Palliative & Supportive Care

Countertransference and ethics: A perspective on clinical dilemmas in end-of-life decisions

BRIAN J.  KELLY  B.Med., Ph.D., FRANZCP, FACHPM a1 c1 , FRANCIS T.  VARGHESE  B.Sc. (Med)., M.B.B.S., FRANZCP a2 and DAN  PELUSI  B.A. (Hons)., M. Clin. Psych. a2
a1 School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, Orange, Australia
a2 University of Queensland, Department of Psychiatry, Princess Alexandra Hospital, Brisbane, Australia

Article author query
kelly bj   [PubMed][Google Scholar] 
varghese ft   [PubMed][Google Scholar] 
pelusi d   [PubMed][Google Scholar] 


Ethical dilemmas in end-of-life care, such as the request for assisted suicide, must be understood in the context of the relationship that exists between patients and the clinicians treating them. This context includes the way health professionals respond to the tasks in caring for a dying patient. This article reviews the literature exploring the factors the influence clinical decision making at the end of life. The interplay of ethics, countertransference and transference are explained in detail.

(Received September 30 2003)
(Accepted November 16 2003)

Key Words: Countertransference; Ethics; End-of-life caregiving; Physician-assisted suicide.

c1 Corresponding author: Assoc. Prof. Brian Kelly, Centre for Rural and Remote Mental Health, University of Newcastle, Bloomfield Hospital, Forest Rd, Orange, NSW, Australia. E-mail: