This perspective is based on the fact that suffering, which is inevitably present in human experience, can be transformed into a source of meaning and personal growth, as suggested by Viktor Frankl’s work on logotherapy ([9]). Indeed, the ability to find meaning even in the most difficult situations is a pillar of existential resilience, allowing us to transcend perceptions of “weariness of life” by reinterpreting them as catalysts for development. It is essential to recognize that existential positive psychology offers a framework for approaching these forms of suffering as opportunities for psychological maturation, emphasizing the cultivation of meaning, virtue, and resilience ([46]). This approach recognizes suffering not as a pathology to be eradicated, but as an inherent component of human existence that can lead to personal growth and increased authenticity ([70]). Similarly, the integration of philosophical perspectives, notably that of Kierkegaard, allows us to conceptualize well-being not as the absence of suffering, but as the ability to find meaning in it, thus recognizing that “negative” emotions are essential to a rich and full life ([70]). This understanding reinforces the idea that authenticity and the search for meaning in suffering can transform the perception of weariness of life into an opportunity for profound transformation ([70]).

Therefore, an in-depth analysis of the ethical implications of “weariness of life” is necessary, particularly with regard to the right to individual autonomy in the face of existential suffering and societal responsibilities in terms of support. This analysis should also consider the possibility that intense existential suffering may paradoxically catalyze greater authenticity, as Heidegger proposes with the concept of Dasein, thus transforming distress into a path to deeper well-being ([125]). This perspective raises complex questions about the balance between respect for individual autonomy and the ethical imperative to provide adequate support to alleviate suffering. It invites us to reflect on the tension between the desire for autonomy and human vulnerability, challenging conventional approaches to managing existential suffering ([59]). Furthermore, exploring the philosophical and ethical frameworks of free choice and decision-making at the end of life, or in situations of “weariness of life”, is fundamental to understanding the complexity of contemporary debates on assisted dying ([95]). This reflection encompasses a critical analysis of the foundations of clinical practices and public policies, highlighting the need for a nuanced approach that reconciles patient dignity and societal values ([27]). This approach must examine how moral obligations towards the suffering of others differ from those towards their well-being, recognizing the asymmetry of ethical imperatives in these contexts ([62]). Furthermore, recognizing the positive aspects of suffering and the search for meaning can transform the perception of this fatigue, allowing individuals to redefine their relationship with existence and consider new perspectives ([16]). This approach implies a deep understanding of human dignity, which, far from being simply linked to rational autonomy, is also rooted in the vulnerability and interdependence of individuals ([104]).

These arguments often crystallize around the notion of autonomy, exploring whether an individual facing profound existential suffering or “weariness of life” has an inalienable right to choose their own end ([115]). The debate then revolves around the question of whether respect for autonomy, often invoked to justify assisted dying, is compatible with the preservation of life, particularly when “weariness of life” is not directly related to a terminal medical condition ([136]). This discussion also raises the importance of considering relational autonomy, which recognizes that individual decisions are often made in a social and family context, influencing and being influenced by interpersonal relationships ([57]). Autonomy, in this context, is not only an individual capacity for rational choice, but also a relational competence that manifests itself in interaction with others and in the recognition of the intrinsic vulnerability of human beings ([63]). Therefore, the analysis of the arguments for and against the right not to live must also incorporate the dimension of vulnerability, not as a simple deficiency, but as a fundamental characteristic of human existence that requires special ethical attention ([43]). Thus, contemporary bioethics strives to reconcile the notion of autonomy with the imperatives of protecting vulnerable persons, recognizing that these two concepts are not mutually exclusive but require a nuanced understanding ([122]). A Kantian framework of autonomy, for example, can offer a relevant perspective on the duty of self-knowledge and the formulation of universalizable principles, thereby enriching the dialogue on end-of-life ethical dilemmas ([49]). This perspective, by recognizing the complexity of autonomy and the intrinsic vulnerability of human beings, moves away from a purely individualistic conception to embrace relational autonomy, where choices are shaped by social interactions and mutual support ([151]; [103]).

