providers commonly have neurology backgrounds, while pediatric providers mostly have hematology/oncology backgrounds. In pediatrics, providers typically meet the patient inpatient before pathology results, adult providers meet their patients in outpatient settings once histopathology results are available. Outpatient management in pediatric oncology centers typically includes labs, infusion centers, provider rooms, and social workers in one area while adults, due to the larger volume, have these services on separate units. Chemotherapy related differences included the primary provider for inpatient admissions and the emphasis of adult institutions on outpatient administration when feasible. Psychosocial factors such as the variety of caregivers, increased opportunity for patient autonomy in decision-making, and the increased fragmentation in care magnifies the importance of providers forming a strong rapport with AYA-NO patients. End of life care is vastly different including the inability for adult patients to receive palliative treatment in hospice care and the availability medically-assisted death. CONCLUSION Pediatric neuro-oncologists building AYA-NO workflows within adult settings can provide unique expertise for AYA-NO patients with pediatric-type tumors. Growing AYA-NO clinics can benefit from allocating AYA CNS specific resources such as chemotherapy/targeted therapy provider education, a dedicated hospital/clinic space, chemotherapy nursing, a care coordinator, and a social worker with experience treating this patient population.

Evaluating Patient Rights and Agency: An In-depth Examination of Autonomous Decision-Making in AI-Powered Telemedicine

This study examines the adequacy of regulations concerning consent and patient autonomy in AI telemedicine in Ghana. Using the IRAC (Issue, Rule, Analysis, and Conclusion) method, the research analyzes existing Ghanaian healthcare laws and regulations in the context of AI-driven telemedicine. The study finds significant gaps in the current regulatory framework, including a lack of specific provisions for informed consent in AI telemedicine, unclear guidelines on maintaining patient autonomy, and inadequate addressing of liability issues in AI-assisted healthcare. Recommendations include developing specific AI healthcare legislation, updating existing laws to incorporate AI and telemedicine considerations, establishing AI ethics committees, and implementing short-term mitigation strategies such as interpretive guidelines and enhanced disclosure protocols. The study emphasizes the need for a two-pronged approach: long-term regulatory development and immediate implementation of interim measures to protect patient rights and ensure ethical use of AI in telemedicine.

Enhancing medical students’ understanding of end-of-life care ethics and law through video-triggered expert-led debriefing: a two-stage study

BackgroundTaiwan enacted the Hospice Palliative Care Act in 2000 and the Patient Autonomy Act in 2016. However, medical education has emphasized palliative care skills over ethical and legal integration. This study developed a curriculum for pre-clinical students, focusing on applying these issues in end of life care.MethodsThe participants were fourth-year medical students enrolled in a 1-credit medical ethics and law course at a medical school in Taiwan. The study employed a two-stage design, combining quantitative pretests and posttests with qualitative data obtained through the Know-Want-Learn strategy. The curriculum, called the video-triggered expert-led debrief module, included a video scenario on end of life care, insights shared by three interprofessional experts, and students debrief. In 2021, 168 students participated, and a quantitative questionnaire using a pretest-posttest design was applied to assess the curriculum’s impact on students’ knowledge and attitudes toward end of life care. In 2022, 157 students participated, and the survey used open-ended questionnaires (the Know-Want-Learn strategy) to evaluate what students already knew and what they wanted to know before the module, as well as what they had learned afterward.ResultsIn 2021, we collected 166 (98.8%) valid responses in the quantitative questionnaire. Seven of the eight knowledge-based questions and four of the seven learning motivation items showed significant improvement in the posttest (P < 0.05). In 2022, 81 (51.6%) valid responses were obtained from the qualitative questionnaire. Before the module, students’ understanding was superficial and focused on literal meanings. Three themes emerged in what they wanted to know: medical decision-making, ethics and laws, and empathetic communication, with eight subthemes. After the module, three themes and six subthemes were identified in the “what I learned” section. Students reported gaining knowledge related to ethics and laws, and empathetic communication.ConclusionsThe video-triggered expert-led debrief module can effectively teach the application of medical ethics and laws in end of life care. This approach has shown positive results among young medical students. It enhances students’ learning motivation, deepens their understanding of ethics and laws, and empathetic communication. It further encourages them to reflect deeply on the meaning of healthcare.

