The ethical evaluation of continuous sedation at the end of life

Delden, van; Johannes, Jimmy

doi:10.1017/cbo9781139856652.013

Cited by 11 publications

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“…It should be noted that ‘temporary’ or ‘intermittent sedation’ as an alternative to assisted suicide, if it is not deep, seems more ethically acceptable than CDSUD because, contrary to CDSUD, it does not generally end a person’s ‘biographical life’ (by ending the ability to interact with other people) and probably does not shorten her ‘biological life’ [ 4 , 5 , 61 ]. In other words, interactions with other people are still possible.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study on continuous deep sedation until death as an alternative to assisted suicide in Switzerland

2021

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Background According to the European Association for Palliative Care, decisions regarding palliative sedation should not be made in response to requests for assisted dying, such as euthanasia or assisted suicide. However, several studies show that continuous deep sedation until death (CDSUD) – a particular form of sedation – has been considered as an alternative to these practices in some countries. In Switzerland, where assisted suicide is decriminalized and CDSUD is not legally regulated, no studies have comprehensively investigated their relation. Our study aimed to identify and describe the experience among palliative care physicians of CDSUD as a potential alternative to assisted suicide in the French-speaking part of Switzerland. Methods We performed an exploratory multicentre qualitative study based on interviews with palliative care physicians in the French-speaking part of Switzerland and conducted linguistic and thematic analysis of all interview transcripts. The study is described in accordance with COREQ guidelines. Results We included 10 interviews conducted in four palliative care units. Our linguistic analysis shows four main types of sedation, which we called ‘rapid CDSUD’, ‘gradual CDSUD’, ‘temporary sedation’ and ‘intermittent sedation’. CDSUD (rapid or gradual) was not considered an alternative to assisted suicide, even if a single situation has been reported. In contrast, ‘temporary’ or ‘intermittent sedation’, although not medically indicated, was sometimes introduced in response to a request for assisted suicide. This was the fact when there were barriers to an assisted suicide at home (e.g., when transfer home was impossible or the patient wished not to burden the family). Conclusion These preliminary results can guide clinical, ethical, linguistic and legal reflection in this field and be used to explore this question more deeply at the national and international levels in a comparative, interdisciplinary and multiprofessional approach. They can also be useful to update Swiss clinical guidelines on palliative sedation in order to include specific frameworks on various sedation protocols and sedation as an alternative to assisted suicide. Potential negative impacts of considering palliative sedation as an alternative to assisted suicide should be nuanced by open and honest societal debate.

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Section: Discussionmentioning

confidence: 99%

A qualitative study on continuous deep sedation until death as an alternative to assisted suicide in Switzerland

2021

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“…13 However, from an ethical point of view, because it means the end of a person’s biographical (social) life, it is always an exceptional last resort measure and should not be considered routine or the default option. 42 Consequently, concern has been expressed that ‘normalization’ could result in the ethical aspects of PS being ignored or glossed over. 43…”

Section: Normal or Exceptional Treatment?mentioning

confidence: 99%

Reflections on palliative sedation

Twycross¹

2019

Palliat�Care

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‘Palliation sedation’ is a widely used term to describe the intentional administration of sedatives to reduce a dying person’s consciousness to relieve intolerable suffering from refractory symptoms. Research studies generally focus on either ‘continuous sedation until death’ or ‘continuous deep sedation’. It is not always clear whether instances of secondary sedation (i.e. caused by specific symptom management) have been excluded. Continuous deep sedation is controversial because it ends a person’s ‘biographical life’ (the ability to interact meaningfully with other people) and shortens ‘biological life’. Ethically, continuous deep sedation is an exceptional last resort measure. Studies suggest that continuous deep sedation has become ‘normalized’ in some countries and some palliative care services. Of concern is the dissonance between guidelines and practice. At the extreme, there are reports of continuous deep sedation which are best described as non-voluntary (unrequested) euthanasia. Other major concerns relate to its use for solely non-physical (existential) reasons, the under-diagnosis of delirium and its mistreatment, and not appreciating that unresponsiveness is not the same as unconsciousness (unawareness). Ideally, a multiprofessional palliative care team should be involved before proceeding to continuous deep sedation. Good palliative care greatly reduces the need for continuous deep sedation.

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“…Some commentators argue that CS causes death and often amounts to ‘slow euthanasia’ [ 8 - 10 ]. Others argue that even if CS does not hasten death, it causes patients to permanently lose the capacity to communicate, and may thus amount to an imposition of social death on the patient [ 11 , 12 ]. However, other commentators, as well as many guidelines [ 1 - 5 ], maintain that there is a distinct difference between CS and euthanasia.…”

Section: Introductionmentioning

confidence: 99%

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium

et al. 2014

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BackgroundContinuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.MethodsThis study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology.ResultsThe participants’ responses can be captured as different dimensions of ‘closeness’, i.e. the degree to which one feels connected or ‘close’ to a certain decision or event. We distinguished four types of ‘closeness’, namely emotional, physical, decisional, and causal. Using these four dimensions of ‘closeness’ it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility.ConclusionFindings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.

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The ethical evaluation of continuous sedation at the end of life

Cited by 11 publications

References 0 publications

A qualitative study on continuous deep sedation until death as an alternative to assisted suicide in Switzerland

A qualitative study on continuous deep sedation until death as an alternative to assisted suicide in Switzerland

Reflections on palliative sedation

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium

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