Considerations of physicians about the depth of palliative sedation at the end of life

Abstract

Interpretation:Physicians who choose either mild or deep sedation appear to be guided by the same objective of delivering sedation in proportion to the relief of refractory symptoms, as well as other needs of patients and their families. This suggests that proportionality should be seen as a multidimensional notion that can result in different approaches toward the depth of sedation. AbstractResearch CMAJ, April 17, 2012, 184 (7)

The Practice of Continuous Sedation Until Death in Nursing Homes in Flanders, Belgium: A Nationwide Study

“…If it is assumed that this element of the guideline was put into practice in all cases, it would mean that most individuals in the current study experienced a high degree of suffering. Alternatively, a qualitative study of physicians revealed that proportionality—in the context of the administration of CSD—covers multiple dimensions, thus not just the degree of suffering, but also individual preferences, communication needs, wishes of relatives, and aesthetic consequences . For example, some physicians aim for mild sedation because they consider communication with the individual to be important.…”

“…Alternatively, a qualitative study of physicians revealed that proportionality-in the context of the administration of CSD-covers multiple dimensions, thus not just the degree of suffering, but also individual preferences, communication needs, wishes of relatives, and aesthetic consequences. 25 For example, some physicians aim for mild sedation because they consider communication with the individual to be important. Other physicians may pursue deep sedation from the start to reassure the individual (and his relatives) that the suffering will continue to be relieved once CSD has been started.…”

Reasons for continuous sedation until death in cancer patients: a qualitative interview study

“…Palliative sedation can be performed for short periods of time, intermittently or continuously until death, and the depth of sedation can vary from a lower level of consciousness to complete unconsciousness (De Graeff & Dean ; Swart et al . ). It is a quite frequently occurring practice (Rietjens et al .…”

Opinions of the Dutch public on palliative sedation: a mixed-methods approach

“…9 International research regarding palliative sedation is increasing rapidly and has been mainly focused on practices, 10,11 experiences, 12,13 and attitudes of professionals. 14,15 There is concern about the potential of palliative sedation to hasten death. Whereas these issues tend to evoke rather fierce debate, also in the lay press, physicians taking care of patients at the end of life may be confronted with varying expectations, attitudes, and possibly misunderstandings.…”