A qualitative study of the ethical issues encountered at end-of-life care at a university teaching hospital in Nigeria

BACKGROUND: End-of-life (EOL) care involves providing quality medical attention to the dying patient. It is fraught with some ethical challenges, often underexplored in African settings. This communication presents a qualitative analysis of ethical issues encountered by caregivers and their patients receiving EOL 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, Enugu State, Nigeria, were explored over 2 months. The participants' sociodemographic data were analysed using descriptive statistics, while qualitative data were analysed using a thematic framework. The transcripts were coded using NVivo V.12 software. RESULTS: All participant groups encountered commonly reported ethical challenges in 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 discuss 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 minimise these issues.