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Mapping ethical issues encompassing end-of-life care for persons experiencing severe and persistent mental illness: a
Loïc Moureau1, Monica Verhofstadt2, Caressa Van Hoe3
1Faculty of Theology and Religious Studies, KU Leuven, Sint-Michielsstraat 4 bus 3100, Leuven, Belgium. loic.moureau@kuleuven.be.
BMC Medical Ethics
|June 2, 2025
Summary
Ethical care for individuals with severe and persistent mental illness (SPMI) faces challenges. Findings highlight the need for accessible ethical support and tailored approaches to ensure dignity and respect for this vulnerable population.
Area of Science:
- Mental Health Care Ethics
- Vulnerable Populations Research
- Bioethics in Psychiatry
Background:
- Severe and persistent mental illness (SPMI) affects a small, vulnerable population with limited research and significant ethical care challenges.
- Ethical issues in SPMI care include illness severity, social isolation, communication barriers, impaired decision-making, and behavioral difficulties.
- Limited research exists on the ethical dimensions of caring for individuals with SPMI, particularly at the end of life.
Purpose of the Study:
- To explore ethical themes in the care of persons with SPMI, both generally and at end-of-life.
- To identify emerging ethical issues, how care teams manage dilemmas, decision-making involvement, and utilized ethical frameworks.
- To understand the practical application of ethical considerations in SPMI treatment.
Main Methods:
- Conducted 73 in-depth qualitative interviews with diverse stakeholders (care users, families, caregivers, managers, experts).
- Study focused on the Flemish region of Belgium.
- Employed content analysis to identify recurring themes and ethical practices in SPMI care.
Main Results:
- Many facilities have ethical guidelines, but frontline staff often find them inaccessible or unknown.
- Ethical dilemmas are primarily addressed at the team level, with some utilizing ethics reference persons or peer support.
- Key ethical issues identified include euthanasia, neglect, delayed palliative care, autonomy maintenance, and resource allocation.
Conclusions:
- Ethical care for SPMI requires focus on autonomy, collaboration, and resource distribution.
- Enhanced accessibility to ethical support systems and tailored approaches are crucial.
- Balancing recovery-oriented and palliative care is essential for ensuring dignity and respect for individuals with SPMI.
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