The lack of inclusive definition of end-of-life care and people who are eligible to receive end-of-life care
creates ethical tensions for nurses. As described before, patients who are admitted to hospice palliative
care units are limited to those with terminal-stage cancer or HIV/AIDS in Japan. A patient who is suffering from advanced-stage chronic obstructive pulmonary disease (COPD) cannot be admitted to the hospice palliative care unit because of his diagnosis. Nurses taking care of him may recognize his needs for
end-of-life care such as good symptom management and assistance to prepare him for death. But nurses
may not be able to bring in resources to meet his needs because he does not meet the hospice palliative
care criteria. Nurses in this situation would feel moral distress for providing unjust and inequitable care
differentiating patients by their diagnosis. Nurses taking care of a young woman who is newly diagnosed
with breast cancer may recognize a need of this woman and her husband to talk about death.