Ethical principles and challenges in end-of-life care for frail older adults

Abstract

Providing end-of-life care to frail, older adults with multiple comorbidities can be ethically complex. As frailty differs from single terminal illness, end-of-life care requires a carefully considered, ethically informed approach. The four core ethical principles of autonomy, beneficence, nonmaleficence and justice need to be applied within this context; they involve challenges specific to frail patients, including fluctuating mental capacity, the risks of aggressive interventions and equitable access to resources. Key ethical issues include do not attempt cardiopulmonary resuscitation orders, confidentiality, mental capacity assessments and palliative sedation. Health professionals require a structured framework for decision-making. By balancing patient dignity, quality of life and legal considerations, practitioners can understand ethical obligations and practical decision-making strategies. For frail, older adults, a compassionate, patient-centred approach that prioritises comfort and dignity, especially as people approach the end of life, ensures care is provided in line with both ethical and legal standards.