Citizens’ perceptions of the ethics of telepalliative care in the intensive care unit: a focus group study

Abstract Background Palliative care can be provided alongside curative or life-sustaining treatments and is not limited to the terminal phase, highlighting the need for integration across healthcare settings, including intensive care units (ICUs). Despite its benefits, ICU integration remains limited, leaving patient and family needs unmet. Telehealth, or telepalliative care, is increasingly investigated to improve ICU palliative care access, yet ethical implications remain unexplored. Early citizen consultation can reveal public concerns and facilitate implementation aligned with societal values. In contrast, failing to consider citizens’ perspectives may lead to resistance toward telepalliative care if perceived as conflicting with societal values. Therefore, this study investigates citizens’ perceptions of the ethical aspects of ICU telepalliative care. Methods Constructivist grounded theory guided a qualitative study exploring citizens’ perspectives on ICU telepalliative care. Twelve focus groups (64 participants), including laypeople and healthcare professionals, were conducted in Flanders, Belgium. Data were analyzed iteratively using the Qualitative Analysis Guide of Leuven (QUAGOL). Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results Participants questioned how telehealth could fit ICU palliative care, given conceptual tensions between telehealth, palliative care, and the ICU, and expressed concern that economic or technological motives might undermine ethical implementation. They recognized opportunities if guided by an ethical purpose with the human being at the center of care. Participants noted that telehealth both challenges and supports human contact: absence of physical presence, including touch, can limit relational aspects such as comfort, but virtual visits can help maintain contact when in-person interaction in the ICU is impossible. They also raised practical ethical concerns, including obtaining informed consent from unconscious patients and camera-related privacy risks, such as surveillance or disrupted intimacy, and proposed mitigations. Participants highlighted telehealth’s potential to improve equitable access to palliative care expertise in the ICU, while noting barriers such as limited digital literacy, language proficiency, and functional limitations. Conclusions Citizens’ perspectives suggest ICU telepalliative care can be valuable under well-defined, human-centered conditions. Its ethical acceptability should be evaluated both for individual patients and for specific applications and continually revisited. Ethical implementation requires specifying use cases rather than treating “telehealth” abstractly.