Dear Editor,

We read with great interest the article by Hendry et al. (Reference Hendry, Poolman and Nelson2026), “What can we learn from the accounts of lay carers administering end of life medications to a loved one at home?”. The study provides an important qualitative account of carers who were trained to administer as-needed subcutaneous medication during home-based end-of-life care. Particularly valuable is the finding that carers often felt empowered by being able to relieve symptoms promptly and support a loved one’s wish to remain at home, while simultaneously experiencing anxiety about symptom recognition, medication errors, and the possibility of hastening death.

We would like to extend this discussion by emphasizing that empowerment must not become obligation. The desire to fulfill a loved one’s preferred place of death may place carers in a morally difficult position, especially when they feel that declining medication administration could jeopardize home death. Hendry et al. themselves appropriately acknowledge that patients’ wishes may overshadow carers’ needs and that carers should neither be coerced nor overburdened. This distinction is important because family caregivers already undertake substantial emotional, practical, and decision-making responsibilities at the end of life (Becqué et al. Reference Becqué, Rietjens and van der Heide2021).

We therefore suggest that lay-carer administration should be implemented through a supported-choice model. Consent should be voluntary, revisitable, and separated from the broader decision to care for someone at home. Training should assess not only technical competence but also emotional readiness, confidence in symptom recognition, and willingness to assume responsibility. Evidence from community end-of-life care shows that family caregivers require flexible professional support and guidance as needs change (Becqué et al. Reference Becqué, Rietjens and van der Heide2021; Bowers et al. Reference Bowers, Pollock and Wilkerson2024).

Equally important is a clearly defined “rescue” pathway. Carers should know that requesting professional administration after training does not represent failure. Twenty-four-hour clinical advice, rapid escalation when symptoms are uncertain, and opportunities for post-bereavement discussion could reduce guilt and perceived responsibility. Observational evidence indicates that anticipatory injectable medicines involve complex clinical judgments even for professionals, while recent CARiAD findings support feasibility but also reinforce the importance of appropriate training and service support (Poolman et al. Reference Poolman, Wright and Hendry2025). Preferences regarding place of death should likewise be interpreted flexibly rather than as an outcome that families must achieve at all costs (Pollock et al. Reference Pollock, Caswell and Turner2024).

In conclusion, Hendry et al. (Reference Hendry, Poolman and Nelson2026) provide compelling evidence that appropriately supported carers can play a meaningful role in home end-of-life symptom management. Future implementation should preserve the benefits of empowerment while ensuring that participation remains genuinely optional. Framing lay administration as supported choice rather than expected caregiving may better protect carer autonomy, reduce emotional burden, and preserve the compassionate intent of home-based palliative care.

Sincerely,

Parid Rilo Pambudi