Autonomy, Violence, and Consent in the Obstetric Field

Abstract Obstetric violence is a structural form of gender, medical, and sexual violence perpetrated by health providers and institutions during pregnancy, birth, and postpartum. It can produce physical, psychological, and symbolic harm to pregnant/birthing people and their families. Obstetric violence results from structural conditions in the technocratic model of birth and the acceptance of biomedicine as the authoritative knowledge in health care. This phenomenon produces patients’ loss of autonomy and capacity to provide informed consent, which increases their vulnerability to unjustified medical procedures, resulting in negative birth experiences. In this paper, I argue that individual autonomy is necessary but not sufficient for legitimately consenting to obstetric care and preventing violence. The liberal framework of individual autonomy often ignores that childbirth is a social event where multiple individuals and cultural factors influence the consent process. Consequently, I discuss the role of relational autonomy in obstetric decision-making and describe some structural barriers that negatively intervene in this process. Finally, I propose that doulas and midwives can help nurture autonomy and caregiving skills in obstetric patients and health providers. This strategy protects the informed consent process, prevents obstetric violence, and can be effective in recentering childbirth in pregnant people and their families.

Nurses' Advocacy in Intensive Care: What Insights Can Nurses' Experiences During the Pandemic Reveal?

Patient advocacy must be understood as an ethical component of nursing practice that involves respecting and defending patients' rights and autonomy. During the COVID-19 pandemic, the vulnerability of patients in intensive care units (ICUs) increased requiring that nurses advocate for those patients more than ever in a context in which changes in daily nursing practices of care imposed by the pandemic deeply impacted nurses' advocacy. In this study, we examined ICU nurses' patient advocacy during the pandemic, using feminist ethics as a theoretical lens. Twenty-five ICU nurses from Brazil participated in individual interviews. Our findings reflect that advocacy is a moral component of nursing identity. This moral identity represents the identity of nurses as a profession as it represents their values and responsibilities which are social in nature. Although the pandemic challenged nurses' advocacy practices these professionals had an important role to give voice to patients and to preserve their autonomy and dignity, strengthening patient-centered care.

Parental Acceptance of Fetal Tissue Donation

Human fetal tissue is essential for biomedical research, providing unparalleled insights into human development and disease. To assess changes in parental decisions to donate fetal tissue following termination of pregnancy after the introduction of the Dutch Fetal Biobank (DFB) and to identify factors associated with consent to donate. This cohort study collected data from all individuals assigned female at birth (hereafter referred to as participants) who underwent a termination of pregnancy at the Amsterdam University Medical Center from January 1, 2008, to December 31, 2022. No exclusion criteria were applied. Introduction of the DFB on September 1, 2017, which offers the option to donate fetal tissue after pregnancy termination. Rates of fetal tissue donation before and after DFB introduction and associations between patient characteristics (maternal age, race and ethnicity, socioeconomic status, gestational age, and reason for termination) and consent to donation were assessed using multivariable binary logistic regression modeling. Of a total of 1272 participants (mean [SD] age, 33.0 [5.4] years), 576 (45.3%) were nulliparous. The mean (SD) gestational age at termination was 18 weeks 3 days (26 days), and reasons for termination were primarily because of structural defects (567 participants [44.6%]), with only a small portion (58 participants [4.6%]) terminating for social reasons (eg, unwanted or unplanned pregnancy). Fetal tissue donations increased from 1.2% (8 donations among 663 terminations) before the DFB introduction to 21.7% (132 donations among 609 terminations) after its introduction. This rise was primarily due to a shift from collective cremation to donation, while individual cremation or burial rates remained stable. The consent rate was 30.3% (132 of 436) for participants informed about the donation option. No significant demographic differences were found between participants who consented and those who did not, except for gestational age; consent rates decreased with advanced gestational age (odds ratio per week, 0.88; 95% CI, 0.83-0.94). Higher consent rates were observed for terminations due to social reasons (odds ratio, 3.56; 95% CI, 1.40-9.10). These findings suggest that a substantial proportion of individuals may be willing to donate fetal tissue for biomedical research after pregnancy termination. Integrating donation options in posttermination counseling respects patient autonomy and could ethically increase tissue availability for research. Expanding biobanks and fostering international collaboration is crucial for standardizing practices and ensuring equitable research benefits.

