Ethical Challenges for healthcare providers in End-of-Life Decision-Making for Severe Head Injury patients

Abstract

Objectives:  This study aims to determine the ethical challenges healthcare providers encounter while making end-of-life decisions for patients with severe head injuries in a tertiary care hospital.

Materials & Methods:  A cross-sectional, questionnaire-based survey was conducted from Feb – May 2025, targeting neurosurgeons, ICU physicians, and nurses with a minimum of one year of experience. The structured tool examined frequency, types, and sources of ethical dilemmas, decision-making approaches, and institutional support. Statistical analysis was performed using SPSS version 26.

Results:  Of the 100 healthcare professionals surveyed, 78% frequently encountered ethical dilemmas, with resource limitations, familial pressure, and lack of institutional policy cited as the primary issues. A significant association was found between professional role and perceived institutional support (p<0.05), and a positive correlation between experience and confidence in decision-making (r=0.32).

Conclusion:  The findings highlight a lack of ethical preparedness and insufficient institutional support for end-of-life decision-making. Improving this area requires structured ethics training, the implementation of formal policies, and multidisciplinary collaboration that reflects the local sociocultural context.

Keywords:  End-of-life care, ethical challenges, severe head injury, healthcare providers, Pakistan.