“Fatigue of living”, or existential fatigue, is a multidimensional phenomenon that transcends simple physical or mental weariness. It is characterized by a profound loss of meaning, an alteration of engagement in life, and poses major ethical, philosophical, and psychosocial challenges. This article analyzes this concept by exploring its psychological, social, and medical dimensions. It examines the crucial questions raised by fatigue of living, particularly with regard to the right to individual autonomy in the face of suffering, the limits of medical intervention, and the definition of a dignified life. Particular attention is paid to debates on medical assistance in dying, where fatigue of living is sometimes invoked as a reason, creating tension between respect for autonomy and the protection of vulnerable individuals. The analysis incorporates philosophical perspectives, such as existentialism and Buddhism, as well as innovative clinical approaches such as positive existential psychology and “philosophical health”. Finally, the article highlights the importance of a holistic and culturally sensitive approach, particularly in African contexts where notions of relational autonomy and community (Ubuntu) redefine the ethical frameworks for end-of-life decision-making.
KeywordsFatigue of LivingEthicsAutonomyEnd of LifeMedical Assistance in Dying
Ajluni, V. (2023). Respecting Autonomy: Prioritizing Patient-Centered Care and Decision-Making Capacity for Stronger Doctor-Patient Relationships. Journal of Family Medicine and Primary Care, 12, 1752-1753. https://doi.org/10.4103/jfmpc.jfmpc_712_23
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical Considerations at the End-Of-Life Care. SAGE Open Medicine, 9, 1-9. https://doi.org/10.1177/20503121211000918
Akpa-Inyang, F., & Chima, S. C. (2021). South African Traditional Values and Beliefs Regarding Informed Consent and Limitations of the Principle of Respect for Autonomy in African Communities: A Cross-Cultural Qualitative Study. BMC Medical Ethics, 22, Article No. 111. https://doi.org/10.1186/s12910-021-00678-4
Alanazi, M. A., Shaban, M. M., Ramadan, O. M. E., Zaky, M. E., Mohammed, H. H., Amer, F. G. M. et al. (2024). Navigating End-Of-Life Decision-Making in Nursing: A Systematic Review of Ethical Challenges and Palliative Care Practices. BMC Nursing, 23, Article No. 467. https://doi.org/10.1186/s12912-024-02087-5
Alfahmi, M. Z. (2022). Patients’ Preference Approach to Overcome the Moral Implications of Family-Centred Decisions in Saudi Medical Settings. BMC Medical Ethics, 23, Article No. 128. https://doi.org/10.1186/s12910-022-00868-8
Allen, F. (2002). Where Are the Women in End-Of-Life Research? Behaviour Change, 19, 39-51. https://doi.org/10.1375/bech.19.1.39
Alodhialah, A. M., Almutairi, A. A., & Almutairi, M. (2024). Ethical and Legal Challenges in Caring for Older Adults with Multimorbidities: Best Practices for Nurses. Healthcare, 12, Article 1585. https://doi.org/10.3390/healthcare12161585
Alolod, G. P., Litsas, D. C., & Siminoff, L. A. (2024). Reconsidering Autonomy: Asian Americans’ Use of Relational Autonomy in Organ Donation Decisions. https://doi.org/10.21203/rs.3.rs-5110495/v1
Alshehri, H., Alturkestani, R., Hijan, B., Almalki, S., Alobaidi, R., Almufti, S. et al. (2024). The Prevalence of Existential Anxiety and Its Association with Depression, General Anxiety, and Stress in Saudi University Students. Middle East Current Psychiatry, 31, Article No. 47. https://doi.org/10.1186/s43045-024-00435-4
Altaf, R., & Dodamani, S. (2024). The Multifaceted Impact of Financial Stress on Physio-logical, Psychological Well-Being, and Success: A Comprehensive Review and Strategic Interventions. https://doi.org/10.20944/preprints202411.1862.v1
Alves, R. M. d. S., & Ribeiro, R. C. (2023). Intensive Care and the Different Meanings of Vulnerability. Critical Care Science, 35, 102-106. https://doi.org/10.5935/2965-2774.20230317-en
Amani, C. (2024). The Impact of Existentialism on Contemporary Mental Health Practices. International Journal of Philosophy, 3, 14-27. https://doi.org/10.47941/ijp.2088
Amathabhani, B., & Dissanayake, N. (2024). Existential Buddhism: Embracing Life’s Uncertainties and Finding Meaning Within. South Florida Journal of Development, 5, e4540. https://doi.org/10.46932/sfjdv5n10-042
Appel, J. M. (2024). Legal and Ethics Considerations in Capacity Evaluation for Medical Aid in Dying. Journal of the American Academy of Psychiatry and the Law , 52 , 311-326.
