{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:22:22Z","timestamp":1791832942279,"version":"4.3.4"},"reference-count":44,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"unspecified","delay-in-days":123,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951526102648_sec1a\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The increasing presence of artificial intelligence (AI), electronic patient-reported outcomes (ePROMs), and digital infrastructures in palliative care is transforming how clinical encounters are organized and how suffering is interpreted. These technological shifts heighten the risk of relational compression and a reduction of dignity to measurable outputs. This paper proposes the DiRePal model (Relational\u2013Temporal Dignity in Palliative Care) as a philosophical framework to re-examine dignity beyond coherent narrative identity or autonomy-centered ethics, emphasizing relational presence, temporal sensitivity, and structural conditions of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102648_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A philosophical\u2013ethical analysis informed by narrative identity (P. Ricoeur), ethics of alterity (E. Levinas), capabilities theory (M. Nussbaum), and care ethics (J. Tronto). Critical readings of dignity frameworks, AI ethics, and digital health literature were synthesized to develop a relational\u2013temporal account of dignity and 2 operational concepts: the temporal dignity indicator and the architecture of prudence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102648_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>While digital tools can enhance communication and support anticipatory care, they also risk reducing patients to data profiles, narrowing listening practices, and eroding opportunities for narrative, silence, and relational presence. The DiRePal model reframes dignity as a fluctuating, co-constructed achievement that depends on temporal attentiveness, ethical listening, institutional conditions, and prudent integration of AI and ePROMs. It further expands dignity to include post-biographical dimensions such as memory, grievability, and digital legacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951526102648_sec4d\">\n                    <jats:title>Significance of results<\/jats:title>\n                    <jats:p>End-of-life care in the algorithmic age requires an ethics that recognizes dignity as relational, temporal, and structurally mediated. The DiRePal model offers clinicians and institutions a conceptual grammar to resist technological reductionism, protect time for presence, and safeguard the narrative and post-biographical continuity of persons whose voices may be fragmented, vulnerable, or digitally extended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951526102648","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:24:36Z","timestamp":1777879476000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Relational\u2013temporal dignity at the end of life: Ethical foundations for the DiRePal model in the algorithmic age"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4115-5012","authenticated-orcid":false,"given":"Abel","family":"Garc\u00eda Abejas","sequence":"first","affiliation":[{"name":"Universidade da Beira Interior"},{"name":"Hospital Lus\u00edadas Lisboa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"S1478951526102648_ref10","doi-asserted-by":"publisher","DOI":"10.1515\/9780823291977-009"},{"key":"S1478951526102648_ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s11019-023-10161-z"},{"key":"S1478951526102648_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2020.11.004"},{"key":"S1478951526102648_ref30","doi-asserted-by":"publisher","DOI":"10.4159\/harvard.9780674061200"},{"key":"S1478951526102648_ref41","volume-title":"Caring Democracy Markets, Equality, and Justice","author":"Tronto","year":"2013"},{"key":"S1478951526102648_ref14","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.18085"},{"key":"S1478951526102648_ref17","volume-title":"The History of Sexuality. 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Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e132"}}