{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:30:48Z","timestamp":1787308248899,"version":"build-2736575974"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>In clinical practice in China, particularly in cancer treatment, family decision-making plays an important role. Over the past few years, efforts have been made across China to promote the implementation of palliative care. Influenced by traditional Chinese culture, an ethical conflict exists between patient autonomous decision-making and family-oriented choices driven by traditional filial piety. This study explores the ethical boundaries of family participation, focusing on how traditional filial piety and family interests affect the judgment of patients\u2019 best interests within the Chinese cultural context. The analysis reveals that the Confucian virtue of filial piety may assist patients during treatment, but may infringe upon patients\u2019 rights and complicate the process of informed consent. Through philosophical reflection, the study reconstructs a context-adapted ethical framework that prioritizes patient wellbeing, takes into account psychological dignity, and clarifies reasonable limits for family participation. The revised standard emphasizes informed consent, transparent communication, and culturally sensitive care, aiming to promote ethical, humane, and sustainable shared decision-making in oncology palliative care.<\/jats:p>","DOI":"10.3389\/fpsyg.2026.1924478","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:13:17Z","timestamp":1787307197000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Who defines good and bad? Boundaries of family decision-making in palliative care: reflections and reconstruction based on Eastern culture"],"prefix":"10.3389","volume":"17","author":[{"given":"Yanke","family":"Li","sequence":"first","affiliation":[{"name":"Faculty of Law, University of Macau","place":["Taipa, Macao SAR, China"]},{"name":"Faculty of Law, Henan University of Urban Construction","place":["Pingdingshan, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man Teng","family":"Iong","sequence":"additional","affiliation":[{"name":"Faculty of Law, University of Macau","place":["Taipa, Macao SAR, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref1","first-page":"46","article-title":"The dialectics of good and evil as the key issue of philosophical-ethical cognition","author":"Arkhangelsky","year":"1983","journal-title":"Transl. Philos."},{"key":"ref2","first-page":"66","article-title":"Relational rationality: the origin tradition and contemporary response of the \u201csocial governance community\u201d","author":"Chen","year":"2026","journal-title":"Stud. Polit. Sci."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1093\/JMP\/JHQ046","article-title":"The family and harmonious medical decision making: cherishing an appropriate Confucian moral balance","volume":"35","author":"Chen","year":"2010","journal-title":"J. Med. Philos."},{"key":"ref4","first-page":"132","article-title":"Modern inheritance of family tradition and kinship: a study on family construction of elderly care inherited by filial piety","volume":"37","author":"Chen","year":"2023","journal-title":"J. Chongqing Univ. Technol. (Soc. Sci.)"},{"key":"ref5","year":"2021"},{"key":"ref6","first-page":"28","article-title":"Dilemmas and solutions of subjects exercising patients\u2019 right to informed consent","volume":"45","author":"Cui","year":"2024","journal-title":"Med. Philos."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/S12910-019-0417-3","article-title":"Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature","volume":"20","author":"G\u00f3mez-V\u00edrseda","year":"2019","journal-title":"BMC Med. Ethics"},{"key":"ref8","first-page":"25","article-title":"A brief analysis of the influence of Confucian thought on traditional geriatric medicine","volume":"34","author":"Gu","year":"2015","journal-title":"Chin. Med. Educ."},{"key":"ref9","first-page":"4","article-title":"Construction of family tradition in the new era: inheritance and creative transformation of Confucian filial piety culture","author":"Guo","year":"2025","journal-title":"New Chu Cult."},{"key":"ref10","first-page":"18","article-title":"Good life and good death: the pursuit of hospice care in Chinese life culture","volume":"15","author":"He","year":"2024","journal-title":"Peking Union Med. College J."