Appiah, R., Raviola, G., & Weobong, B. (2024). Balancing Ethics and Culture: A Scoping Review of Ethico-Cultural and Implementation Challenges of the Individual-Based Consent Model in African Research. Journal of Empirical Research on Human Research Ethics, 19, 143-172. https://doi.org/10.1177/15562646241237669
Arredondo, A. Y., & Caparrós, B. (2023). Positive Facets of Suffering, Meaningful Moments, and Meaning Fulfilment: A Qualitative Approach to Positive Existential Issues in Trauma-Exposed University Students. Psychological Studies, 68, 13-23. https://doi.org/10.1007/s12646-022-00698-z
Arshad, W., Dehkhoda, A., Carey, M., Menkes, D. B., Hoeh, N., Sundram, F., Frey, R., & Cheung, G. (2025). The First Year of Assisted Dying in New Zealand through the Lens of Healthcare Professionals Not Directly Involved in the Process. BMC Palliative Care , 24, Article No. 194. https://doi.org/10.1186/s12904-025-01838-8
Barazzetti, G., Borreani, C., Miccinesi, G., & Toscani, F. (2010). What “Best Practice” Could Be in Palliative Care: An Analysis of Statements on Practice and Ethics Expressed by the Main Health Organizations. BMC Palliative Care, 9, Article No. 1. https://doi.org/10.1186/1472-684x-9-1
Baylet, R. (2012). Anthropology and healing practices in West Africa. Montpellier Academy of Sciences and Letters.
Beek, K. V., Woitha, K., Ahmed, N., Menten, J., Jaspers, B., Engels, Y. et al. (2013). Comparison of Legislation, Regulations and National Health Strategies for Palliative Care in Seven European Countries (Results from the Europall Research Group): A Descriptive Study. BMC Health Services Research, 13, Article No. 275. https://doi.org/10.1186/1472-6963-13-275
Behrens, K. G. (2017). A Critique of the Principle of ‘Respect for Autonomy’, Grounded in African Thought. Developing World Bioethics, 18, 126-134. https://doi.org/10.1111/dewb.12145
Berens, N., & Kim, S. Y. (2022). Rapid-Response Treatments for Depression and Requests for Physician-Assisted Death: An Ethical Analysis. The American Journal of Geriatric Psychiatry, 30, 1255-1262. https://doi.org/10.1016/j.jagp.2022.07.003
Berestova, A. V., Gorenkov, R. V., Orlov, S., & Starostin, V. P. (2019). Ethics in Medical Decision Making: An Intercultural Outlook. Utopía y Praxis Latinoamericana: Revista Internacional de Filosofía Iberoamericana y Teoría Social, 24, 144-151. https://dialnet.unirioja.es/descarga/articulo/7531733.pdf
Bergström, T. (2023). From Treatment of Mental Disorders to the Treatment of Difficult Life Situations: A Hypothesis and Rationale. Medical Hypotheses, 176, Article ID: 111099. https://doi.org/10.1016/j.mehy.2023.111099
Berna, F., Mandhouj, O., & Huguelet, P. (2015). Les éléments psychologiques du rétablissement dans les troubles mentaux sévères: Identité, spiritualité et sens. European Psychiatry, 30, S26-S26. https://doi.org/10.1016/j.eurpsy.2015.09.079
Bertaud, S., Wilkinson, D., & Kelley, M. (2025). The Heart of Palliative Care Is Relational: A Scoping Review of the Ethics of Care in Palliative Medicine. BMC Palliative Care, 24, Article No. 150. https://doi.org/10.1186/s12904-025-01784-5
Binder, P. (2022). Suffering a Healthy Life—On the Existential Dimension of Health. Frontiers in Psychology, 13, Article 803792. https://doi.org/10.3389/fpsyg.2022.803792
Bofarull, M., Esquerda, M., Lorenzo, D., Torralba, F., Cusi, V., Suffo, J. A. et al. (2024). Life Fatigue: A Critical Analysis. The American Journal of Geriatric Psychiatry, 33, 200-208. https://doi.org/10.1016/j.jagp.2024.08.002
Boldt, J. (2019). The Concept of Vulnerability in Medical Ethics and Philosophy. Philosophy, Ethics, and Humanities in Medicine, 14, Article No. 6. https://doi.org/10.1186/s13010-019-0075-6
Borges, P. J., Hernández-Marrero, P., & Martins Pereira, S. (2024). A Bioethical Perspective on the Meanings behind a Wish to Hasten Death: A Meta-Ethnographic Review. BMC Medical Ethics, 25, Article No. 23. https://doi.org/10.1186/s12910-024-01018-y
Brock, D. W., Park, J. K., & Wendler, D. (2014). Making Treatment Decisions for Oneself: Weighing the Value . Hastings Center Report, 44, 22-25. https://doi.org/10.1002/hast.284
Budd, M. A., & Mlinac, M. E. (2025). Overview of Practical Applications of Healthcare Ethics for Older Adults. OBM Geriatrics, 9, 1-26. https://doi.org/10.21926/obm.geriatr.2502314
