Background <p>Nurses are integral to delivering humanistic care in palliative care settings. While Artificial Intelligence (AI) boasts significant potential for palliative care practices, its integration raises critical ethical concerns such as AI’s impact on patient autonomy and its risks of depersonalized care that warrant further exploration.</p> Methods <p>A qualitative study using reflexive thematic analysis was conducted to explore nurses’ perspectives on the potential impact of AI integration in palliative care, with a focus on ethical considerations and the prospective actions needed for implementation. Semi-structured interviews were conducted with 20 registered nurses experienced in palliative care, recruited from four hospitals across two urban centers in Sichuan Province, China.</p> Results <p>Nurses perceive AI integration as ethically transformative rather than merely technical, raising concerns regarding autonomy, trust, justice, and cultural alignment. The thematic analysis identified five major ethical considerations regarding AI integration in palliative care from nurses’ perspectives: (1) ethical challenges to patients’ autonomy and dignity; (2) AI-driven reconstruction of trust dynamics; (3) decision making conflicts in palliative care; (4) difficulties in achieving equity in AI-enabled health services; and (5) adaptation to cultural sensitivity.</p> Conclusions <p>The inclusion of AI ethics and dynamic moral decision‑making modules in nursing education is suggested to enhance nurses’ moral sensitivity to deliver equitable care, and strengthen their digital literacy and ethical awareness in AI‑mediated environments. Nurses may assume an ethical responsibility to reduce the risks of cultural bias in AI tools, and to advocate the integration of multicultural perspectives into AI design, training and evaluation, thereby advancing the development of more culturally responsive technologies. </p>