Physician's ethical perspectives on research involving terminally ill patients in Nigeria: A qualitative study

Research involving terminally ill patients presents unique ethical challenges due to vulnerability, fluctuating consent capacity, and risk of undue influence. In Nigeria, cultural norms, religious beliefs, and family dynamics further shape ethical engagement, but empirical evidence regarding physicians' perspectives remains limited.

Exploring physicians' ethical perspectives regarding the involvement of terminally ill patients in research by focusing on consent practices, safeguards, and culturally sensitive approaches to participation.

A qualitative descriptive study was conducted at two tertiary hospitals in Enugu State, Nigeria. Twenty-four purposively selected physicians involved in oncology and palliative care participated in in-depth and key informant interviews. Data were analyzed thematically using Braun and Clarke's framework.

Four themes emerged: facilitators of consent, consent practices, preferred decision-makers, and ethical concerns. Physicians emphasized clear communication, empathy, and culturally sensitive support. Direct patient consent was prioritized, with surrogate consent and pediatric assent used when appropriate. Family involvement was central, although surrogate reliability required careful assessment. Ethical concerns focused on minimizing harm, ensuring equity, and integrating cultural and spiritual guidance.

In general, physicians in this study supported the ethical inclusion of terminally ill patients in research provided rigorous safeguards are applied. They operationalize autonomy, beneficence, and justice within a relational framework that integrates family and spiritual guidance. These findings highlight culturally sensitive consent practices and provide practical guidance for ethics committees, researchers, and educators when promoting the ethical participation of vulnerable patients.