Who defines good and bad? Boundaries of family decision-making in palliative care: reflections and reconstruction based on Eastern culture.

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' 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' 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.