Ethical Challenges in End-of-Life Care for Individuals with Severe and Persistent Mental Illness: A Qualitative Study

People living with severe and persistent mental illness (SPMI) constitute a small yet highly vulnerable group within mental health care. Their care raises complex ethical challenges due to factors such as the intensity of their conditions, limited social support, communication difficulties, impaired decision-making, and, occasionally, disruptive behaviors. Despite these challenges, research on ethical issues in this population remains limited. This study explores the ethical considerations invol