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

Abstract

Background: In the last two decades, nursing authors have published ethical analyses of palliative sedation—an end-of-life care practice that also receives significant attention in the broader medical and bioethics literature. This nursing literature is important, because it contributes to disciplinary understandings about nursing values and responsibilities in end-of-life care. Research aim: The purpose of this project is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses’ moral identities are portrayed within this literature. Research design: We reviewed discussion papers, written by nurses about the ethics of palliative sedation, which were cited in MEDLINE, CINAHL, Nursing and Allied Health, or Philosopher’s Index (search date March 2018). Twenty-one papers met selection criteria. We performed a comprehensive review and analysis (using the Qualitative Analysis Guide of Leuven), of the values, responsibilities, and relationships reflected in authors’ portrayal of the nursing role. Findings: Two different tones are apparent in the extant nursing ethics literature. One is educational, while the other is critically reflective. Irrespective of tone, all authors agree on the alleviation of suffering as a fundamental nursing responsibility. However, they differ in their analysis of this responsibility in relation to other values in end-of-life care, including those that depend on consciousness. Finally, authors emphasize the importance of subjective and experience-based understandings of palliative sedation, which they argue as depending on nurses’ proximity to patients and families in end-of-life care. Discussion and conclusion: Based on our findings, we develop three recommendations for future writing by nurses about palliative sedation. These relate to the responsibility of recognizing how consciousness might matter in (some) peoples’ moral experiences of death and dying, to the importance of moral reflectiveness in nursing practice, and to the value of a relational approach in conceptualizing the nursing ethics of palliative sedation.

Nursing students' perceptions of euthanasia legislation: A qualitative study

“…Consequently, one of the most influential determinants for students is respect for the patient's right to autonomy. This is in line with previous studies in which this ethical principle is key and is decisive in nurses' thinking about euthanasia and assisted suicide (Lavoie et al, 2016;Terkamo-Moisio et al, 2017;Wilson et al, 2021;Wright et al, 2020).…”

Fertility preservation for transgender children and young people in paediatric healthcare: a systematic review of ethical considerations

“…QUAGOL is an iterative, systematic method of data analysis 36. Initially, developed as a way of analysing qualitative interview data, it has been increasingly used in reviews of normative literature 37 38. QUAGOL involves two parts, each consisting of five stages, where researchers manually draw themes from and subsequently code the literature 36…”

The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death

“…The psychological adjustment of HCP and their experience of their job are becoming subjects of growing interest in scientific literature. Regarding the HCP, American studies indicated that palliative sedation (no specific focus on CDSUD) might arouse very strong ethical issues that can cause professional distress in nurses [ 27 ]. However, the nature of this distress is not systematically described.…”