Nmezi J. (2026).
Cureus, 18(6), e111202.
Abstract
End-of-life care presents some of the most complex and emotionally challenging ethical dilemmas in modern medicine. For anesthetists and clinical psychologists, these dilemmas intersect at the critical juncture where physiological support meets psychological suffering. This editorial advances the novel argument that the psychological distress inherent to the dying process constitutes a specific clinical entity (existential suffering), which requires interdisciplinary management distinct from standard symptom control. It explores the major ethical challenges encountered in end-of-life care, including decisions about withholding and withdrawing life-sustaining treatment, do-not-resuscitate orders, medically administered nutrition and hydration, palliative sedation, and requests for assisted dying. The specific, practical roles of the anesthetist and clinical psychologist are detailed within a collaborative model, moving beyond generalities of "symptom management" and "grief support." Principles of biomedical ethics (autonomy, beneficence, non-maleficence, and justice) provide a framework for analyzing these dilemmas. Culturally specific decision-making frameworks for Nigerian and African contexts, including family-centric consensus models and communication scripts, are introduced. Practical recommendations are offered in the form of specific communication tools and assessment prompts for clinicians navigating these challenging situations and self-care to prevent moral distress and burnout.
Here are some thoughts:
This editorial argues that existential suffering in end-of-life care is a distinct clinical entity requiring interdisciplinary management beyond standard symptom control. It outlines specific roles for anesthetists (e.g., translating physiological decline, managing terminal weaning) and clinical psychologists (e.g., dignity therapy, screening for demoralization) within a collaborative tiered model. Using biomedical ethics principles (autonomy, beneficence, non-maleficence, justice), it analyzes dilemmas like withholding treatment, DNR orders, palliative sedation, and assisted dying. The piece introduces culturally specific frameworks for Nigerian/African contexts, including family-centric consensus models and communication scripts. Practical tools, communication scripts, and self-care strategies are offered to help clinicians navigate these challenges and prevent moral distress.
