Bioethical conflicts in end of life care

Abstract This integrative review of the literature aims to identify the main conflicts between patients in palliative care, family and healthcare team from the point of view of the principialist ethics. A search was performed on databases, generating a final sample of 12 publications that, after being evaluated by the content analysis technique, enabled the emergence of three thematic categories: professional conduct – respect for the patient’s autonomy and the principle of beneficence; bioethical principles in the context of end of life care; and bioethical dilemmas in this context. We concluded that autonomy and beneficence stand out in the palliative care, ratifying the idea that the patient is the main actor and needs a humanized and comprehensive health care. In addition, we found some weaknesses in the process of education and communication in the healthcare team, patient and family relationship.摘要 本整合性文献综述旨在从原则主义伦理学（principialist ethics）视角，识别姑息治疗（palliative care）场景中患者、家属与医疗团队之间的主要冲突。研究通过数据库检索最终纳入12篇文献样本，经内容分析法（content analysis technique）评估后，提炼出三大主题类别：其一为职业行为——尊重患者自主权（autonomy）与行善原则（beneficence）；其二为临终关怀（end of life care）场景下的生命伦理学原则；其三为该场景中的生命伦理困境。研究结论显示，自主权与行善原则在姑息治疗中占据突出地位，佐证了患者为医疗照护核心主体、需获得人性化且全方位医疗服务的观点。此外，本研究还发现医疗团队、患者与家属之间的教育与沟通流程存在若干不足。