Carrese, J. A. (2006). Refusal of Care: Patients’ Well-Being and Physicians’ Ethical Obligations. JAMA, 296, 691-695. https://doi.org/10.1001/jama.296.6.691
Chen, L. H., Law, W., Chang, D. H. F., & Sun, D. (2023). Editorial: The Bio-Psycho-Social Approach to Understanding Mental Disorders. Frontiers in Psychology, 14, Article 1225433. https://doi.org/10.3389/fpsyg.2023.1225433
Chen, L., & Ren, M. (2024). Is It Really Better to “Die” than “Live”? Reflections on the Practice of “Death with Dignity” in China. Frontiers in Public Health, 12, Article 1426257. https://doi.org/10.3389/fpubh.2024.1426257
Chhajer, R., Chaudhry, S., & Mishra, A. (2024). Combating the Mental Health Challenge of Loneliness among Urban Youth: Could Finding Meaning in Life and Experiencing Thriving Enhance Their Well-Being? BMC Public Health, 24, Article No. 3586. https://doi.org/10.1186/s12889-024-21185-2
Chigangaidze, R. K., Matanga, A. A., & Katsuro, T. R. (2021). Ubuntu Philosophy as a Humanistic-Existential Framework for the Fight against the COVID-19 Pandemic. Journal of Humanistic Psychology, 62, 319-333. https://doi.org/10.1177/00221678211044554
Costanza, A., Chytas, V., Piguet, V., Luthy, C., Mazzola, V., Bondolfi, G. et al. (2021). Meaning in Life among Patients with Chronic Pain and Suicidal Ideation: Mixed Methods Study. JMIR Formative Research, 5, e29365. https://doi.org/10.2196/29365
Cucchi, A., & Qoronfleh, M. W. (2025). Cultural Perspective on Religion, Spirituality and Mental Health. Frontiers in Psychology, 16, Article 1568861. https://doi.org/10.3389/fpsyg.2025.1568861
Cueto de Souza, R., & Scott, C. (2022). From Mental Health Crisis to Existential Human Suffering: The Role of Self-Transcendence in Contemporary Mindfulness. Religions, 13, Article 681. https://doi.org/10.3390/rel13080681
de Miranda, L., & Loughlin, M. (2023). Philosophical Health: Unveiling the Patient’s Personal Philosophy with a Person-Centred Method of Dialogue. Journal of Evaluation in Clinical Practice, 29, 1161-1170. https://doi.org/10.1111/jep.13871
de Vries, M. L. D., Janse, P., Anbeek, C. W., & Braam, A. W. (2025). Existential Concerns among Young Adults with Psychotic Vulnerability in Mental Health Care: A Qualitative Study in the Netherlands. BMC Psychiatry, 25, Article No. 103. https://doi.org/10.1186/s12888-025-06551-7
Delgado Rodriguez, J. (2017). The Relevance of the Ethics of Vulnerability in Bioethics. Les ateliers de l ’ éthique , 12, 154-179. https://doi.org/10.7202/1051280ar
Dove, E. S., Kelly, S. E., Lucivero, F., Machirori, M., Dheensa, S., & Prainsack, B. (2017). Beyond Individualism: Is There a Place for Relational Autonomy in Clinical Practice and Research? Clinical Ethics, 12, 150-165. https://doi.org/10.1177/1477750917704156
Dysvik, E., & Furnes, B. (2018). Living a Meaningful Life with Chronic Pain—Further Follow‐up. Clinical Case Reports, 6, 896-900. https://doi.org/10.1002/ccr3.1487
Eisenbeck, N., Carreno, D. F., & Pérez-Escobar, J. A. (2021). Meaning-Centered Coping in the Era of COVID-19: Direct and Moderating Effects on Depression, Anxiety, and Stress. Frontiers in Psychology, 12, Article 648383. https://doi.org/10.3389/fpsyg.2021.648383
El Khoury-Malhame, M., Bou Malhab, S., Chaaya, R., Sfeir, M., & El Khoury, S. (2024). Coping during Socio-Political Uncertainty. Frontiers in Psychiatry, 14, Article 1267603. https://doi.org/10.3389/fpsyt.2023.1267603
Elina, H., Sofia, E., Tricia, C. S., Jaana-Maija, K., Katariina, K., & Anu, S. (2022). Patients Receiving Palliative Care and Their Experiences of Encounters with Healthcare Professionals. OMEGA — Journal of Death and Dying, 89, 497-513. https://doi.org/10.1177/00302228221077486
Elsner, A. M., & Rampton, V. (2022). “Accompanied Only by My Thoughts”: A Kantian Perspective on Autonomy at the End of Life. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 47, 688-700. https://doi.org/10.1093/jmp/jhac026
Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010). Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships. Journal of General Internal Medicine, 25, 741-745. https://doi.org/10.1007/s11606-010-1292-2
Finlayson, C. (2013). Review: Reflections on Access: Too Vulnerable to Research? Journal of Research in Nursing, 20, 38-38. https://doi.org/10.1177/1744987113499519
Gandhi, A. (2020). Euthanasia: A Study into the Ethical and Legal Dimensions . Zenodo (CERN European Organization for Nuclear Research).
