Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

Abstract

Objective: Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients.Method: Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data.Results: Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened.Significance of results: Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.

Moral identity and palliative sedation: A systematic review of normative nursing literature

“…Thus, while nurses play a key role in palliative sedation care processes, and generally support its place in palliative and end-of-life care as an important last-resort option, they nevertheless experience ethical challenges with its enactment. [15][16] Purpose The purpose of this project is to review existing nursing ethics literature about…”

The experience of delirium in palliative care settings for patients, family, clinicians and volunteers: A qualitative systematic review and thematic synthesis

“…Usefulness of findings for this review Agar et al 22 High Medium Bolton et al 54 Medium Medium Brajtman [51][52][53] Medium Medium Brajtman et al 40 Medium Medium Bush et al 41 High Medium Cohen et al 48 Medium Medium De Vries et al 45 Medium Medium Gagnon et al 42 Low Low Greaves et al 36 High Medium Hosie et al 23,37,38 High High Hosie et al 38,39 High High Namba et al 49 Low Medium Szarpa et al 47 Medium Medium Uchida et al 50 Low Medium Waterfield et al 46 Medium Medium Wright et al 43,44 Medium Medium clinicians' decision-making about medication use to manage the distressing symptoms of delirium.…”

“…48,49 Beyond 'person-centred' care: responding to the needs of the family: Clinicians went beyond the person-centred care of the patient to respond to the needs of the family. In several studies, clinicians recognised the distress that delirium can cause to family members and sought to alleviate it, 40,43,45 "You don't want. .…”

Ethical Problems in Palliative Care: A Systematic Review

“…36 Vries de ve Plaskota'nın çalışmasında, sedasyon uygulanıp uygulanmaması konusunda etik ikilem yaşandığı sonucuna varılmıştır. 37 Sandman ve ark. tarafından hemşirelerle yürütülen çalışma sonucunda; tedavi planlaması, hasta, hasta yakını ve sağlık profesyoneli arasındaki ilişki kaynaklı etik sorunlar, iletişim sorunları ve sağlık profesyoneli ile kurum arasındaki etik çatışma yaşandığı belirlenmiştir.…”