Proponents of this right rely primarily on the principle of autonomy, arguing that every competent individual has the right to make decisions about their own life and death, particularly in the face of suffering deemed unbearable or a loss of dignity ([73]; [35]). This perspective highlights a conception of autonomy that values the independence of individual will ([50]), even in the face of radical existential choices. This approach implies a recognition of the right to self-determination, where the individual is seen as the primary arbiter of their own well-being, even if this leads to decisions that may seem paradoxical or contrary to prevailing societal norms ([50]). It is based on an understanding of autonomy as negative freedom, where the state and society have no right to interfere with personal choices, even if those choices are perceived as self-destructive ([145]). Furthermore, the argument in favor of this right can be extended to the notion of dignity, positing that prolonging life in conditions perceived as undignified by the individual may constitute a violation of that dignity ([52]).

Furthermore, some argue that denying an individual the opportunity to choose their own end in cases of unbearable suffering is a form of coercion, thereby denying their fundamental freedom ([54]). This position is reinforced by the idea that patient autonomy must be respected, even in end-of-life situations, and that caregivers have a responsibility to support the patient’s wishes ([2]). This approach emphasizes that respect for patient autonomy is a fundamental ethical principle in medicine, particularly at the end of life, where decisions must above all reflect individual values and preferences ([88]). Therefore, a nuanced understanding of autonomy, including relational autonomy, is essential to support patients in their end-of-life decision-making, recognizing that these decisions are often influenced by social context and interpersonal relationships ([50]; [144]). This broader conception of autonomy encourages recognition that the ability to make informed decisions is often modulated by support and interaction with the patient’s social and family circle, particularly when it comes to choices as crucial as those at the end of life ([63]). However, the question arises as to whether this autonomy should always take precedence over other considerations, such as the preservation of life or the protection of vulnerable individuals, particularly when it comes to such irreversible decisions ([31]; [114]).

Those who oppose this right often invoke the intrinsic value of human life, believing that it is sacred and should not be voluntarily ended, even in cases of suffering ([134]; [118]). This position is often rooted in ethical, religious, or philosophical considerations that view life as a gift or a fundamental good that must be protected, regardless of individual desires. Furthermore, arguments against the right not to live highlight the risks of potential abuses, such as pressure on vulnerable individuals to choose death, or the erosion of respect for life in society ([126]). Some critics also fear that legalizing the right not to live could weaken efforts in palliative care and psychological support, diverting attention from solutions aimed at improving the quality of life of those who are suffering. Moreover, the distinction between autonomy and excessive individualism is crucial, as an overly strict view of autonomy may overlook the influence of relational and societal factors on end-of-life decisions ([139]). This nuance is particularly relevant when considering the implications of relational autonomy, which recognizes that individual choices are intrinsically linked to interpersonal relationships and social supports, particularly within the family and circle of friends ([61]; [113]). This understanding of autonomy calls for increased vigilance regarding implicit or explicit pressures that could influence such a momentous decision. Furthermore, recognition of the vulnerability inherent in human existence underscores the need for robust safeguards to ensure that such decisions are made of one’s own free will and not under duress. This approach highlights the need for rigorous assessment of decision-making capacity and the absence of coercion, particularly for individuals in vulnerable situations ([83]; [127]).

A cross-examination of these arguments reveals fundamental tensions between individual autonomy, the sanctity of life, and society’s role in protecting vulnerable individuals. This tension is palpable in debates on medical assistance in dying, where respect for patient autonomy must be balanced with the prevention of abuse and the protection of individuals who may be unduly influenced ([150]). The legalization of medical assistance in dying is a complex ethical issue that provokes intense debate, as it challenges the foundations of social morality and traditional medical ethics ([102]). The debate is often polarized between those who advocate an approach based on patient autonomy, valuing the individual freedom to choose how to end one’s life, and those who advocate an approach based on the “best option” or the best interests of the patient, involving a broader medical and ethical assessment ([123]). A critical examination of the opposing positions reveals that a partial resolution to these dilemmas may lie in relational understandings of autonomy, which justify interventions by healthcare professionals and family members to support patients in their decision-making process ([99]). This perspective highlights the need to develop policy frameworks that minimize the risks of abuse while respecting patient autonomy ([102]). Furthermore, assessing decision-making capacity for medical assistance in dying remains a major concern, requiring precise criteria to ensure that patients are fully capable of consenting ([14]). Thus, it is imperative to adopt a multidimensional approach to assessing this capacity, integrating medical, psychological, and ethical dimensions ([68]). This holistic approach must consider the influence of contextual factors, such as social support and access to palliative care, on the desire to end one’s life. This assessment must also take into account the concept of relational autonomy, recognizing that individual decisions are often embedded in a complex network of interpersonal relationships, and that the involvement of family and caregivers can be a key factor in ensuring that choices are truly autonomous and not the result of external pressures ([99]).

