What do you mean by “palliative sedation”?

Abstract

Background Sedation in palliative care is frequently but controversially discussed. Heterogeneous definitions and conceptual confusion have been cited as contributing to different problems 1) relevant to empirical research, for example, inconsistent data about practice, the ‘data problem’, and 2) relevant for an ethically legitimate characterisation of the practice, the ‘problem of ethical pre-emption’. However, little is known about how exactly definitions differ, how they cause confusion and how this can be overcome. Method Pre-explicative analyses: (A) systematic literature search for guidelines on sedation in palliative care and systematic decomposition of the definitions of the practice in these guidelines; (B) logical distinction of different ways through which the two problems reported might be caused by definitions; and (C) analysis of how content of the definitions contributes to the problems reported in these different ways. Results 29 guidelines from 14 countries were identified. Definitions differ significantly in both structure and content. We identified three ways in which definitions can cause the ‘data problem’ – 1) different definitions, 2) deviating implicit concepts, 3) disagreement about facts. We identified two ways to cause the problem of ethical pre-emption: 1) explicit or 2) implicit normativity. Decomposition of definitions linked to the distinguished ways of causing the conceptual problems shows how exactly single parts of definitions can cause the problems identified. Conclusion Current challenges concerning empirical research on sedation in palliative care can be remediated partly by improved definitions in the future, if content and structure of the used definitions is chosen systematically. In addition, future research should bear in mind that there are distinct purposes of definitions. Regarding the ‘data problem’, improving definitions is possible in terms of supplementary information, checking for implicit understanding, systematic choice of definitional elements. ‘Ethical pre-emption’, in contrast, is a pseudo problem if definitions and the relationship of definitions and norms of good practice are understood correctly.

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

“…However, extensive literature clearly shows that it is not only the clinical practice of CDSUD, but also the terminology and definitions of this therapy that are heterogeneous and sometimes highly controversial. This problem has been frequently demonstrated and discussed in the international literature for several years, without consensus or guidelines being achieved [4,5,[7][8][9][10][11][12]. In this paper, we use the framework of terms and conceptualizations proposed by the EAPC [1] and Morita et al [6].…”

Intentional Sedation as a Means to Ease Suffering: A Systematically Constructed Terminology for Sedation in Palliative Care

“…In most guidelines, the authors have summarized parts of their understanding of clinically and ethically good sedation practice in palliative care in the respective definitions of “palliative sedation.” 3 We deviate from this strategy for the following reasons: first, the definition of a practice should not vary between institutions/countries as a consequence of slightly different rules of good practice. Second, this strategy has caused an abundance of concurrent definitions with no tendency toward any international consensus.…”

“…As a starting point, we used logical analyses of the content and structure of the definitions (or definition-like passages) identified in a systematic literature search for guidelines on sedation in palliative care. 3 This was followed by repeated discussions within the SedPall study group, including work with case vignettes on controversial cases. We also included emerging results from the qualitative interviews on perspectives of health care professionals, relatives, and patients.…”

“…Experts within and outside palliative care criticize the terminological situation concerning sedation in palliative care and have repeatedly requested improvement. 1 , 2 Definitions differ significantly in content and structure, 3 and there is uncertainty among practitioners about identifying cases with commonly used terms such as “palliative sedation.” 4–6 …”

Continuous Deep Sedation Until Death Is Not an Alternative to Assisted Suicide in Palliative Care Units in the French-Speaking Part of Switzerland: A Multicentre Qualitative Study Based on Interviews With Physicians.

“…However, the extensive literature clearly shows that it is not only the clinical practice of CDSUD, but also the terminology and de nitions of this therapy that are heterogeneous and sometimes highly controversial. This problem has been frequently demonstrated and discussed in the international literature for several years, without consensus or guidelines being achieved [4,5,[7][8][9][10][11][12]. In this paper, we use the framework of terms and conceptualizations proposed by the EAPC and Morita et al [1,6].…”