Ge, B. H., & Yang, F. (2023). Transcending the Self to Transcend Suffering. Frontiers in Psychology, 14, Article 1113965. https://doi.org/10.3389/fpsyg.2023.1113965
Gedge, E., Giacomini, M., & Cook, D. (2007). Withholding and Withdrawing Life Support in Critical Care Settings: Ethical Issues Concerning Consent. Journal of Medical Ethics, 33, 215-218. https://doi.org/10.1136/jme.2006.017038
Gilbar, R., & Miola, J. (2014). One Size Fits All? On Patient Autonomy, Medical Decision-Making, and the Impact of Culture. Medical Law Review, 23, 375-399. https://doi.org/10.1093/medlaw/fwu032
Gjengedal, E., Ekra, E. M., Hol, H., Kjelsvik, M., Lykkeslet, E., Michaelsen, R. et al. (2013). Vulnerability in Health Care—Reflections on Encounters in Every Day Practice. Nursing Philosophy, 14, 127-138. https://doi.org/10.1111/j.1466-769x.2012.00558.x
Gómez-Vírseda, C., de Maeseneer, Y., & Gastmans, C. (2020). Relational Autonomy in End-Of-Life Care Ethics: A Contextualized Approach to Real-Life Complexities. BMC Medical Ethics, 21, Article No. 50. https://doi.org/10.1186/s12910-020-00495-1
Graffigna, G., Vegni, E., Barello, S., Olson, K., & Bosio, C. A. (2011). Studying the Social Construction of Cancer-Related Fatigue Experience: The Heuristic Value of Ethnoscience. Patient Education and Counseling, 82, 402-409. https://doi.org/10.1016/j.pec.2010.12.017
Hall, M. E. L., Langer, R., & Mcmartin, J. (2010). The Role of Suffering in Human Flourishing: Contributions from Positive Psychology, Theology, and Philosophy. Journal of Psychology and Theology, 38, 111-121. https://doi.org/10.1177/009164711003800204
Hell, D. (2015). Fatigue et dépression. Revue Médicale Suisse, 11, 918-921. https://doi.org/10.53738/REVMED.2015.11.471.0918
Ho, A. (2008). Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-Making. Scandinavian Journal of Caring Sciences, 22, 128-135. https://doi.org/10.1111/j.1471-6712.2007.00561.x
Hofmann, B. (2024). Moral Obligations Towards Human Persons’ Wellbeing versus Their Suffering: An Analysis of Perspectives of Moral Philosophy. Health Policy, 142, Article ID: 105031. https://doi.org/10.1016/j.healthpol.2024.105031
Houska, A., & Loučka, M. (2019). Patients’ Autonomy at the End of Life: A Critical Review. Journal of Pain and Symptom Management, 57, 835-845. https://doi.org/10.1016/j.jpainsymman.2018.12.339
Ibrahim, A. M., Zaghamir, D. E. F., Ramadan Abdel-Aziz, H., Elalem, O. M., Al-yafeai, T. M., Sultan, H. M. S. et al. (2024). Ethical Issues in Palliative Care: Nursing and Quality of Life. BMC Nursing, 23, Article No. 854. https://doi.org/10.1186/s12912-024-02530-7
Ikuenobe, P. (2015). Relational Autonomy, Personhood, and African Traditions. Philosophy East and West, 65, 1005-1029. https://doi.org/10.1353/pew.2015.0101
Jason, L. A., Evans, M., Brown, M., & Porter, N. (2010). What Is Fatigue? Pathological and Nonpathological Fatigue. PM&R, 2, 327-331. https://doi.org/10.1016/j.pmrj.2010.03.028
Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A Contextually Enlightened Analysis of Three Cases. Developing World Bioethics, 22, 112-122. https://doi.org/10.1111/dewb.12324
Jöbges, S., Kumpf, O., Hartog, C. S., Spies, C., Haase, U., Balzer, F. et al. (2022). Presentation of Ethical Criteria during Medical Decision-Making for Critically Ill Patients: A Mixed Methods Study. BJA Open, 2, Article ID: 100015. https://doi.org/10.1016/j.bjao.2022.100015
Jung, J., Mukherjee, K., Brown, M., & Sadigh, G. (2024). Association between Financial Hardship and Psychological Burden and the Role of Social and Mental Health Support: An Observational Study. Medicine, 103, e38871. https://doi.org/10.1097/md.0000000000038871
Kaftański, W., & Hanson, J. (2022). Suffering, Authenticity, and Meaning in Life: Toward an Integrated Conceptualization of Well-Being. Frontiers in Psychology, 13, Article 1079032. https://doi.org/10.3389/fpsyg.2022.1079032
Kałwak, W., Weziak-Bialowolska, D., Wendołowska, A., Bonarska, K., Sitnik-Warchulska, K., Bańbura, A. et al. (2024). Young Adults from Disadvantaged Groups Experience More Stress and Deterioration in Mental Health Associated with Polycrisis. Scientific Reports, 14, Article No. 8757. https://doi.org/10.1038/s41598-024-59325-8
Kapp, M. (2015). Evaluating Decision Making Capacity in Older Individuals: Does the Law Give a Clue? Laws, 4, 164-172. https://doi.org/10.3390/laws4020164
Karnik, S., & Kanekar, A. (2016). Ethical Issues Surrounding End-Of-Life Care: A Narrative Review. Healthcare, 4, Article 24. https://doi.org/10.3390/healthcare4020024
Kedzierska Manzon, A. (2022). Retour Aux Sources? Nouvelles formes de ritualisation et d’expertise rituelle en Afrique et ailleurs. École pratique des hautes études. Section des sciences religieuses, 129, 1-6. https://doi.org/10.4000/asr.3973
Kieselbach, K., Koesling, D., Wabel, T., Frede, U., & Bozzaro, C. (2022). Chronischer Schmerz als existenzielle Herausforderung. Der Schmerz, 37, 116-122. https://doi.org/10.1007/s00482-022-00632-2
