What frameworks exist for addressing ethical dilemmas in end-of-life care within primary care settings?

Within primary care settings, ethical dilemmas in end-of-life care are addressed through structured frameworks centred on shared decision-making, advance care planning, and holistic needs assessment. Shared decision-making is a core framework where healthcare professionals establish the dying person's desired level of involvement and ensure honesty and transparency in care planning discussions, taking into account mental capacity, advance decisions, and cultural or spiritual preferences. Advance care planning is a voluntary, ongoing process involving discussions about future care preferences, values, and goals, enabling personalised care aligned with the person's wishes. Holistic needs assessment supports identifying all aspects of a person's wellbeing, including spiritual and social needs, to guide ethical care decisions. Additionally, identifying a named lead healthcare professional responsible for coordinating care and encouraging shared decision-making helps manage ethical complexities. When uncertainty or conflict arises, seeking advice from more experienced colleagues is recommended. These frameworks are supported by tools such as the Gold Standards Framework and SPICT to identify patients approaching end of life, facilitating timely ethical discussions and planning.

These approaches ensure that ethical dilemmas are navigated by respecting patient autonomy, promoting transparency, and involving multiprofessional teams and those important to the patient in decisions about care.

Key frameworks include:

• Shared decision-making with the dying person and those important to them, respecting mental capacity and preferences ¹.
• Advance care planning discussions to clarify future care wishes and values ².
• Holistic needs assessment to address comprehensive wellbeing and support ethical care ².
• Designation of a named lead healthcare professional to coordinate care and communication ¹.
• Use of validated tools (e.g., Gold Standards Framework, SPICT) to identify patients for timely ethical engagement ².
• Consultation with experienced colleagues when clinical uncertainty or ethical conflict arises ¹.