Ethical principles and challenges in end-of-life care for frail older adults

Providing end-of-life care to frail, older adults with multiple comorbidities can be ethically complex. As frailty differs from single terminal illness, end-of-life care requires a carefully considered, ethically informed approach. The four core ethical principles of autonomy, beneficence, nonmaleficence and justice need to be applied within this context; they involve challenges specific to frail patients, including fluctuating mental capacity, the risks of aggressive interventions and equitable access to resources. Key ethical issues include do not attempt cardiopulmonary resuscitation orders, confidentiality, mental capacity assessments and palliative sedation. Health professionals require a structured framework for decision-making. By balancing patient dignity, quality of life and legal considerations, practitioners can understand ethical obligations and practical decision-making strategies. For frail, older adults, a compassionate, patient-centred approach that prioritises comfort and dignity, especially as people approach the end of life, ensures care is provided in line with both ethical and legal standards

Sustainable Management of Mediterranean Superyacht Marinas: A Comparative Assessment of Environmental Practices and Policy Implications

The Mediterranean superyacht industry significantly contributes to the region’s economy, but its rapid growth has raised serious environmental concerns. This study compares the emissions, waste management, and biodiversity protection of two marinas located in Sicily, Italy, and the Balearic Islands, Spain. A survey assessing the carbon footprint and water quality was distributed to the management of the marinas. The collected data were analysed and translated into tonnes of CO2 equivalent using emission factors. By calculating the carbon and water footprints of the two marinas, this study aimed to understand the environmental impact of port-related operations. The JMarinas Environmental Decision Support System and a P-Mapping/Pareto approach were used to identify pollutant sources, following Pareto’s principle. The findings indicated that the primary operations of the marina sector are the main sources of pollution, with significant contributions from supporting activities. This study clarifies the origins of CO2 and pollution in marina operations, enabling the authors to recommend the close supervision of all recreational boating activities to reduce CO2 emissions and environmental degradation. By adopting these recommendations, policymakers, marina operators, and yacht owners can ensure the long-term sustainability of Mediterranean marinas