Kirshbaum, M. N., Olson, K., Pongthavornkamol, K., & Graffigna, G. (2012). Understanding the Meaning of Fatigue at the End of Life: An Ethnoscience Approach. European Journal of Oncology Nursing, 17, 146-153. https://doi.org/10.1016/j.ejon.2012.04.007
Koslander, T., da Silva, A. B., & Roxberg, Å. (2009). Existential and Spiritual Needs in Mental Health Care. Journal of Holistic Nursing, 27, 34-42. https://doi.org/10.1177/0898010108323302
Koulayan, N. (2008). Mondialisation et dialogue des cultures: L’Ubuntu d’Afrique du Sud. Hermès, 51, 183-187. https://doi.org/10.4267/2042/24195
Kring, L., Iversen, E., Ibsen, B., & Fehsenfeld, M. (2024). Exploring the Impact of Stressful Life Events on Quality of Life: Meaning Making and Narrative Reconstruction. International Journal of Qualitative Studies on Health and Well-Being, 19, Article ID: 2330117. https://doi.org/10.1080/17482631.2024.2330117
Kurkowski, S., Heckel, M., Pfaller, L., Peters, J., Bazata, J., Schildmann, E. et al. (2022). Possible Age-Related Differences in Healthcare Professionals’ Perspectives on Younger and Older Patients’ Autonomy and Decision-Making in the Context of Sedation in Specialised Palliative Care: Exploratory Secondary Qualitative Content and Linguistic Conversation Analysis of Interviews with Healthcare Professionals. BMC Palliative Care, 21, Article No. 71. https://doi.org/10.1186/s12904-022-00963-y
Le Breton, D. (2021). De la souffrance d’existence à celle du corps. Douleurs : Évaluation — Diagnostic — Traitement , 22, 140-147. https://doi.org/10.1016/j.douler.2021.04.003
Leshchenko, A., Lauta, O., Shaulska, H., Yarovyi, A., & Makarov, Z. (2023). Existential Aspects of Human Existence and the Human-Centered Paradigm in Public Administration. Revista Amazonia Investiga , 12, 361-367. https://doi.org/10.34069/ai/2023.64.04.38
Lewis, J. (2021). Safeguarding Vulnerable Autonomy? Situational Vulnerability, the Inherent Jurisdiction, and Insights from Feminist Philosophy. Medical Law Review, 29, 306-336. https://doi.org/10.1093/medlaw/fwab010
Lima, D., Alves, V. L., & Turato, E. (2014). The Phenomenological-Existential Comprehension of Chronic Pain: Going Beyond the Standing Healthcare Models. Philosophy, Ethics, and Humanities in Medicine, 9, Article No. 2. https://doi.org/10.1186/1747-5341-9-2
Liu, C. T. X., Menzies, R. E., & Menzies, R. G. (2023). A Systematic Review of Existential Concerns in Borderline Personality Disorder. Journal of Humanistic Psychology . https://doi.org/10.1177/00221678231165792
Lloyd, C. S., Af Klinteberg, B., & DeMarinis, V. (2017). An Assessment of Existential Worldview Function among Young Women at Risk for Depression and Anxiety—A Multi-Method Study. Archive for the Psychology of Religion, 39, 165-203. https://doi.org/10.1163/15736121-12341337
López-Soto, P., & Santos, M. J. (2023). El problema de la autonomía individual y la autoridad familiar en la toma de decisiones en ética clínica. Medicina y Ética , 34, 585-648. https://doi.org/10.36105/mye.2023v34n3.01
Lorenzl, S. (2013). End of One’s Life—Decision Making between Autonomy and Uncertainty. Geriatric Mental Health Care, 1, 63-66. https://doi.org/10.1016/j.gmhc.2013.04.009
Loriol, M. (2017). A Sociological Stance on Fatigue and Tiredness: Social Inequalities, Norms and Representations. Neurophysiologie Clinique/Clinical Neurophysiology, 47, 87-94. https://doi.org/10.1016/j.neucli.2016.12.001
Lundvall, M., Palmér, L., Hörberg, U., Carlsson, G., & Lindberg, E. (2022). Finding an Existential Place to Rest: Enabling Well-Being in Young Adults. International Journal of Qualitative Studies on Health and Well-being, 17, Article ID: 2109812. https://doi.org/10.1080/17482631.2022.2109812
Mackay, K. (2017). Choosing to Live with Harm? A Presentation of Two Case Studies to Explore the Perspective of Those Who Experienced Adult Safeguarding Interventions. Ethics and Social Welfare, 11, 33-46. https://doi.org/10.1080/17496535.2017.1280069
Mackenzie, C., & Rogers, W. (2013). Autonomy, Vulnerability and Capacity: A Philosophical Appraisal of the Mental Capacity Act. International Journal of Law in Context, 9, 37-52. https://doi.org/10.1017/s174455231200047x
Magomedova, A., & Fatima, G. (2025). Mental Health and Well-Being in the Modern Era: A Comprehensive Review of Challenges and Interventions. Cureus, 17 , e77683. https://doi.org/10.7759/cureus.77683
Mapes, M. V., DePergola, P. A., & McGee, W. T. (2019). Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill. Journal of Intensive Care Medicine, 35, 1352-1355. https://doi.org/10.1177/0885066619870458
Marimuthu, P. (2024). Exploring Unconventional Approaches to Morality: An Existentialist Framework. Social Science and Humanities Journal, 8, 4498-4507. https://doi.org/10.18535/sshj.v8i07.1028
Marnfeldt, K., & Wilber, K. (2025). The Safety-Autonomy Grid: A Flexible Framework for Navigating Protection and Independence for Older Adults. The Gerontologist, 65, gnaf111. https://doi.org/10.1093/geront/gnaf111
