Decision making towards the end of life involves navigating and addressing the values, experiences, beliefs and fears of patients and their loved ones- more so than in other areas of medicine. This moral consideration of what we should do for an individual is largely uncontroversial but how it precisely translates into practice may be unclear. This presentation will focus on one aspect of ethical decision making at the end of life: whether or not a person should be admitted to hospital. It is important to consider the reality of situations where hospital admissions decisions are made, and this presentation will include case examples and empirical research to ensure our discussion is relevant. We speak from a commitment to the importance of empirical work within ethics.

We will consider two separate aspects of hospitalisation decisions:

1. Why do hospital admissions specifically deserve moral scrutiny? We will illustrate some of the potential hazards of end of life admissions and then focus on the concepts of uncertainty, risk and the extent to which we can know the preferences of others.

2. The role of the clinician as a moral agent: Here we will consider how clinicians may face competing moral commitments or judgements and how these could be navigated. Not all questions of what we should do involve conflict but may still require reflection. We will discuss how ethical frameworks may be suited to retrospectively frame a problem but that thinking of the clinician as a ‘moral craftsman’ may be more appropriate to proactively help them make difficult decisions.

This presentation covers work within a larger PhD project exploring the lived experience of hospital admissions decisions and what ‘good’ decision making in this context might look like.