In African traditions, particularly through the concept of Ubuntu—“I am because we are”—autonomy is not conceived as radical independence, but as a constitutive interdependence. This perspective enriches the analysis of fatigue of living by emphasizing that vulnerability and the meaning of existence are constructed within the fabric of relationships. Thus, clinical care cannot be limited to the isolated individual, but must include community dynamics, family solidarity, and collective rituals that contribute to resilience. This is particularly evident in African cultures, where Ubuntu means that medical decisions, including those concerning the end of life, are often collective and involve the extended family or community ([135]). “I am because we are” implies an approach where individual preferences are often subordinated to collective well-being and social cohesion ([21]).

In modern Western logic, autonomy is often understood as the ability to decide alone and to assert one’s personal preferences. In Ubuntu, autonomy is not denied, but it is reconfigured: it exists in and throughrelationships. Thus, an individual decision is evaluated in terms of its impact on the community, because collective well-being is considered the very condition of personal fulfillment. Personal choices (for example, in the areas of health, justice, or family life) are often negotiated with relatives, elders, or the community. This is not an arbitrary constraint, but a search for balance: preserving social cohesion, avoiding exclusion, and maintaining solidarity. Individuals accept that some of their preferences may be adjusted or deferred, as they know that their well-being depends on that of others ([120]; [101]).

This cultural complexity highlights the need to develop ethical frameworks that are sensitive to different conceptions of autonomy and decision-making, avoiding a universalist approach that does not take into account societal specificities ([55]). Therefore, it is essential to recognize the diversity of understandings of autonomy and decision-making, particularly by considering non-Western frameworks of relational autonomy that can enrich the ethical dialogue on assisted dying ([44]; [50]).

Psychological factors play a central role in existential suffering, encompassing dimensions such as psychological vulnerability, coping mechanisms, and the impact of trauma on the construction of meaning. This vulnerability may be heightened in young adults who experience psychotic episodes, causing them to question their identity and purpose in life ([42]). These experiences can induce profound ontological anxiety, where the fragility of perceived reality and the threat of identity disintegration confront the individual with the fundamental absurdity of existence ([85]). In addition, stressful life events can disrupt an individual’s worldview and life goals, leading to existential questions and a loss of identity ([79]). Qualitative research has shown that the existential concerns of Mexican university students are mainly focused on career goals, interpersonal relationships, and personal growth ([16]). In this context, existential suffering can even become a catalyst for post-traumatic growth, promoting a reorganisation of values and the acquisition of new skills, as evidenced by some qualitative studies on trauma survivors ([16]).

However, it is crucial to distinguish existential suffering from clinical psychological distress, even though they may influence each other, in order to tailor interventions appropriately ([16]). For example, existential anxiety can be exacerbated by global crises, such as the COVID-19 pandemic, which confronts individuals with uncertainty and mortality ([106]). This period has also highlighted the importance of psychosocial factors in mental health, in contrast to a purely biological approach, emphasizing the need for a more nuanced understanding of psychological distress ([109]). The ability to endure suffering, whether existential or psychological, can be modulated by coping mechanisms and personality traits, as highlighted in the empirical literature ([53]). Furthermore, recent studies suggest that worldview and ontological security, as well as self-concept, may play a protective role against the risks of mental health problems in young women, particularly depression and anxiety ([86]). This psychological resilience is also shaped by the ability to navigate periods of prolonged uncertainty, a common feature of major life transitions such as entering college, where adjustment challenges and relationship issues can exacerbate existential crises ([124]).

The social dimension of existential suffering highlights the influence of contextual and relational factors on the search for meaning and individual well-being ([47]). Interpersonal dynamics, cultural norms, and societal structures can either amplify or mitigate feelings of existential emptiness and loss of bearings. It is surprising to learn, for example, that in Burkina Faso, nearly 45% of the population suffers from a mental or neurological disorder, which represents a considerable burden on the healthcare system and society. This high prevalence highlights the interconnection between socioeconomic challenges, community support structures, and the mental health of populations, illustrating how social deficiencies can exacerbate existential suffering on a collective scale. Societal crises, such as pandemics or armed conflicts, can also exacerbate existential suffering by creating conditions of uncertainty and disruption of social ties ([130]; [129]; [93]). Social isolation and disconnection from support networks can therefore hinder individuals’ ability to find meaning in their lives, increasing their vulnerability to psychological distress ([34]). This loss of collective and individual reference points can lead to profound disorientation, exacerbating existing feelings of meaninglessness and futility ([131]; [90]).

