Physicians have been subject to increasing external control to improve their medical practice, and scholars have theorized extensively about their opposition to such control. However, little empirical attention has been paid to the views and reasoning that lie behind this opposition. An in-depth understanding is necessary for enhancing the effectiveness and efficiency of external controls, and continuous deep sedation until death (CDS) is an interesting case in this regard. This study aims to explore how physicians frame control measures for CDS. We conducted 47 semi-structured interviews with Belgian physicians in 2019. A qualitative framing analysis was performed to analyze their views and reasoning. This study reveals that physicians approach CDS practice and control measures with different emphases. Controlling by mechanisms of professional self-regulation and state governance are put forward as appropriate means to improve CDS practice. Policymakers should take into consideration physicians’ frames to develop sound control measures.
AbarshiE.PapavasiliouE.PrestonN.BrownJ.PayneS. (2014). The complexity of nurses’ attitudes and practice of sedation at the end of life: A systematic literature review. Journal of Pain and Symptom Management, 47(5), 915–925. https://doi.org/10.1016/j.jpainsymman.2013.06.011
2.
AbarshiE.RietjensJ.RobijnL.CaraceniA.PayneS.DeliensL.Van Den BlockL. (2017). International variations in clinical practice guidelines for palliative sedation: A systematic review. BMJ Supportive and Palliative Care, 7(3), 223–229. https://doi.org/10.1136/bmjspcare-2016-001159
3.
AnquinetL.RietjensJ. A. C.MathersN.SeymourJ.Van Der HeideA.DeliensL. (2015). Descriptions by general practitioners and nurses of their collaboration in continuous sedation until death at home: In-depth qualitative interviews in three European countries. Journal of Pain and Symptom Management, 49(1), 98–109. https://doi.org/10.1016/j.jpainsymman.2014.05.012
4.
AnquinetL.RietjensJ. A. C.SealeC.SeymourJ.DeliensL.Van Der HeideA. (2012). The practice of continuous deep sedation until death in Flanders (Belgium), the Netherlands, and the UK: A comparative study. Journal of Pain and Symptom Management, 44(1), 33–43. https://doi.org/10.1016/j.jpainsymman.2011.07.007
CharlesC.GafniA.WhelanT. (1999). Decision making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Social Science & Medicine, 49(5), 651–661. https://doi.org/10.4324/9781315013015-30
9.
ChernyN. I.RadbruchL.ChasenM.CoyleN.CharlesD.DeanM.DerbyS.FallonM.FerrelB.FerrisF.KirkT.LacyJ.LieR.LieberS.LoprinziC.ObermanA.RosengartenO.RegnardC.SellaG. B.DeConnoF. (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine, 23(7), 581–593. https://doi.org/10.1177/0269216309107024
10.
ClaessensP.MentenJ.SchotsmansP.BroeckaertB. (2008). Palliative sedation: A review of the research literature. Journal of Pain and Symptom Management, 36(3), 310–333. https://doi.org/10.1016/j.jpainsymman.2007.10.004
11.
ClaessensP.MentenJ.SchotsmansP.BroeckaertB. (2011). Palliative sedation, not slow euthanasia: A prospective, longitudinal study of sedation in Flemish palliative care units. Journal of Pain and Symptom Management, 41(1), 14–24. https://doi.org/10.1016/j.jpainsymman.2010.04.019
12.
CohenJ.Van DeldenJ.MortierF.LöfmarkR.NorupM.CartwrightC.FaisstK.CanovaC.Onwuteaka-PhilipsenB.BilsenJ. (2008). Influence of physicians’ life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries. Journal of Medical Ethics, 34(4), 247–253. https://doi.org/10.1136/jme.2006.020297
13.
