{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:58:01Z","timestamp":1790603881358,"version":"4.1.0"},"reference-count":12,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Ajinomoto Foundation for Dietary Culture"},{"name":"Shikishima Foundation for the Promotion of Science and Culture"},{"DOI":"10.13039\/100019727","name":"Japan Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019727","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The selection of an end-of-life meal for a person nearing death is often framed as a deeply personal and meaningful act. Distinct from the well-documented practice of last-meal requests before execution, food and meal choices during the terminal phase of illness are shaped by medical constraints, family dynamics, cultural expectations, and ethical judgements. Palliative-care nursing literature increasingly recognises food and mealtimes as sources of both meaning and distress for patients and families. As generative artificial intelligence (AI) systems are increasingly introduced into healthcare contexts, they may also generate recommendations in ethically sensitive areas such as end-of-life care. Such recommendations are not neutral; they may reflect normative assumptions about safety, comfort, and what constitutes a \u201cgood death.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research aim<\/jats:title>\n                    <jats:p>This study examines how generative AI constructs and justifies end-of-life meal suggestions, and how these outputs reflect, reinforce, or silence particular ethical and cultural imaginaries of dying.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design<\/jats:title>\n                    <jats:p>A qualitative, interpretive research design grounded in science and technology studies (STS) and critical AI-ethics perspectives on non-human actors as normative agents (see Theoretical framework, Section 4.1) was adopted, treating AI-generated outputs as cultural texts rather than clinical guidance. The analysis focused on both proposed meals and the justificatory language accompanying them.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and research context<\/jats:title>\n                    <jats:p>No human participants were involved. The dataset consisted of 75 AI-generated meal proposals produced by a single large language model. Fifteen systematically varied prompts were generated five times each, manipulating age, cultural background, religious orientation, family presence, swallowing difficulty, and preference deviation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>The authors\u2019 institutional research ethics committee confirmed that the study was exempt from full ethical review because it involved no human participants, patient data, or identifiable personal information (determination no. 001, dated 4 August 2026). The relevant institutional office also confirmed that no separate approval was required for the use and analysis of LLM-generated outputs. The analysis was conducted in accordance with the applicable terms of use of the LLM provider.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Safety-oriented language dominated across outputs (93.3%), alongside emotional comfort and nostalgia. By contrast, explicit conflict, ritual specificity, and strong desire prioritisation were consistently absent. Even when preference deviation was prompted, AI outputs tended to neutralise tension and redirect choices towards harmonised, risk-averse narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across the outputs analysed, generative AI reproduced a narroaw moral script of dying that privileged safety and emotional tranquillity while marginalising conflict, ritual, and embodied desire. We do not claim that clinicians currently rely on generic AI tools to determine patients\u2019 final meals; rather, the findings speak to how such tools may function as an informal reference point when preferences cannot be directly confirmed, or as an unexamined \u201cfirst draft\u201d in busy clinical settings, and to the moral script such tools default to when consulted in this way. Nursing ethics must therefore interrogate not only what AI recommends, but the normative visions of care and death that such recommendations sustain, and must keep the nurse\u2019s own moral agency\u2014rather than AI output\u2014at the centre of end-of-life decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261483891","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:52:44Z","timestamp":1790337164000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["How generative AI shapes the last meal at life\u2019s end"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4307-5104","authenticated-orcid":false,"given":"Masahiro","family":"Shirotsuki","sequence":"first","affiliation":[{"name":"Nagoya University of Foreign Studies"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Otsuki","sequence":"additional","affiliation":[{"name":"Kochi University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoko","family":"Oiwa","sequence":"additional","affiliation":[{"name":"Nagoya University of Foreign Studies"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Sugama","sequence":"additional","affiliation":[{"name":"Fujita Health University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-025-01935-8"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330231197708"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/hast.70030"},{"key":"e_1_3_4_5_2","volume-title":"And a time to die: how American hospitals shape the end of life","author":"Kaufman SR","year":"2006","unstructured":"Kaufman SR. And a time to die: how American hospitals shape the end of life. University of Chicago Press, 2006."},{"key":"e_1_3_4_6_2","volume-title":"Twice dead: organ transplants and the reinvention of death","author":"Lock M","year":"2002","unstructured":"Lock M. Twice dead: organ transplants and the reinvention of death. University of California Press, 2002."},{"key":"e_1_3_4_7_2","first-page":"409","article-title":"Cold (Comfort?) Food: The Significance of Last Meal Rituals in the United States","volume":"3","author":"Gerwig-Moore S","year":"2014","unstructured":"Gerwig-Moore S, Davies A, Atkins S. Cold (Comfort?) Food: The Significance of Last Meal Rituals in the United States. British Journal of American Legal Studies. 2014; 3: 409\u2013440.","journal-title":"British Journal of American Legal Studies"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.13345"},{"issue":"6","key":"e_1_3_4_9_2","first-page":"276","article-title":"What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU? An integrative review","volume":"87","author":"O\u2019Neill K","year":"2025","unstructured":"O\u2019Neill K, Bloomer MJ. What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU? An integrative review. Intensive and Critical Care Nursing. 2025; 87(6): 276\u2013103883. https:\/\/doi.org\/10.1016\/j.iccn.2024.103883.","journal-title":"Intensive and Critical Care Nursing"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.02740.x"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/2053951716679679"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/2053951718819032"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-021-00691-7"}],"container-title":["Nursing Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261483891","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09697330261483891","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261483891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:17:38Z","timestamp":1790601458000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09697330261483891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":12,"alternative-id":["10.1177\/09697330261483891"],"URL":"https:\/\/doi.org\/10.1177\/09697330261483891","relation":{},"ISSN":["0969-7330","1477-0989"],"issn-type":[{"value":"0969-7330","type":"print"},{"value":"1477-0989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"09697330261483891"}}