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"142","DOI":"10.13644\/j.cnki.cn31-1112.2025.04.013","article-title":"What constitutes \u201cfilial piety\u201d: understanding the judgment of filial piety in contemporary Chinese society from the actor perspective","author":"Hu","year":"2025","journal-title":"Soc. Sci."},{"key":"ref12","first-page":"110","article-title":"Misunderstandings, ethical dilemmas and countermeasures in the practice of hospice care for advanced tumor patients","volume":"19","author":"Jiang","year":"2019","journal-title":"J. Nanjing Med. Univ. (Soc. Sci. Ed.)"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"15","DOI":"10.14185\/j.cnki.issn1008-2026.2011.08.018","article-title":"What exactly is \u201cgood\u201d?","author":"Li","year":"2011","journal-title":"Soc. Sci. For."},{"key":"ref14","first-page":"39","article-title":"Hospice care: the path to dignity in death","volume":"25","author":"Liao","year":"2012","journal-title":"Chin. J. Med. Ethics"},{"key":"ref15","first-page":"52","article-title":"Reference of elderly care from ancient and modern times: the true essence of filial piety culture","author":"Lin","year":"2025","journal-title":"Cult. Ind."},{"key":"ref16","first-page":"12","article-title":"On the localization requirements for the development of Chinese bioethics","volume":"33","author":"Liu","year":"2012","journal-title":"J. Hunan City Univ."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1017\/S0963180117000792","article-title":"Patient engagement at the household level: a feasible way to improve the Chinese healthcare delivery system toward people-centred integrated care","volume":"27","author":"Liu","year":"2018","journal-title":"Camb. Q. Healthc. Ethics"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"47","DOI":"10.16659\/j.cnki.1672-5654.2021.15.047","article-title":"Discussion on informed consent and its dilemmas in clinical practice","volume":"18","author":"Liu","year":"2021","journal-title":"China Health Ind."},{"key":"ref19","first-page":"112","article-title":"Research on patients\u2019 rights and their protection in palliative and hospice care","volume":"14","author":"Liu","year":"2022","journal-title":"Med. Law"},{"key":"ref20","first-page":"845","article-title":"Observation on the effect of hospice care on improving the quality of life of advanced lung cancer patients with pain in intensive care unit","volume":"18","author":"Ma","year":"2020","journal-title":"Progress Cancer"},{"key":"ref21","first-page":"77","article-title":"From survival security to \u201cdignified elderly care\u201d: dilemmas and reflections on China\u2019s elderly care system","volume":"19","author":"Ma","year":"2025","journal-title":"J. China Pudong Cadre College"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.12982\/CMUJASR.2015.0006","article-title":"Medical ethics and therapeutic knowledge from China as contested knowledge in times of globalization","volume":"2","author":"Micollier","year":"2015","journal-title":"Chiang Mai Univ. J. Nat. Sci."},{"key":"ref23","first-page":"29","article-title":"The dual variation of \u201cfilial piety\u201d and \u201cloyalty\u201d\u2014a historical practice of Confucian tradition from the evolution of the loyalty-filial piety relationship","author":"Ren","year":"2016","journal-title":"J. Hist. Polit. Thought"},{"key":"ref24","author":"Selvamani","year":"2025"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"172","DOI":"10.20060\/j.cnki.ISSN1009-3222.2024.0172","article-title":"On the right to palliative and hospice care for the elderly and its legal protection principles","volume":"25","author":"Sun","year":"2024","journal-title":"J. Nanjing Univ. Tradit. Chin. Med. (Soc. Sci. Ed.)"},{"key":"ref26","first-page":"39","article-title":"Path analysis of social support and mental health of adult child caregivers","author":"Tang","year":"2008","journal-title":"J. Sichuan Educ. Inst."},{"key":"ref27","first-page":"84","article-title":"Argumentation on Confucian ethical responsibility of filial piety and fraternal respect","author":"Tu","year":"2017","journal-title":"Stud. Zhouyi"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"121","DOI":"10.19624\/j.cnki.cn42-1005\/c.2019.03.014","article-title":"Multidimensional review and modern transformation of traditional loyalty and filial piety ethics","author":"Wang","year":"","journal-title":"Stud. Pract."