Professionalism and Medical Ethics in End-of-Life Decision-Making: A Phenomenological Study of ICU Physicians at Public Teaching Hospital, Sahiwal, Pakistan

Abstract

Objective: The study aimed to explore the lived experiences of ICU physicians in Pakistan regarding
professionalism and medical ethics in end-of-life decision-making, with particular focus on emotional burden,
ethical dilemmas, religious and cultural influences, family involvement, and institutional challenges.
Study Design: A qualitative phenomenological study using a hermeneutic approach.
Place and Duration of Study: The study was conducted in the Medical Intensive Care Unit at Sahiwal Teaching
Hospital, Sahiwal, Pakistan, from November 2024 to April 2025.
Methods: Semi-structured, in-depth interviews were conducted over a period of six months in the Medical
Intensive Care Unit at Sahiwal Teaching Hospital with eight physicians and postgraduate trainees. They were
selected using a purposive sampling technique, and were directly involved in decision-making regarding endof-
life care. Data was analyzed through thematic analysis. Credibility and dependability were ensured through
participant validation and expert peer review.
Results: Six key themes emerged from the analysis using thematic analysis based on Braun and Clarke's
framework and supported by NVivo 12 Pro software: Emotional burden of decision-making, Religious and
cultural influences, Family-centered pressure and misunderstanding, Systemic and institutional gaps, Personal
beliefs, professional ethics, and reflection, and External interference and hierarchical pressure. Physicians
described moral distress, emotional exhaustion, and fear of legal repercussions in the absence of clear
institutional protocols or legal protection. Family expectations and cultural norms frequently conflicted with
medical judgment, intensifying ethical challenges.
Conclusion: End-of-life decision-making among Pakistani intensive care physicians is influenced by emotional,
cultural, ethical, and institutional pressures. The findings suggest a need for improved institutional guidance,
ethics training, and structured communication with families to support ethical practice, reduce physician
distress, and promote more consistent end-of-life care.

How to cite this: Waseem M, Ajmal MO, Butt WA, Mir A, UZ Mir, Qaiser A. Professionalism and Medical Ethics in End-of-Life Decision-Making: A Phenomenological Study of ICU Physicians at Public Teaching Hospital, Sahiwal, Pakistan. Life and Science. 2026; 7(1): 17-24. doi: http://doi.org/10.37185/LnS.1.1.1042