Young adults, in particular, are more exposed to stress and at an increased risk of mental health deterioration in the face of the current polycrisis, which is characterized by interconnected global crises ([14]). In addition, financial insecurity and lack of family support exacerbate psychological distress among university students, rendering coping strategies ineffective in the face of these multiple pressures ([133]). The university environment, despite its role in human development, is often associated with negative outcomes due to the academic, financial, and psychosocial constraints that students encounter ([121]). Indeed, the search for meaning in life is a significant protective factor against loneliness and psychological distress among urban youth ([36]), while the lack of social support is a major risk factor for mental disorders ([93]). These observations corroborate the hypothesis that socioeconomic and relational factors, such as poverty and social isolation, are crucial determinants of mental health and well-being, particularly among vulnerable populations ([116]). Psychological distress can be significantly amplified by financial insecurity, particularly among young adults, where economic burdens can have lasting consequences on financial security, physical health, and overall well-being ([105]). This dynamic can create a vicious cycle in which economic hardship exacerbates mental health problems, thereby reducing individuals’ ability to overcome financial challenges ([105]).

The medical dimensions of existential suffering address the interface between subjective experiences of meaning and meaninglessness and the somatic or psychiatric manifestations that may result. This includes consideration of chronic conditions, terminal illnesses, or even mental disorders that may deprive an individual of the ability to find meaning in their existence, thereby altering their quality of life. This complex interaction between the physical and the psychological requires an integrative approach that takes existential suffering into account in the diagnosis and management of medical conditions. In addition, access to appropriate mental health care and psychosocial interventions can play a crucial role in alleviating this suffering by providing a supportive framework for the restructuring of meaning and hope. The comorbidity between existential suffering and medical conditions such as depression or anxiety, often exacerbated by factors such as stress or loneliness, highlights the need for holistic care that includes strategies for reducing stress and promoting well-being ([137]). Therefore, the integration of palliative care and patient-centered approaches is essential to address existential suffering in the medical context, recognizing the importance of patient dignity and autonomy in the face of serious or chronic illness. This interdisciplinary approach provides a better understanding of how financial challenges intertwine with mental health issues, significantly affecting individuals’ overall well-being ([10]; [69]). Studies have shown that unresolved financial distress can manifest itself in physical pain, acting as a metaphor for existential suffering or even reinforcing existing pain ([143]). Thus, chronic pain, for example, can become a profound existential experience, altering an individual’s self-image and understanding of the world, and impacting their life goals and integrity ([75]). This interdependence between physical pain and the quest for existential meaning requires a therapeutic approach that transcends the traditional biomedical model ([84]; [81]). Therefore, a thorough understanding of the mechanisms underlying psychiatric disorders concomitant with medical conditions is essential for effective clinical interventions, especially in cases where existential suffering is exacerbated by these comorbidities ([146]).

Analysis of public policies reveals a diversity of regulatory approaches, ranging from strict prohibition to legalization under very specific conditions, as is the case in the Netherlands, where patient autonomy is a central criterion for euthanasia, including for “weariness of life” ([149]). This divergence highlights the tension between protecting life and respecting individual autonomy in the face of suffering deemed unbearable ([28]). The complexity of this tension is amplified by the clinical observation that chronic pain often requires a revision of life goals and expectations, thus impacting the individual’s existential dimension and perception of the meaning of life ([38]). Furthermore, data from jurisdictions that have legalized assisted dying, such as Oregon, provide crucial insights into the clinical criteria and safety practices necessary for its implementation, highlighting the importance of rigorous assessment of the patient’s decision-making capacity ([112]).

Case studies from these contexts reveal that a patient’s ability to lead a meaningful life, even with chronic pain, is highly dependent on their leading role in their own care, which requires balanced, patient-centered support from healthcare professionals ([45]). This situation highlights the need for a holistic approach to the regulation of end-of-life care, which goes beyond simple regulatory instrumentalization to embrace broader ethical considerations ([152]). It must also address issues of equitable access to palliative care and assisted dying, ensuring that socioeconomic disparities do not influence access to these options ([20]). Therefore, particular attention must be paid to the integration of psychological and social support services, ensuring that patients experiencing fatigue of living receive comprehensive support before making any final decisions. This comprehensive approach aims to prevent requests for assistance in dying resulting from a lack of support or treatable suffering ([28]). Furthermore, the implementation of these policies requires in-depth training for healthcare professionals so that they can navigate the ethical and clinical nuances associated with the end of life ([97]). Finally, legal and ethical frameworks must incorporate a thorough consideration of “weariness of life” as a complex component of existential suffering, distinguishing this profound weariness from traditional psychiatric diagnoses ([115]).