},{"key":"ref29","first-page":"52","article-title":"Life and death education in hospice care","volume":"36","author":"Wang","year":"","journal-title":"Med. Res. Educ."},{"key":"ref30","first-page":"17","article-title":"Dignity, conflicts and ethical dilemmas in medical autonomy of patients with end-stage cancer pain","author":"Wang","year":"2020","journal-title":"Narrat. Med."},{"key":"ref31","first-page":"93","article-title":"Research on the legitimacy of terminally ill patients\u2019 right to choose life-sustaining treatment","volume":"34","author":"Wang","year":"2021","journal-title":"Chin. Med. Ethics"},{"key":"ref32","first-page":"56","article-title":"Meta-integration of qualitative studies on influencing factors of family members participating in nursing activities of ICU patients","volume":"41","author":"Wang","year":"2026","journal-title":"J. Nurs. Sci."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.11124\/JBISRIR-2017-003867","article-title":"Meaningful and culturally appropriate palliative care for Chinese immigrants with a terminal condition: a qualitative systematic review protocol","volume":"17","author":"Wei","year":"2019","journal-title":"JBI Database Syst. Rev. Implement. Rep."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"28","DOI":"10.15995\/j.cnki.llxyj.2025.06.002.","article-title":"Modern challenges, inheritance and development of traditional filial piety","author":"Xiao","year":"2025","journal-title":"Stud. Ethics"},{"key":"ref35","first-page":"66","article-title":"Construction of a theoretical framework for relational autonomous treatment decision-making behavior among cancer patients based on grounded theory","volume":"39","author":"Xiao","year":"2022","journal-title":"Mil. Nurs."},{"key":"ref36","first-page":"25","article-title":"Meta-integration of qualitative studies on family members\u2019 experience of participating in hospice care decision-making for advanced cancer patients","volume":"42","author":"Xu","year":"2025","journal-title":"Mil. Nurs."},{"key":"ref37","first-page":"3192","article-title":"Analysis of influencing factors of family members\u2019 clinical decision-making for terminal cancer patients","volume":"33","author":"Xu","year":"2019","journal-title":"Nurs. Res."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"10071","DOI":"10.3390\/IJERPH191610071","article-title":"Confucian familism and shared decision making in end-of-life care for patients with advanced cancers","volume":"19","author":"Yang","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"193","DOI":"10.15886\/j.cnki.hnus.202402.0075","article-title":"From filial piety to elderly care: historical reflection and modern transformation of traditional filial piety culture","volume":"43","author":"Yang","year":"2025","journal-title":"J. Hainan Univ. Humanit. Soc. Sci."},{"key":"ref40","first-page":"15","article-title":"Two connotations of \u201cfilial piety\u201d in Zhuangzi: ordinary filial piety and supreme filial piety in serving parents","volume":"40","author":"Zhang","year":"2020","journal-title":"J. Hubei Eng. Univ."},{"key":"ref41","first-page":"28","article-title":"Series discussions on \u201clife dignity\u201d part three: dignity of terminally ill patients","volume":"31","author":"Zhang","year":"2018","journal-title":"Chin. J. Med. Ethics"},{"key":"ref42","volume-title":"Rites","author":"Zheng","year":"2020"},{"key":"ref43","first-page":"126","article-title":"Application and dilemma of the hermeneutic model of legal application","volume":"37","author":"Zhu","year":"2013","journal-title":"J. Anhui Univ. (Philos. Soc. Sci. Ed.)"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1177\/1937586720908508","article-title":"Respect for autonomy: seeking the roles of healthcare design from the principle of biomedical ethics","volume":"13","author":"Zhu","year":"2020","journal-title":"HERD"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1924478\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:13:26Z","timestamp":1787307206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1924478\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":44,"alternative-id":["10.3389\/fpsyg.2026.1924478"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1924478","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"1924478"}}