McDougall, R., Pratt, B., & Sellars, M. (2023). Ethical Diversity and Practical Uncertainty: A Qualitative Interview Study of Clinicians’ Experiences in the Implementation Period Prior to Voluntary Assisted Dying Becoming Available in Their Hospital in Victoria, Australia. Journal of Bioethical Inquiry, 20, 71-88. https://doi.org/10.1007/s11673-022-10224-5
Mennella, C., Maniscalco, U., De Pietro, G., & Esposito, M. (2024). Ethical and Regulatory Challenges of AI Technologies in Healthcare: A Narrative Review. Heliyon , 10, e26297. https://doi.org/10.1016/j.heliyon.2024.e26297
Menon, S., Entwistle, V. A., Campbell, A. V., & van Delden, J. J. M. (2020). Some Unresolved Ethical Challenges in Healthcare Decision-Making: Navigating Family Involvement. Asian Bioethics Review, 12, 27-36. https://doi.org/10.1007/s41649-020-00111-9
Metz, T. (2009). African and Western Moral Theories in a Bioethical Context. Developing World Bioethics, 10, 49-58. https://doi.org/10.1111/j.1471-8847.2009.00273.x
Metz, T. (2011). Ubuntu as a Moral Theory and Human Rights in South Africa. African Human Rights Law Journal, 11, 532-559.
Miller, F. G., & Fletcher, J. C. (1993). The Case for Legalized Euthanasia. Perspectives in Biology and Medicine, 36, 159-176. https://doi.org/10.1353/pbm.1993.0079
Morberg Jämterud, S. (2022). Acknowledging Vulnerability in Ethics of Palliative Care—A Feminist Ethics Approach. Nursing Ethics, 29, 952-961. https://doi.org/10.1177/09697330211072361
Muñoz Terrón, J. M. (2021). Vulnerable Dignity, Dignified Vulnerability: Intertwining of Ethical Principles in End-Of-Life Care. International Journal of Environmental Research and Public Health, 18, Article 482. https://doi.org/10.3390/ijerph18020482
Nasir, A., Javed, U., Hagan, K., Chang, R., Kundi, H., Amin, Z. et al. (2025). Social Determinants of Financial Stress and Association with Psychological Distress among Young Adults 18-26 Years in the United States. Frontiers in Public Health, 12, Article 1485513. https://doi.org/10.3389/fpubh.2024.1485513
Nel, K. A., & Govender, S. (2022). Existential Positive Psychology (EPP): A Positive Tool for Healing Existential Anxieties in South Africa During, and After, the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 19, Article 10248. https://doi.org/10.3390/ijerph191610248
Ngomane, M. (2019). Ubuntu: I Am Because You A re. Lessons in African Wisdom . Harper Collins.
Nnate, D. A. (2021). Treatment Withdrawal of the Patient on End of Life: An Analysis of Values, Ethics and Guidelines in Palliative Care. Nursing Open, 8, 1023-1029. https://doi.org/10.1002/nop2.777
Oakes, M. B. (2023). Ontological Insecurity in the Post-Covid-19 Fallout: Using Existentialism as a Method to Develop a Psychosocial Understanding to a Mental Health Crisis. Medicine, Health Care and Philosophy, 26, 425-432. https://doi.org/10.1007/s11019-023-10157-9
Odero, B., Nderitu, D., & Samuel, G. (2024). The Ubuntu Way: Ensuring Ethical AI Integration in Health Research. Wellcome Open Research, 9, Article 625. https://doi.org/10.12688/wellcomeopenres.23021.1
Oliveira, A. C. d., & Silva, M. J. P. d. (2010). Autonomia em cuidados paliativos: Conceitos e percepções de uma equipe de saúde. Acta Paulista de Enfermagem, 23, 212-217. https://doi.org/10.1590/s0103-21002010000200010
Orentlicher, D., Pope, T. M., & Rich, B. A. (2015). Clinical Criteria for Physician Aid in Dying. Journal of Palliative Medicine, 19, 259-262. https://doi.org/10.1089/jpm.2015.0092
Parks, J. A., & Howard, M. (2021). Dying Well in Nursing Homes during COVID‐19 and Beyond: The Need for a Relational and Familial Ethic. Bioethics, 35, 589-595. https://doi.org/10.1111/bioe.12881
Peterková, H. (2013). Autonomy—A Leading Principle in the End-Of-Life Decision Making? Journal of Hospital Administration, 3, 19-23. https://doi.org/10.5430/jha.v3n2p19
Petersen, T. S., & Dige, M. (2022). Critique of Autonomy‐based Arguments against Legalising Assisted Dying. Bioethics, 37, 165-170. https://doi.org/10.1111/bioe.13125
Pigeon-Gagné, É., Hassan, G., Yaogo, M., & Ridde, V. (2017). An Exploratory Study Assessing Psychological Distress of Indigents in Burkina Faso: A Step Forward in Understanding Mental Health Needs in West Africa. International Journal for Equity in Health, 16, Article No. 143. https://doi.org/10.1186/s12939-017-0633-8
Pols, J., Pasveer, B., & Willems, D. (2017). The Particularity of Dignity: Relational Engagement in Care at the End of Life. Medicine, Health Care and Philosophy, 21, 89-100. https://doi.org/10.1007/s11019-017-9787-9
Rababah, D. M. (2012). Physician-Assisted Suicide: Legality and Ethicality. SSRN Electronic Journal . https://doi.org/10.2139/ssrn.2063919
Ramabu, N. M. (2019). Whose Autonomy Is It? Botswana Socio‐ethical Approach to the Consenting Process. Developing World Bioethics, 20, 184-193. https://doi.org/10.1111/dewb.12253
Ramose, M. B. (1999). African Philosophy through Ubuntu. Mond Books.