An Exploratory Study of Capacity Assessment in Medical Practice in Ireland.

The current legal test for capacity under the common law is a functional test. It determines whether a person can make a particular decision at a particular time; it focuses on retained abilities rather than on presumed deficits - in order to promote patient autonomy in decision-making. International evidence suggests however that the test is not well understood and consequently not being correctly applied in practice by a range of medical professionals. Donnelly has argued that gaining a better understanding of how capacity assessments are actually employed is essential to improving the quality of assessments. To date, there is little data on how doctors in particular make their assessments in practice. Using a socio-legal methodology, this quantitative study aims to assess understanding of capacity among a group of general practitioners/family medicine doctors in Ireland, and to determine how they assess capacity in clinical practice. Our study found that notwithstanding a lack of confidence in their ability to assess decision-making capacity, that respondents in fact demonstrated a high level of understanding and of ability to correctly apply the functional test in practice.

Póster n.° PO-R-09 admitido en los XV Encuentros Nacionales en Psiquiatría (Sevilla, 2024).

The evaluation of a possible inability to make decisions must be careful to respect the principle of patient autonomy and to preserve the ethical principle of non-maleficence. The presumption that the patient retains his de facto capacity must always prevail. The Aid to Capacity Evaluation is the most appropriate tool for assessment in Liaison Psychiatry.

Operationalizing shared decision making in clinical practice.

Shared decision-making (SDM) requires a clear-eyed view of evidence certainty, context, and equipoise in clinical care. This paradigm of care builds on the foundational ethical principle of patient autonomy, further leveraging beneficence, nonmaleficence, and justice to provide bespoke care in the appropriate clinical setting. When evidence is carefully evaluated together with acceptability and feasibility, equity, cost-effectiveness, resources, and patient preferences, an individualized assessment of the trade-off between possible benefits and harms can optimize patient management. In the setting of a conditional recommendation, it is appropriate to engage in SDM with patient partners, to the extent each patient is willing and able to engage in the SDM process. Three conversations inform SDM and include team talk, option talk, and decision talk with discussion of the plan of care. During these conversations, clear communication strategies that are specific, measurable, achievable, realistic, time sensitive, and provide assessment of absolute (not just relative) risk are important to provide necessary education to patient partners. Follow-up is key to ensure that decisions lead to effective treatment. Through this process, it is necessary to minimize cognitive overload and promote a minimally disruptive medicine approach. The acronym "HOW" promotes a holistic appraisal of evidence in context, open-minded teamwork with patients and families, and willingness to be a listening presence while serving as a partner and guide and appreciating the multidimensional and unique nature of each individual. SDM is and will continue to remain a cornerstone of appropriate medical care in settings of clinical equipoise.

Bioethical and Medical-Legal Challenges in Multimodal Cancer Treatment: Addressing Misinformation and Informal, Unregistered Advice

This article addresses the bioethical and medico-legal challenges in the multimodal treatment of cancer, emphasizing the growing gap between therapeutic advances and their clinical implementation. Many patients remain uninformed or lack access to advanced therapies, such as immunotherapy or targeted treatments, due to outdated practices in their healthcare centers. This situation often leads to frustration, as patients feel that not all potential treatment options have been explored. The right of patients to receive clear, informed, and transparent guidance on their treatment is highlighted, as well as the necessity for proper documentation of medical decisions to ensure traceability and protect both the patient and the medical professionals involved. The lack of information or bias directly impacts patient autonomy, limiting their ability to make well-founded decisions. The article also highlights the significant benefits of multimodal therapies, such as cytoreductive surgery and personalized immunotherapy, which have been shown to improve outcomes and quality of life in advanced cancer cases. It calls for treating physicians to act as guides or, when necessary, defer to specialized centers with proven expertise, thus avoiding limiting patients to conventional protocols. The need for a multidisciplinary approach is clear, with a committee of clinical oncologists, radiation-oncologists, surgical oncologists, and pathologists, alongside immuno- oncopathology specialists, being essential to the development of personalized, biologically driven therapies. Advances in cancer treatment confirm the importance of this integrated approach, particularly through collaboration between pathologists and clinical oncologists who have specialized in biotechnology and precision medicine.

