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Current debates on end-of-life sedation: an international expert elicitation study

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Abstract

Purpose

End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates.

Methods

Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited. Open-ended, semi-structured interviews, following a topic-oriented structure reflecting on current debates, were conducted. Results were analysed using thematic content analysis.

Results

Three main aspects of sedation were identified and discussed as potentially problematic: (a) continuous deep sedation as an extreme facet of end-of-life sedation, (b) psycho-existential suffering as an ambivalent indication for sedation and (c) withdrawal or withholding of artificial nutrition and hydration as potentially life-shortening. On these grounds, concerns were reported over end-of-life sedation being morally equivalent to euthanasia. Considerable emphasis was placed on intentions as the distinguishing factor between end-of-life acts, and protective safeguards were introduced to distance sedation from euthanasia.

Conclusions

This study shows that, despite the safeguards introduced, certain aspects of sedation, including the intentions associated with the practice, are still under question, parallels being drawn between end-of-life sedation and euthanasia. This reaffirms the existence of a grey area surrounding the two practices, already evidenced in countries where euthanasia is legalized. More clarity over the issues that generate this grey area, with their causes being uncovered and eliminated, is imperative to resolve current debates and effectively inform research, policy and practice of end-of-life sedation.

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Acknowledgments

This paper is part of the EUROIMPACT (European Intersectorial and Multidisciplinary Palliative Care Research Training) and is funded by the European Union Seventh Framework Programme (FP7/2007–2013, under grant agreement no. [264697]). EUROIMPACT aims to develop a multi-disciplinary, multi-professional and inter-sectorial educational and research training framework for palliative care research in Europe. EUROIMPACT is coordinated by Prof Luc Deliens and Prof Lieve Van den Block of the End-of-Life Care Research Group, Ghent University, and Vrije Universiteit Brussel, Brussels, Belgiuma. Other partners are as follows: VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands;b King’s College London, Cicely Saunders Institute, London;c Cicely Saunders International, London,d and International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK;e Norwegian University of Science and Technologyf and EAPC Research Network,g Trondheim, Norway; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy,h and Cancer Research and Prevention Institute, Florence, Italy;i EUGMS (European Union Geriatric Medicine Society), Geneva, Switzerland;j Springer Science and Business Media, Houten, the Netherlandsk. The authors would like to thank all palliative care experts for their contribution to this study.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. International Observatory on End of Life Care, Lancaster University, Lancaster, LA1 4YT, UK

    Evangelia (Evie) Papavasiliou, Sheila Payne & Sarah Brearley

Authors
  1. Evangelia (Evie) Papavasiliou
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  2. Sheila Payne
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  3. Sarah Brearley
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on behalf of EUROIMPACT

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Correspondence to Evangelia (Evie) Papavasiliou.

Additional information

The members of EUROIMPACT are Van den Block Lieve,a De Groote Zeger,a Brearley Sarah,e Caraceni Augusto,g, h Cohen Joachim,a Francke Anneke,b Harding Richard,c, d Higginson Irene J,c, d Kaasa Stein,f Linden Karen,k Miccinesi Guido,i Onwuteaka-Philipsen Bregje,b Pardon Koen,a Pasman Roeline,b Pautex Sophie,j Payne Sheila,e and Deliens Luc.a, b

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Papavasiliou, E.(., Payne, S., Brearley, S. et al. Current debates on end-of-life sedation: an international expert elicitation study. Support Care Cancer 22, 2141–2149 (2014). https://doi.org/10.1007/s00520-014-2200-9

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  • DOI: https://doi.org/10.1007/s00520-014-2200-9

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