Control Measures for Continuous Deep Sedation Until Death: A Framing Analysis of the Views of Physicians

Abstract

Physicians have been subject to increasing external control to improve their medical practice, and scholars have theorized extensively about their opposition to such control. However, little empirical attention has been paid to the views and reasoning that lie behind this opposition. An in-depth understanding is necessary for enhancing the effectiveness and efficiency of external controls, and continuous deep sedation until death (CDS) is an interesting case in this regard. This study aims to explore how physicians frame control measures for CDS. We conducted 47 semi-structured interviews with Belgian physicians in 2019. A qualitative framing analysis was performed to analyze their views and reasoning. This study reveals that physicians approach CDS practice and control measures with different emphases. Controlling by mechanisms of professional self-regulation and state governance are put forward as appropriate means to improve CDS practice. Policymakers should take into consideration physicians’ frames to develop sound control measures.

Physicians’ Experiences and Perceptions of Environmental Factors Affecting Their Practices of Continuous Deep Sedation until Death: A Secondary Qualitative Analysis of an Interview Study

“…We performed a secondary study drawing on primary pre-existing data, namely indepth interviews with physicians, from a broader qualitative primary study that explored physicians' framing of CDS practice and its appropriate control measures [23]. Findings on the latter are reported elsewhere [23]. Following Heaton's classification of secondary studies, our study design reflects an inside supplementary approach [25,26].…”

“…The research paradigm of our primary study, i.e., the set of beliefs and assumptions that guide the research process [40], was based on social constructionism [41]. As such, we sought to grasp the social phenomena of CDS practice, namely, the multiple understandings and diverse realities of how physicians define and experience the specific context of the practice and potential control measures [23].…”

“…We performed a secondary qualitative analysis on the data from our primary study [23,[25][26][27]. Given the research question of the secondary study, the overall process of our secondary analysis was informed by the theoretical framework of new ecology of social practice, which merges the ecological and constructivist traditions [43,44].…”

“…The main research question of this study is: What are physicians' experiences and perceptions of what environmental factors affect their practice of CDS? To that end, we conducted a secondary analysis on primary data from a qualitative interview study with Belgian physicians [23]. The particular focus on perceptions and experiences of physicians has been chosen because they are prominent protagonists in CDS practice.…”

Continuous palliative sedation until death: a qualitative study of palliative care clinicians’ experiences

“…The indications for continuous sedation are linked to clinicians' intention to offer a "good" death for the patient and their family [18][19][20][21][22]. Palliative care clinicians also encounter challenges in providing quality sedation, including fear that continuous sedation hastens death, conflicting wishes between patients and families, and disagreements within care teams [13,[23][24][25].…”