CohenJ.Van WesemaelY.SmetsT.BilsenJ.DeliensL. (2012). Cultural differences affecting euthanasia practice in Belgium: One law but different attitudes and practices in Flanders and Wallonia. Social Science & Medicine, 75(5), 845–853. https://doi.org/10.1016/j.socscimed.2012.04.021
DavidC. C.AtunJ. M.FilleE.MonterolaC. (2011). Finding frames: Comparing two methods of frame analysis. Communication Methods and Measures, 5(4), 329–351. https://doi.org/10.1080/19312458.2011.624873
FalkumE.FørdeR. (2001). Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship: Attitudes among Norwegian physicians. Social Science & Medicine, 52(2), 239–248. https://doi.org/10.1016/S0277-9536(00)00224-0
19.
FiskeS.TaylorS. E. (2017). Social cognition: From brains to culture (3rd ed.). SAGE.
20.
FoleyK.WardP.McNaughtonD. (2019). Innovating qualitative framing analysis for purposes of media analysis within public health inquiry. Qualitative Health Research, 29(12), 1810–1822. https://doi.org/10.1177/1049732319826559
21.
GreenfieldG.PliskinJ. S.Feder-BubisP.WientroubS.DavidovitchN. (2012). Patient-physician relationships in second opinion encounters: The physicians’ perspective. Social Science & Medicine, 75(7), 1202–1212. https://doi.org/10.1016/j.socscimed.2012.05.026
22.
HoekP.GrandjeanI.VerhagenC.Jansen-LandheerM.SchersH.GaleslootC.VissersK.EngelsY.HasselaarJ. (2015). Addressing palliative sedation during expert consultation: A descriptive analysis of the practice of Dutch palliative care consultation teams. PLOS ONE, 10(8), Article e0136309. https://doi.org/10.1371/journal.pone.0136309
KoenigT. (2006). Compounding mixed-methods problems in frame analysis through comparative research. Qualitative Research, 6(1), 61–76. https://doi.org/10.1177/1468794106058874
25.
KoperI.Van Der HeideA.JanssensR.SwartS.PerezR.RietjensJ. (2014). Consultation with specialist palliative care services in palliative sedation: Considerations of Dutch physicians. Supportive Care in Cancer, 22(1), 225–231. https://doi.org/10.1007/s00520-013-1972-7
26.
LloydB.HaweP. (2003). Solutions forgone? How health professionals frame the problem of postnatal depression. Social Science & Medicine, 57(10), 1783–1795. https://doi.org/10.1016/S0277-9536(03)00061-3
27.
MaedaS.MoritaT.IkenagaM.AboH.KizawaY.TsunetoS. (2019). Changes in opinions on palliative sedation of palliative care specialists over 16 years and their effects on clinical practice. Supportive Care in Cancer, 27(6), 2211–2219. https://doi.org/10.1007/s00520-018-4497-2
28.
MaltoniM.PittureriC.ScarpiE.PiccininiL.MartiniF.TurciP.MontanariL.NanniO.AmadoriD. (2009). Palliative sedation therapy does not hasten death: Results from a prospective multicenter study. Annals of Oncology, 20(7), 1163–1169. https://doi.org/10.1093/annonc/mdp048
29.
MatthesJ.KohringM. (2008). The content analysis of media frames: Toward improving reliability and validity. Journal of Communication, 58(2), 258–279. https://doi.org/10.1111/j.1460-2466.2008.00384.x
30.
MoritaT.ImaiK.YokomichiN.MoriM.KizawaY.TsunetoS. (2017). Continuous deep sedation: A proposal for performing more rigorous empirical research. Journal of Pain and Symptom Management, 53(1), 146–152. https://doi.org/10.1016/j.jpainsymman.2016.08.012
31.
MoritaT.TsunetoS.ShimaY. (2002). Definition of sedation for symptom relief: A systematic literature review and a proposal of operational criteria. Journal of Pain and Symptom Management, 24(4), 447–453. https://doi.org/10.1016/S0885-3924(02)00499-2
32.
NumeratoD.SalvatoreD.FattoreG. (2012). The impact of management on medical professionalism: A review. Sociology of Health & Illness, 34(4), 626–644. https://doi.org/10.1111/j.1467-9566.2011.01393.x
33.
