Abstract Background The Accident and Emergency Department (AED) is a critical entry point for patients with terminal illnesses, yet it traditionally focuses on acute resuscitation. Emergency physicians in Hong Kong frequently face ethically challenging end‐of‐life (EOL) care decisions. The ethical decision‐making climate (EDMC)—shared perception of ethical procedures and practices—is crucial for managing these dilemmas. Objective The objective of this paper is to explore the EDMC among Hong Kong emergency doctors and nurses, identify its key drivers, and assess its relationship with formal EOL care services in the emergency medicine ward. Methods A cross‐sectional online survey was conducted (April 1 to 30 June 2025) targeting doctors ( n = 96) and nurses ( n = 236) from six public hospital AEDs. The validated 32‐item EDMC questionnaire (EDMCQ) was adapted for the AED context (Cronbach's α = 0.971). Participants rated their agreement on initiating EOL care in three hypothetical scenarios. Data were analyzed using descriptive statistics, Mann–Whitney U tests, and Spearman's correlation. Results The overall EDMC was moderately positive (mean = 3.45/5.0). Nurses perceived the EDMC significantly less positively than doctors (mean 3.40 vs. 3.58 and p = 0.022). A perceptual gap regarding the involvement in EOL decision‐making between doctors and nurses was observed. Staff in AEDs with a formal EOL care program reported more positive overall EDMC (mean 3.92 vs. 3.09 and p < 0.001). Strong positive correlations ( p < 0.001) were found between the overall EDMC and key factors, including nurse–physician collaboration ( r = 0.678), interdisciplinary tolerance ( r = 0.640), and empowering physician leadership ( r = 0.556–0.596). In clinical scenarios, staff from AEDs with formal EOL care were significantly more likely to agree on the appropriateness of EOL interventions. Conclusion The EDMC in Hong Kong's AEDs is moderately positive, with a doctor–nurse perceptual gap over nurse involvement in EOL decisions. Positive climates are driven by collaboration, tolerance, and empowering leadership. Formal EOL care programs are associated with a better ethical environment for decision‐making.
Yiu et al. (Mon,) studied this question.