Beyond treatment: Ethical decision-making and palliative care in critically ill patients with cancer

Over recent decades, advances in cancer diagnosis and treatment have improved survival and quality of life, leading to a growing number of cancer patients being admitted to Intensive Care Units (ICUs). In this setting, clinical decision-making is challenged by prognostic uncertainty, intensive technology use, and therapeutic interventions whose proportionality may be uncertain, generating relevant ethical conflicts in clinical practice. The application of bioethics to critical oncology provides a deliberative framework based on the principles of autonomy, beneficence, nonmaleficence, and justice, aimed at ensuring value-based, dignity-centered care. This review addresses three key decisions in managing critically ill oncology patients: ICU admission criteria, integration of palliative care, and definition of terminal illness, offering ethical tools to support prudent, proportionate, and humane decision-making.