Relational-temporal dignity at the end of life: Ethical foundations for the DiRePal model in the algorithmic age

Clinical Snapshot

Key Findings

• Effect Size: Not applicable - theoretical framework

• Primary Outcome: Development of DiRePal model emphasizing relational-temporal dignity

• Nnt Or Sensitivity: Framework proposes temporal dignity indicator and architecture of prudence as operational tools

Clinical Application

Requires institutional commitment and staff training; implementation complexity moderate Relevant to Australian palliative care services increasingly using telehealth and digital patient-reported outcomes; aligns with RACGP emphasis on person-centred care and National Palliative Care Strategy priorities Palliative care teams, healthcare institutions implementing digital health technologies, ethics committees

Abstract

OBJECTIVES: 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-Temporal 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. METHODS: A philosophical-ethical 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-temporal account of dignity and 2 operational concepts: the temporal dignity indicator and the architecture of prudence. RESULTS: 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. SIGNIFICANCE OF RESULTS: 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.

References

1. 1.García Abejas, A. (2026). Relational-temporal dignity at the end of life: Ethical foundations for the DiRePal model in the algorithmic age. Palliative & Supportive Care. https://doi.org/10.1017/S1478951526102648