In comparison, in the Netherlands, the notion of “weariness of life” (or voltooidleven, “completed life”) is discussed as a possible reason for assisted dying, even in the absence of a terminal illness. Although the 2001 law strictly regulates euthanasia and assisted suicide, this debate questions the boundaries between medical suffering, personal autonomy, and the dignity of life.

Clinical practices at the end of life require a multidisciplinary, patient-centered approach that integrates not only the relief of physical pain, but also consideration of the psychological, social, and spiritual dimensions of existential suffering ([18]). This approach must include a rigorous assessment of the patient’s relational autonomy, recognizing that end-of-life decisions are often influenced by the social and family support network ([57]; [128]). This broader perspective of autonomy, going beyond a simple capacity for individual choice, is essential to ensure that the preferences of patients at the end of life are fully respected and integrated into their care plan ([63]). It also requires transparent and empathetic communication between healthcare professionals, patients, and their loved ones in order to navigate the complex ethical dilemmas that frequently arise in end-of-life care ([2]). In this context, training healthcare teams in the ethical and legal specifics of assisted dying becomes essential to ensure that care is provided in a manner that respects the patient’s wishes ([2]).

For clinicians, it is important not to confuse “weariness of life” with “clinical depression” when requests for “terminal sedation” come from certain patients. “Weariness of life” expresses an existential weariness: the subject says they are “tired of living”, which reflects real suffering. It is a subjective indicator of distress: it reveals that the person is experiencing saturation, a loss of meaning, or difficulty in planning for the future. It may be linked to contextual factors that need to be deciphered and managed (stress, isolation, spiritual crisis, social difficulties); this cry of distress should therefore be heard as a call for help.

Clinical depression, on the other hand, is defined by specific diagnostic criteria (DSM-5, ICD-10): persistent depressive mood, anhedonia, sleep disturbances, guilt, psychomotor retardation, suicidal thoughts, etc. The diagnosis of depression requires a structured and multidimensional assessment: duration of symptoms, intensity, impact on daily functioning, and the presence of biological or cognitive signs. Fatigue of living is too general and non-specific: it can appear in many situations (burnout, grief, spiritual crisis, physical fatigue), as shown in Table 1below. Two pitfalls must be avoided: pathologizing an existential feeling, which requires listening and empathy; or trivializing real depression, which requires an evaluative approach, objective criteria, and appropriate therapeutic care ([60]).

Table 1. Comparison between fatigue of living and clinical depression.

In New Zealand, for example, studies have highlighted the need for better training of healthcare professionals in discussing end-of-life options and managing family dynamics ([17]). Furthermore, it is also crucial to take into account the emotional and ethical burden on caregivers, particularly in contexts where assisted dying is legalized, as evidenced by the challenges faced by nurses confronted with these difficult decisions ([4]). This complexity highlights the importance of robust psychological and institutional support for healthcare teams in order to prevent burnout and maintain a high quality of care in such a sensitive area ([4]). In addition, the integration of early palliative care is recognized as a best practice, aimed at improving the quality of life of patients and their families by addressing physical, psychological, social, and spiritual symptoms as soon as a serious illness is diagnosed ([4]). This approach optimizes symptom control, improves existential well-being, and facilitates peaceful preparation for the end of life, in accordance with best practices in palliative care ([18]).

The challenges and controversies associated with end-of-life care and assisted dying are manifold, encompassing profound ethical dilemmas concerning patient autonomy, the value of life, and the role of medicine in death ([4]). Navigating these complex issues requires careful consideration of the perceptions of healthcare professionals, particularly palliative care nurses, who face ethical dilemmas on a daily basis and must assess patients’ quality of life while adhering to their rights ([64]). A case in point is that of a young girl who asked to go to another country to die because assisted suicide is prohibited in her own country. This case highlights international legislative disparities and the cross-border ethical implications of medical assistance in dying, raising the question of access to this option for individuals residing in restrictive jurisdictions. It also highlights the tension between national sovereignty and the individual’s right to control their own body, exacerbated by the globalization of healthcare and patient mobility. Furthermore, the issue of “weariness of life” differs from recognized psychiatric illnesses, which complicates the determination of eligibility for assisted dying and raises debates about the medicalization of existential suffering. This distinction is crucial to avoid the excessive pathologization of existential distress while recognizing the legitimacy of profound suffering that does not fall within a standardized psychiatric diagnosis. This nuance implies a reassessment of the eligibility criteria for assisted dying, incorporating a more sophisticated understanding of suffering beyond traditional diagnostic categories.

