Moonshot Ethics: A Framework for Preventing Prudential Gaps in End-of-Life Deliberation

Abstract This essay proposes “moonshot ethics” as an alternative to overtreatment or unilateral withdrawal in end-of-life care. A moonshot is a mutually chosen, limited pursuit of aggressive or experimental treatment despite low chances of benefit. Building on Mercurio’s I-P-O framework and Aquinas’ account of prudence, I argue justified moonshots require more than wishing, that is, a rational plan responsive to changing clinical realities. When these criteria are met, moonshots are prima facie permissible and outline considerations for approaching discussions about moonshots as defensible medical efforts that can sustain therapeutic alliances and mitigate moral distress. When these criteria are not met, a moonshot is an aspiration but not a plan and is not morally justified, insofar as it is indistinguishable from deliberately prolonging the dying process.