Rethinking end-of-life preferences: beyond universal values in palliative care

Dear Editor,

We read with enthusiasm the latest article by Mroz et al., ¹ entitled “What Do Physicians Want at the end? An international qualitative study on physicians’ personal end-of-life preferences and what influences them.” This timely study makes an essential contribution by examining how personal experiences, cultural contexts, and legislative frameworks influence physicians’ end-of-life (EOL) preferences. The cross-national qualitative approach and the reflective methodology employed by the authors provide much-needed deep insights into the complex decision-making processes of physicians in Belgium, Italy, and the United States.

The study convincingly demonstrates that many doctors, particularly those working in palliative care, generally prefer nonaggressive interventions at the EOL. They place greater value on comfort, dignity, and the meaningful presence of loved ones in the final days of life.^1,2 Interestingly, the article also highlights how doctors’ personal and professional experiences in dealing with challenging clinical cases and losing loved ones significantly shape their EOL preferences. Additionally, these findings underscore the importance of social, cultural, religious, and legislative contexts in determining doctors’ preferences, and how they provide care to patients. ³

Although its contribution is significant, the article’s conclusion leans toward a universal tendency in EOL values such as dignity and comfort while acknowledging notable variations in attitudes toward issues like assisted dying based on cultural, legal, and religious factors. The tension between universal values and cultural or legislative environmental specifics remains significant. In many regions of Asia, Africa, or the Middle East, religious beliefs and family obligations are often prioritized over individual autonomy, leading to very different understandings of the meaning of a “good death.” ⁴ Expanding the scope of future research to more diverse cultural environments is crucial to avoid overly Western-centric interpretations of EOL ideals. ⁵

Additionally, while the authors accurately describe how clinical experience influences doctors’ personal preferences, exploring how doctors navigate potential conflicts between their personal EOL preferences and professional obligations when guiding patients is essential. ⁶ More in-depth qualitative research on how doctors navigate the boundaries between individual values and clinical recommendations, particularly in complex ethical situations, will provide crucial insights for medical policy and education. ⁷

In conclusion, Mroz et al.’s work has advanced our understanding of how doctors reflect on their mortality and EOL care preferences. I encourage further exploration of the influence of underrepresented cultural, spiritual, and legal contexts on the perspectives of both healthcare providers and patients. Ultimately, fostering open dialogue and ongoing reflection within the medical community will be crucial for developing truly patient-centered and globally relevant palliative care services.