Ramsden, E., & Talbot, C. V. (2024). The Role of Tiktok in Students’ Health and Wellbeing. International Journal of Mental Health and Addiction, 23, 2180-2202. https://doi.org/10.1007/s11469-023-01224-6
Rogers, W., Mackenzie, C., & Dodds, S. (2012). Why Bioethics Needs a Concept of Vulnerability. International Journal of Feminist Approaches to Bioethics, 5, 11-38. https://doi.org/10.3138/ijfab.5.2.11
Rosenwohl-Mack, S., Dohan, D., Matthews, T., Batten, J. N., & Dzeng, E. (2021). How Individual Ethical Frameworks Shape Physician Trainees’ Experiences Providing End-Of-Life Care: A Qualitative Study. Journal of Medical Ethics, 47, e72. https://doi.org/10.1136/medethics-2020-106690
Roy, P., Muhamad, M. M., & Che Amat, M. A. B. (2023). Existential Crisis among University Students in Bangladesh. International Journal of Academic Research in Progressive Education and Development, 12, 676-690. https://doi.org/10.6007/ijarped/v12-i2/16989
Russo-Netzer, P. (2025). Positive Anxiety: Existential Authenticity as a Pathway to Well-Being. The Journal of Positive Psychology, 20, 823-833. https://doi.org/10.1080/17439760.2025.2498128
Sambrizzi, E. A. (2022). Un Proyecto de ley que admite la eutanasia activa. Prudentia Iuris , 93 , 271-285. https://doi.org/10.46553/prudentia.93.2022.pp.271-285
Sanchini, V., Sala, R., & Gastmans, C. (2022). The Concept of Vulnerability in Aged Care: A Systematic Review of Argument-Based Ethics Literature. BMC Medical Ethics, 23, Article No. 84. https://doi.org/10.1186/s12910-022-00819-3
Sayid Ahmad, M., & Peled Raz, M. (2025). End of Life Care Preferences in the Arab Population in Israel—Bridging the Gap between Unfounded Assumptions and Autonomous Wishes. BMC Medical Ethics, 26, Article No. 42. https://doi.org/10.1186/s12910-025-01201-9
Schäfer, S. K., Kunzler, A. M., Kalisch, R., Tüscher, O., & Lieb, K. (2022). Trajectories of Resilience and Mental Distress to Global Major Disruptions. Trends in Cognitive Sciences, 26, 1171-1189. https://doi.org/10.1016/j.tics.2022.09.017
Schäfer, S. K., Supke, M., Kausmann, C., Schaubruch, L. M., Lieb, K., & Cohrdes, C. (2024). A Systematic Review of Individual, Social, and Societal Resilience Factors in Response to Societal Challenges and Crises. Communications Psychology, 2, Article No. 92. https://doi.org/10.1038/s44271-024-00138-w
Schweizer, S., Lawson, R. P., & Blakemore, S. (2023). Uncertainty as a Driver of the Youth Mental Health Crisis. Current Opinion in Psychology, 53, Article ID: 101657. https://doi.org/10.1016/j.copsyc.2023.101657
Seedsman, T. (2019). Aging, Informed Consent and Autonomy: Ethical Issues and Challenges Surrounding Research and Long-Term Care. OBM Geriatrics, 3, 1-30. https://doi.org/10.21926/obm.geriatr.1902055
Segú-Odriozola, M. (2025). The Mental Health of University Students: A Social Ecology Perspective. Societies, 15, Article 110. https://doi.org/10.3390/soc15040110
Shahiefisally, M. (2025). Euthanasia in Singapore: Laying the Push for Legalisation to Rest. SSRN Electronic Journal . https://doi.org/10.2139/ssrn.5031592
Sharif, T., & Bugo, J. (2015). The Anthropological Approach Challenges the Conventional Approach to Bioethical Dilemmas: A Kenyan Maasai Perspective. African Health Sciences, 15, 628-633. https://doi.org/10.4314/ahs.v15i2.41
Sjöstrand, M., Helgesson, G., Eriksson, S., & Juth, N. (2011). Autonomy-Based Arguments against Physician-Assisted Suicide and Euthanasia: A Critique. Medicine, Health Care and Philosophy, 16, 225-230. https://doi.org/10.1007/s11019-011-9365-5
Slimmen, S., Timmermans, O., Mikolajczak-Degrauwe, K., & Oenema, A. (2022). How Stress-Related Factors Affect Mental Wellbeing of University Students a Cross-Sectional Study to Explore the Associations between Stressors, Perceived Stress, and Mental Wellbeing. PLOS ONE, 17, e0275925. https://doi.org/10.1371/journal.pone.0275925
Sossauer, L., Schindler, M., & Hurst, S. (2019). Vulnerability Identified in Clinical Practice: A Qualitative Analysis. BMC Medical Ethics, 20, Article No. 87. https://doi.org/10.1186/s12910-019-0416-4
