Jenny Lindberg

Background Physician-assisted dying (PAD) remains prohibited in Sweden despite increasing public and professional support, and ongoing societal debate. Since medical students are future physicians, they constitute a relevant group for studying potential shifting attitudes to PAD. The present study examined Swedish medical students’ attitudes toward PAD, explored how ethical reasoning and individual characteristics relate to these attitudes, and assessed whether value-laden terminology influenced responses. Methods A cross-sectional mixed-methods study was conducted among medical students from all semesters and at all seven Swedish medical faculties (2024–2025). Two parallel questionnaires, differing only in terminology (“physician-assisted dying” [PAD] versus “physician-assisted suicide” [PAS]), were electronically distributed. Each defined the practice as a physician prescribing lethal medication for patient self-administration and presented a clinical vignette designed to reflect a typical case under the Oregon Death with Dignity Act, structured questions and free-text response fields. Quantitative data from the questionnaires were analysed using chi-square tests and qualitative data using thematic analysis. In total, 2,107 responses were included (response rate 23%). Results Overall, 57% of the participants supported legalisation of the specific form of PAD described in the vignette, 23% opposed it, and 20% were undecided; 53% reported willingness to personally assist if legal, while 68% opposed mandatory participation. No significant differences were observed between questionnaire versions. Prioritisation of autonomy was associated with support for PAD and willingness to assist, whereas prioritisation of non-maleficence and beneficence was associated with opposition or uncertainty (p

In health care, the provision of pertinent information to patients is not just a moral imperative but also a legal obligation, often articulated through the lens of obtaining informed consent. Codes of medical ethics and many national laws mandate the disclosure of basic information about diagnosis, prognosis, and treatment alternatives. However, within publicly funded health care systems, other kinds of information might also be important to patients, such as insights into the health care priorities that underlie treatment offers made. While conventional perspectives do not take this as an obligatory part of the information to be shared with patients, perhaps through viewing it as clinically “non-actionable,” we advocate for a paradigm shift. Our proposition diverges from the traditional emphasis on actionability. We contend that honoring patients as equal moral agents necessitates, among other principles, a commitment to honesty. Withholding specific categories of information pertinent to patients’ comprehension of their situation is inherently incompatible with this principle. In this article, we advocate for a recalibration of the burden of proof. Rather than requiring special justifications for adding to the standard set of information items, we suggest that physicians should be able to justify excluding relevant facts about the patient’s situation and the underlying considerations shaping health care professionals’ choices. This perspective prioritizes transparency and empowers patients with a comprehensive understanding, aligning with the ethos of respect for the patient as person.

The right of patients to decline information about their health, prognosis, and available treatment options is a salient principle in both domestic law and international declarations and conventions. This right may be considered either unnegotiable or subject to certain terms and conditions. While respecting this right may seem straightforward, doing so in clinical practice can be challenging. This article uses a realistic hypothetical scenario to examine the epistemic, moral, and practical challenges that can arise, particularly with patients nearing the end of life. These challenges include how and when to honor the right and its potential conflict with moral values such as self-determination, authenticity, and avoiding harm to oneself and others. The end of life exacerbates these issues because of the irretrievability of decisions and the successive reduction of possible courses of action, as well as potentially changing preferences. These potential conflicts of values deserve further attention and must be considered when deciding whether to honor a patient’s wish not to know.

The principle of self-determination plays a crucial role in contemporary clinical ethics. Somewhat simplified, it states that it is ultimately the patient who should decide whether or not to accept suggested treatment or care. Although the principle is much discussed in the academic literature, one important aspect has been neglected, namely the fact that real-world decision making is temporally extended, in the sense that it generally takes some time from the point at which the physician (or other health care professional) determines that there is a decision to be made and that the patient is capable of making it, to the point at which the patient is actually asked for his or her view. This article asks under what circumstances, if any, temporising—waiting to pose a certain treatment question to a patient judged to have decision-making capacity—is compatible with the principle of self-determination.

Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.