A Qualitative Study of the Ethical Issues Encountered at End-of-life Care at a University Teaching Hospital in Nigeria

Abstract

Abstract Background End-of-life (EOL) care involves providing quality medical attention to the dying patient. It is fraught with some ethical challenges, often under-explored in African settings. This communication presents a qualitative analysis of ethical issues encountered by caregivers and their patients who are receiving end-of-life care in a teaching hospital in Nigeria. Methods Ethical issues in EOL care encountered by 40 people (dying patients, their families, nurses, and doctors) at the University of Nigeria Teaching Hospital, Enugu (UNTH-E) Enugu State, Nigeria was explored over two months. The Participants’ socio-demographic data was analyzed using descriptive statistics, while qualitative data was analyzed using a thematic framework. The coding of transcripts was done with NVivo 12 software. Results All participant groups encountered commonly reported ethical challenges in end-of-life (EOL) care, including issues of medical futility, treatment refusal, truthful disclosures, families requesting that a competent patient not be informed about their condition, confidentiality, limiting or withdrawing a treatment, limited or insufficient pain management, conflicting interests in care, an unfair financial burden without the patient consent, and an unfair burden on the healthcare system. Additionally, the uncommon issues included the patient’s unwillingness to discussions about their terminal status; families withdrawing due care and support prematurely, and delayed referrals. Conclusion Ethical issues are commonly encountered in caring for the patient at EOL in the Nigerian environment notwithstanding the paucity of literature on them. This underscores the importance of adopting known preventive measures to eliminate or minimize these issues.