Spicer, J., Ahluwalia, S., & Shah, R. (2021). On Challenges to Respect for Autonomous Decision Making in Primary Care. Clinical Ethics, 17, 458-464. https://doi.org/10.1177/14777509211069908
Spitale, G., Schneider, G., Germani, F., & Biller-Andorno, N. (2023). Exploring the Role of AI in Classifying, Analyzing, and Generating Case Reports on Assisted Suicide Cases: Feasibility and Ethical Implications. Frontiers in Artificial Intelligence, 6, Article 1328865. https://doi.org/10.3389/frai.2023.1328865
Staats, K., Svendsen, S. J., & Lockertsen, V. (2025). Navigating toward Acceptance of Death: Home-Dwelling Patients in the Palliative Phase. BMC Palliative Care, 24, Article No. 71. https://doi.org/10.1186/s12904-025-01707-4
Stavert, J. (2020). Respecting the Autonomy of the Living and Dying. Journal of Integrated Care, 28, 379-385. https://doi.org/10.1108/jica-06-2020-0038
Strang, P., Strang, S., Hultborn, R., & Arnér, S. (2004). Existential Pain—An Entity, a Provocation, or a Challenge? Journal of Pain and Symptom Management, 27, 241-250. https://doi.org/10.1016/j.jpainsymman.2003.07.003
Tahmasebi, M. (2023). Ethics and Palliative Care: A Case of Patient’s Autonomy. Journal of Medical Ethics and History of Medicine, 15 , Article 16. https://doi.org/10.18502/jmehm.v15i16.11574
Takala, T. (2007). Concepts of “Person” and “Liberty”, and Their Implications to Our Fading Notions of Autonomy. Journal of Medical Ethics, 33, 225-228. https://doi.org/10.1136/jme.2006.016816
Țenea-Cojan, Ș., Dinescu, V., Gheorman, V., Dragne, I., Gheorman, V., Forțofoiu, M. et al. (2025). Exploring Multidisciplinary Approaches to Comorbid Psychiatric and Medical Disorders: A Scoping Review. Life, 15, Article 251. https://doi.org/10.3390/life15020251
Thompson, G. A., Segura, J., Cruz, D., Arnita, C., & Whiffen, L. H. (2022). Cultural Differences in Patients’ Preferences for Paternalism: Comparing Mexican and American Patients’ Preferences for and Experiences with Physician Paternalism and Patient Autonomy. International Journal of Environmental Research and Public Health, 19, Article 10663. https://doi.org/10.3390/ijerph191710663
van Bruchem-Visser, R. L., van Dijk, G., de Beaufort, I., & Mattace-Raso, F. (2020). Ethical Frameworks for Complex Medical Decision Making in Older Patients: A Narrative Review. Archives of Gerontology and Geriatrics, 90, Article ID: 104160. https://doi.org/10.1016/j.archger.2020.104160
van der Geest, S., & Satalkar, P. (2019). Autonomy and Dying: Notes about Decision-Making and “Completed Life” Euthanasia in the Netherlands. Death Studies, 45, 613-622. https://doi.org/10.1080/07481187.2019.1671543
Vogelstein, E. (2017). Evaluating the American Nurses Association’s Arguments against Nurse Participation in Assisted Suicide. Nursing Ethics, 26, 124-133. https://doi.org/10.1177/0969733017694619
Walter, J. K., & Ross, L. F. (2014). Relational Autonomy: Moving Beyond the Limits of Isolated Individualism. Pediatrics, 133, S16-S23. https://doi.org/10.1542/peds.2013-3608d
White, B. P., Willmott, L., & Close, E. (2022). Better Regulation of End-Of-Life Care: A Call for a Holistic Approach. Journal of Bioethical Inquiry, 19, 683-693. https://doi.org/10.1007/s11673-022-10213-8
Wilson, P. M., & Appel, S. W. (2013). Existential Counselling and Psychotherapy and Māori Clients. Asia Pacific Journal of Counselling and Psychotherapy, 4, 137-146. https://doi.org/10.1080/21507686.2013.822400
Wong, P. T. P., & Laird, D. (2023). Varieties of Suffering in the Clinical Setting: Re-Envisioning Mental Health Beyond the Medical Model. Frontiers in Psychology, 14, Article 1155845. https://doi.org/10.3389/fpsyg.2023.1155845
Wong, P. T. P., & Yu, T. T. F. (2021). Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective. Medicina, 57, Article 924. https://doi.org/10.3390/medicina57090924
Yedidia, M. J. (2006). Transforming Doctor-Patient Relationships to Promote Patient-Centered Care: Lessons from Palliative Care. Journal of Pain and Symptom Management, 33, 40-57. https://doi.org/10.1016/j.jpainsymman.2006.06.007