Implementation of bedside handover that includes patients or carers in hospital settings: A systematic review.

Increasing complexity in healthcare systems necessitates effective handover. While a universal structure is often recommended, many frameworks do not include the patient. A systematic review was completed examining outcomes following handover that included patients or carers using a realist-orientated paradigm. The research group used Covidence™ software and followed PRISMA guidelines. A librarian-led search of Embase, Medline, PsycINFO and SCOPUS yielded 5,790 relevant studies for screening. Included studies reported on peer-reviewed studies that assessed qualitative or quantitative outcomes resulting from patient-centred handover. To assess quality, we used the McMaster Mixed Methods Appraisal Tool (MMAT). Patient-orientated and quantitative outcomes are reported descriptively. For qualitative outcomes, we employed a deductive analytical approach. Braun and Clarke's steps were followed to develop themes with group work used to clarify and discuss the various codes. Heterogenous reporting precluded meta-analysis. Thirty studies were eligible (10 mixed methods; 11 quantitative; 9 qualitative) with variable quality and scope. Most studies related to nursing-led bedside handover and originated in Anglophone countries. Positive effects were reported for patient satisfaction, engagement, autonomy and effective information exchange. Providers reported a positive experience but also barriers to implementation, cognitive load and reducing compliance over time. There were contradicting findings for patient-orientated outcomes including falls risk. Publication bias may have led to under reporting of negative trials. There was limited reporting on physician-led handovers that included patients. Patient-centred handover was associated with self-reported benefits for patients and providers but potential advantages over conventional handover could be undermined by barriers such as time, implementation challenges and a perceived increase in staff workload.

EUTANÁSIA: O ELO ENTRE UM FIM DE VIDA DIGNA E SUA RESTRIÇÃO LEGAL

This study analyzes the role of euthanasia as a way of guaranteeing a dignified end of life and the legal restrictions that this practice faces in Brazil. The central problem is to understand how legal restrictions on euthanasia impact the search for a dignified end of life and respect for the patient's autonomy? The general objective of this study is to analyze the relationship between the concept of euthanasia, the search for a dignified end of life and the legal restrictions imposed in different social, cultural and legal contexts. The choice of topic is part of the growing discussion about the right to choose for terminally ill patients in countries where euthanasia is legalized, contrasting with the Brazilian scenario, where the practice is criminalized. In this context, the tensions between the patient's autonomy, unbearable suffering and the value of life according to the national legal system will be addressed. The methodology used is qualitative and bibliographic in nature, with the analysis legislation, relevant judicial decisions, and the collection of data on the public and academic perception of euthanasia. Furthermore, legal doctrines dealing with bioethics and the right to life will be presented, with the aim of offering a critical reflection on the dilemmas involved in this debate.

Ethical Dilemmas in Home Palliative Care

Abstract Background In the past two decades, there has been a noticeable shift towards home-based care, reflecting the broader trend among OECD countries to prioritize a comprehensive approach to health and well-being. This approach emphasizes preventive and proactive measures, often relying on home-based care delivered by multidisciplinary teams providing both curative and palliative care. However, the unique nature of providing care in a home environment raises ethical questions among healthcare providers, necessitating high levels of attentiveness and sensitivity from the caregiving team to address them effectively. Research Objectives This study aims to identify ethical challenges encountered by a multidisciplinary team, as perceived by managers of an organization offering home palliative services in Israel. Methods A qualitative study was conducted, involving interviews with nine key managers to explore prevalent ethical issues in delivering home-based care. Findings Thematic analysis unveiled common ethical dilemmas in providing Home Palliative Care. These dilemmas include balancing patient preferences with professional obligations, addressing the needs of both patients and their families, navigating caregiver-patient relationships, understanding patients’ cultural backgrounds, and advocating for home care as the preferred option while considering alternative treatment approaches. Conclusions Home palliative care poses ethical dilemmas for caregiving teams. It’s imperative for organizations in the home care sector to devise strategies aimed at assisting teams in navigating these challenges while upholding the autonomy and dignity of patients within their home environment. Key messages • Home-based care faces ethical challenges, requiring strategies to balance patient preferences and professional duties. • Ethical home hospice care needs strategies that respect patient autonomy and dignity.