BIOETHICARE 360O: A Deliberative Software for Ethical Computational Support in Complex Clinical Decision-Making

Background: Clinical decision-making at the end of life often involves complex ethical dilemmas that require balancing core principles such as patient autonomy, beneficence, justice, and non-maleficence. Although various clinical decision-support tools exist, few incorporate bioethical deliberation, argument traceability, and multiperspective participation. To address this gap, BIOETHICARE 360° was developed as a computational system designed to facilitate ethical analysis in terminal clinical cases. This study aimed to evaluate the software’s ability to identify ethical dilemmas, propose context-sensitive recommendations, and support real-time deliberative processes. Results. The system was applied to thirteen synthetic clinical cases representing common scenarios in palliative care and morally complex situations. BIOETHICARE 360° enabled the structured registration of clinical, sociocultural, and ethical information from the perspectives of the medical team, the patient's family, and the bioethics committee. Through its functional modules, the system performed ethical principle weighting, generated graphical visualizations of dissent, identified potential algorithmic biases, and activated narrative-based deliberations through a conversational assistant. In five of the thirteen cases, the primary dilemma identified involved conflicts between the patient’s advance directives and the family’s intention to pursue invasive interventions. In 77% of cases, the final recommendation was the early integration of palliative care. The system provided reasoned responses that included legal analysis, proposals for empathetic communication, and the automated generation of informed consent documents, demonstrating both technical consistency and ethical sensitivity. Conclusions. BIOETHICARE 360° represents a methodological and technological advancement in ethical support for clinical practice. Its modular architecture, ability to integrate multiple stakeholder perspectives, and deliberative engine grounded in bioethical principles enhance the transparency, traceability, and quality of decision-making in critical clinical settings. Beyond its clinical utility, the tool holds significant educational value by facilitating reflective processes within interdisciplinary teams. This study suggests that the use of artificial intelligence in medical ethics may offer a viable and trustworthy strategy for strengthening decision-making at the end of life.