End-of-life sedation remains a controversial and ill-defined clinical practice; its applications vary considerably. With this in mind, a study was conducted using a 2 × 2 experimental design. The variables experimented with were prognosis (short- or long-term) and type of suffering (physical or existential). The goal was to study the influence of the two independent variables on attitude toward sedation. Four clinical vignettes were completed by 124 clinicians, doctors, and pharmacists working in different palliative care environments in the Province of Quebec. The results indicate that the type of suffering influences a subject's attitude to end-of-life sedation. Thus, when a patient was suffering physically, the respondents were significantly in favour of sedation, whereas they were not in favour of this practice if the suffering was existential. Lastly, it is clear that health professionals are uncomfortable when confronted with their patients’ existential suffering. This is an issue worth exploring in future studies.
Get full access to this article
View all access options for this article.
References
1.
RévelartE.“Faire dormir” le malade: une autre réponse aux morts “difficiles.” In: JacqueminD. (ed). Manuel de soins palliatifs.Paris: Dunod, 2001; pp. 681–692.
2.
FondrasJ., DunphyK.Feedback. The ethics of sedation-further issues… “sedation and ethical contradiction.” Eur J Palliat Care1996; 3: 17–20.
CôtéS.La sédation profonde…pour qui?Bulletin de l'AQSP2000; 8: 8–12.
5.
QuillT.E., ByockI.R.Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of foods and fluids. Ann Intern Med2000; 132: 408–414.
6.
WeinS.Sedation in the imminently dying patient. Oncology2000; 14: 585–598.
7.
MountB., FlandersE.M.Morphine drips, terminal sedation, and slow euthanasia: definitions and facts, not anecdotes. J Palliat Care1996; 12: 31–37
8.
PeruselliC., GiulioP.D., ToscanlF., GalluciM.Home palliative care for terminal cancer patients: a survey on the final week of life. Palliat Med1999; 13: 233–241.
9.
BroeckaertB.Palliative sedation: ethical aspects. In: GastmansC. (ed). Between Technology and Humanity.Leuven, Belgium: Leuven University Press, 2002; pp. 239–259.
10.
RousseauP.The ethical validity and clinical experience of palliative sedation. Mayo Clin Pro2000; 75: 1064–1069.
11.
MazzocatoC.À propos de la “sédation” en phase terminale. Le point de vue clinique. Infokara1996; 43: 31–37.
12.
OrentlicherD.The Supreme Court and physician-assisted suicide: rejecting assisted suicide but embracing euthanasia. N Engl J Med1997; 337: 1236–1239.
13.
QuillT.E., DresserR., BrockD.W.The rule of double effect— a critique of its role in end-of-life decision making. New Engl J Med1997; 337: 1768–1771.
14.
RousseauP.Existential suffering and palliative sedation in terminal illness. Prog Palliat Care2002; 10(5): 222–224.
15.
HallenbeckJ.L.Terminal sedation: ethical implications in different situations. J Palliat Med2000; 3(3): 313–320.
16.
Porto SalesJ.La sédation et les soins en fin de vie. Journal européen des soins palliatifs2001; 8: 97–100.
17.
MoritaT.Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients. J Pain Symptom Manage2004; 28(5): 445–450.
18.
MayerR., OuelletF.Méthodologie de recherche pour les intervenants sociaux.Boucherville: Gaëtan Morin, 1999; p. 537.
World Health Organization.Cancer Suffering Relief and Palliative Care. Report of a WHO Expert Committee. WHO Technical Report Series. Report No. 804.Geneva: WHO, 1990.
21.
DurandG.Introduction générale à la bioéthique. Histoire, concepts et outils.Montreal: Éditions Fides, 1999.
22.
BeauchampT.L., ChildressJ.F.Principles of Biomedical Ethics. 3rd edition. New York: Oxford University Press, 1989.
23.
CavanaughT.A.The ethics of death-hastening death-causing palliative analgesic administration to the terminally ill. J Pain Symptom Manage1996; 12: 248–254.
24.
BernatJ.L.Ethical and legal issues in palliative care. Neurol Clin2001; 19: 969–987.
25.
BradyH.Commentary on Billings and Block's “Slow Euthanasia.”J Palliat Care1996; 12: 38–41.
26.
GillonR.Palliative care ethics: non-provision of artificial nutrition and hydration to terminally ill sedated patients. J Med Ethics1994; 20: 131–132.
27.
LavoieM.Philosophie du soin palliatif [doctoral dissertation].Québec: Université Laval, 2003.
28.
RadbruchL.Réflexions sur l'emploi de la sédation en soins palliatifs. Journal européen de soins palliatifs2002; 9: 237–239.
29.
MoritaT., TsunodaJ., InoueS., ChiharaS.Terminal sedation for existential distress. Am J Hosp Palliat Care2000; 17: 189–195.
30.
RousseauP.Existential suffering and palliative sedation: a brief commentary with a proposal for clinical guidelines. Am J Hosp Palliat Care2001; 18(3): 151–153.
31.
MoritaT., TsunetoS., ShimaY.Definition of sedation for symptom relief: a systematic literature review and a proposal of operational criteria. J Pain Symptom Manage2002; 24(4): 447–453.
32.
HallenbeckJ.Terminal sedation for intractable distress. Not slow euthanasia but a prompt response to suffering. West J Med1999; 171: 222–223.
33.
ChaterS., ViolaR., PatersonJ., JarvisV.Sedation for intractable distress in the dying—a survey of experts. Palliat Med1998; 12: 255–269.