Therefore, it is imperative to develop clear ethical guidelines and nuanced clinical protocols to address these complex situations, ensuring both respect for individual autonomy and the protection of vulnerable individuals. This requires effective communication and patient involvement in end-of-life decisions, a complex process in which caregivers must balance autonomy, beneficence, and relationships ([4]). In addition, conflicts between family members and healthcare professionals may arise, particularly when end-of-life decision-making involves differences of opinion regarding the withdrawal or continuation of treatment, highlighting the importance of ethical mediation ([108]). The emergence of artificial intelligence in the field of healthcare could offer new perspectives to assist in these complex decision-making processes, particularly by classifying and analyzing cases of assisted dying according to established standards, although its application in such sensitive areas inevitably raises new ethical questions ([140]).

Positive existential psychology and philosophical health, benefiting from innovative clinical approaches, can be translated into concrete interventions. For example, in a palliative care unit, the practitioner may invite the patient to revisit their sources of meaning through open-ended questions (“What remains essential to you today?”). In a community setting, ethical reflection workshops or Ubuntu-inspired talking circles allow patients to share their values and strengthen their resilience. These practices illustrate how a philosophical approach can enrich therapeutic communication and support dignity at the end of life. A specialization in palliative care would allow all these aspects to be integrated, benefiting the overall care of patients at the end of life.

Therefore, a thorough understanding of autonomy requires consideration of how caregiver-patient relationships can support or hinder an individual’s ability to exercise meaningful autonomy ([50]). This approach highlights the crucial role of caregivers in maintaining and strengthening patient autonomy, going beyond simply facilitating decisions to encompass support for identity and self-determination capacities ([50]). Thus, patient autonomy is not a static entity, but a dynamic and evolving process, intrinsically linked to the context of palliative care and the quality of human interactions ([50]). This relational conception of autonomy implies a reassessment of clinical practices, promoting continuous and empathetic dialogue where the patient’s voice is central and respected, even in the face of increasing vulnerability ([26]). This approach recognizes that autonomy at the end of life is intrinsically linked to a person’s ability to exercise their choices and preferences in a supportive environment ([142]). It also emphasizes the importance for healthcare professionals to consider family and relational dimensions in decision-making, as these are often paramount for patients and their loved ones ([113]). Another point to clarify is the patient’s dependence in relation to their claim to autonomy. A nuanced understanding of this dynamic is essential to ensure that decision-making fully respects the patient’s values and wishes, without their physical or emotional dependence compromising the expression of their self-determination ([144]). It is therefore crucial to adopt a perspective that integrates vulnerability as an inherent component of autonomy, in order to ensure care that not only respects individual choices, but also protects and supports individuals in their integrity in the face of illness and the end of life ([1]).

In this context, vulnerability is perceived not as a deficiency, but as a universal human condition that requires special attention and tailored support strategies ([117]). This recognition of the intrinsic vulnerability of human existence enriches our understanding of patient autonomy, highlighting the need for an individualized approach and enhanced relational support to ensure informed decisions that respect patient dignity ([48]; [80]). It highlights the importance of a patient-centered approach in palliative care, where dignity and acceptance of death are crucial aspects that influence patients’ choices and preferences ([141]; [94]; [156]; [111]). This perspective recognizes that vulnerability is often exacerbated by specific circumstances, such as advanced illness or end of life, requiring a pragmatic and contextual approach to protection and support ([138]). Thus, vulnerability is not a static attribute but a dynamic condition, influenced by personal, relational, and environmental factors that require in-depth exploration to fully understand its ethical and clinical implications ([91]). This complexity requires a rigorous analysis of conceptual frameworks of vulnerability in the context of end-of-life care, particularly with regard to older populations and the ethical challenges posed by informed consent and decision-making ([127]). It is therefore imperative to reconcile respect for patient autonomy with the obligations to protect vulnerable individuals ([122]).