Honors Theses and Capstones

Date Completed

Spring 2026

Abstract

Hospice care is intended to prioritize comfort, dignity, symptom management, and quality of life for individuals with life-limiting illness. However, when hospice-eligible patients are managed within inpatient hospital settings, significant ethical challenges frequently emerge due to the tension between comfort-focused care and the curative, intervention-driven structure of acute care medicine. This paper presents a systematic literature review and thematic analysis examining the ethical considerations surrounding hospice patients in inpatient settings, with particular attention to clinical decision-making, communication, prognostic uncertainty, moral distress among nurses, and conflicts involving patient autonomy and family wishes. A structured review of peer-reviewed literature was conducted using PubMed, CINAHL, and Google Scholar, focusing on adult inpatient populations and ethical issues related to end-of-life care.

The findings revealed several recurring ethical themes. Conflicts between patient autonomy and the principles of beneficence and nonmaleficence frequently arose when aggressive life-sustaining interventions were pursued despite limited clinical benefit. Prognostic uncertainty and delayed hospice referral contributed to late transitions to comfort-focused care and increased exposure to burdensome treatments. Communication failures, including delayed goals-of-care discussions and inconsistent interdisciplinary messaging, were identified as central contributors to ethical conflict. The review also highlighted the prevalence of moral distress among nurses, particularly in critical care settings where providers often perceived treatments as prolonging suffering. Additionally, growing numbers of socially isolated and “unrepresented” patients lacking surrogate decision-makers or advance directives introduced further ethical and legal complexity into end-of-life decision-making.

The literature suggests that many ethical dilemmas in inpatient hospice care are not inevitable, but rather stem from delayed communication, inadequate advance care planning, and systemic hospital cultures that prioritize intervention over comfort-focused care. Implications for nursing practice include strengthening advocacy, improving communication competency, addressing moral distress, promoting early palliative care integration, and increasing nursing involvement in interdisciplinary ethical decision-making. Ultimately, improving ethical care for hospice patients in inpatient settings requires both individual and systemic transformation to better align hospital-based care with the principles of hospice and palliative medicine.

Document Type

Undergraduate Thesis

First Advisor

Alyssa O'Brien

College or School

CHHS

Department or Program

School of Nursing

Degree Name

Bachelor of Science

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