Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach

Foley, Rose-Anna; Johnston, Wendy; Bernard, Mathieu; Canevascini, Michela; Currat, Thierry; Borasio, Gian Domenico; Beauverd, Michel

doi:10.1080/07481187.2015.1029142

Cited by 23 publications

(28 citation statements)

References 33 publications

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“…They find it difficult to accept their ambivalence toward sedation – the tension between the reasoned approach to the decision based on the intention to provide relief and the fear of harmful consequences that the power of the act of sedation generates in their minds [38, 39]. This tension should be examined from an ethics perspective, by looking at intention to treat principles in care provision and in clinical practice [40–43] and at the fact that although the decision is made by the team, its implementation involves the conscience of the individual nurse or physician carrying it out [6, 44–46]. …”

Section: Discussionmentioning

confidence: 99%

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

et al. 2017

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BackgroundDespite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation.MethodsData were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives.ResultsHealth care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients.ConclusionsThe uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it.

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Section: Discussionmentioning

confidence: 99%

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

et al. 2017

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“…This diversity in conceptual frameworks and clinical experience has produced uneasiness in health care professionals. Empirical studies indicate that clinicians still feel ambivalent about using PS-ES in their practice, 50,51 and a consensus for PS-ES is far from being reached. 27,52e54 Although use of PS-ES lacks a clear consensus, competing conceptual frameworks have not matured, and definitions vary about what constitutes suffering.…”

Section: Introductionmentioning

confidence: 99%

Palliative Sedation for Existential Suffering: A Systematic Review of Argument-Based Ethics Literature

Rodrigues

Crokaert

Gastmans

2018

Journal of Pain and Symptom Management

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“…In turn, less experienced healthcare professionals were more often ambivalent towards continuous deep sedation and thus more likely to consider it as possibly life shortening. [37][38][39] The variation in sedation practice is not only related to professionals' palliative care experience but also to different resources provided by the clinical setting. 40 According to clinical guidelines, continuous deep sedation until death requires a multidisciplinary decision-making process with the option to call in palliative care experts, continuous administration of benzodiazepines and regular patient's monitoring.…”

Section: Discussionmentioning

confidence: 99%

Using sedative substances until death: A mortality follow-back study on the role of healthcare settings

et al. 2018

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Background: In the last decade, the use of sedative substances to keep a patient in deep sedation until death increased fourfold in German-speaking Switzerland, where every third patient admitted to hospital, palliative care unit or hospice died continuously deeply sedated. Aim: To investigate sedation practices across healthcare settings and to identify their associations with conventional symptom control. Design: National mortality follow-back study in Switzerland between 2013 and 2014. Questionnaires on medical end-of-life decisions were sent to attending physicians of a continuous random sample of all registered deaths aged 1 year or older. Setting/participants: Of all sampled deaths, 3678 individuals who died non-suddenly and not through an external cause were included. Results: Across settings, continuous deep sedation appeared more likely in patients aged younger than 65 years (odds ratio range: 1.53–2.34) and as part of or after intensified alleviation of pain and symptoms (odds ratio range: 1.90–10.27). In hospitals, sedation was less likely for cancer patients (odds ratio: 0.7, 95% confidence interval: 0.5–1.0, p = 0.022). In nursing homes, sedation was more likely for people who were married (odds ratio: 1.8, 95% confidence interval 1.3–2.5, p = 0.001). Conclusion: In all settings, sedated patients have significantly more pain problems compared to patients not receiving sedation. Large differences between settings seem to indicate different patient populations, different levels of professionals’ palliative care experience and different availability of treatment options. Our study suggests that certain patient groups who may be as vulnerable to refractory pain and symptoms as others are less likely to receive continuous deep sedation until death when warranted.

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Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach

Cited by 23 publications

References 33 publications

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

Palliative Sedation for Existential Suffering: A Systematic Review of Argument-Based Ethics Literature

Using sedative substances until death: A mortality follow-back study on the role of healthcare settings

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