Onwuteaka-PhilipsenB.Van Der WalG.KostenseP.Van Der MaasP. (2000). Consultation with another physician on euthanasia and assisted suicide in The Netherlands. Social Science & Medicine, 51(3), 429–438. https://doi.org/10.1016/S0277-9536(99)00476-1
34.
PalinkasL.HorwitzS.GreenC.WisdomJ.DuanN.HoagwoodK. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y
35.
PattonM. Q. (2015). Qualitative research and evaluation methods (4th ed.). SAGE.
36.
PontE. (2000). The culture of physician autonomy; 1900 to the present. Cambridge Quarterly of Healthcare Ethics, 9(1), 98–119. https://doi.org/10.1017/s0963180100001109
37.
RausK.BrownJ.SealeC.RietjensJ. A.JanssensR.BruinsmaS.MortierF.PayneS.SterckxS. (2014). Continuous sedation until death: The everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium. BMC Medical Ethics, 15(1), Article 14. https://doi.org/10.1186/1472-6939-15-14
38.
ReuzelR. P. B.HasselaarG. J.VissersK. C. P.van der WiltG. J.GroenewoudJ. M. M.CruiB. J. P. (2008). Inappropriateness of using opioids for end-stage palliative sedation: A Dutch study. Palliative Medicine, 22(5), 641–646. https://doi.org/10.1177/0269216308091867
39.
RietjensJ. A. C.BuitingH. M.PasmanH. R. W.van der MaasP. J.van DeldenJ. J. M.van der HeideA. (2009). Deciding about continuous deep sedation: Physicians’ perspectives: A focus group study. Palliative Medicine, 23(5), 410–417. https://doi.org/10.1177/0269216309104074
40.
RobijnL.CohenJ.RietjensJ.DeliensL.ChambaereK. (2016). Trends in continuous deep sedation until death between 2007 and 2013: A repeated nationwide survey. PLOS ONE, 11(6), Article e0158188. https://doi.org/10.1371/journal.pone.0158188
41.
RoelandE.CainJ.OnderdonkC.KerrK.MitchellW.ThornberryK. (2014). When open-ended questions don’t work: The role of palliative paternalism in difficult medical decisions. Journal of Palliative Medicine, 17(4), 415–420. https://doi.org/10.1089/jpm.2013.0408
42.
SchildmannE.SchildmannJ. (2014). Palliative sedation therapy: A systematic literature review and critical appraisal of available guidance on indication and decision making. Journal of Palliative Medicine, 17(5), 601–611. https://doi.org/10.1089/jpm.2013.0511
43.
SchildmannE.SchildmannJ.KiesewetterI. (2014). Medication and monitoring in palliative sedation therapy: A systematic review and quality assessment of published guidelines. Journal of Pain and Symptom Management, 49(4), 734–746. https://doi.org/10.1016/j.jpainsymman.2014.08.013
44.
SeymourJ.RietjensJ.BruinsmaS.DeliensL.SterckxS.MortierF.BrownJ.MathersN.Van Der HeideA. (2015). Using continuous sedation until death for cancer patients: A qualitative interview study of physicians’ and nurses’ practice in three European countries. Palliative Medicine, 29(1), 48–59. https://doi.org/10.1177/0269216314543319
45.
SmetsT.BilsenJ.CohenJ.RurupM. L.De KeyserE.DeliensL. (2009). The medical practice of euthanasia in Belgium and The Netherlands: Legal notification, control and evaluation procedures. Health Policy, 90(2–3), 181–187. https://doi.org/10.1016/j.healthpol.2008.10.003
46.
SrivastavaP.HopwoodN. (2009). A practical iterative framework for qualitative data analysis. International Journal of Qualitative Methods, 8(1), 76–84. https://doi.org/10.1177/160940690900800107
47.
StreetR. L.GordonH.HaidetP. (2007). Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?Social Science & Medicine, 65(3), 586–598. https://doi.org/10.1016/j.socscimed.2007.03.036
48.
Van Den BlockL.DeschepperR.BilsenJ.BossuytN.Van CasterenV.DeliensL. (2009). Euthanasia and other end-of-life decisions: A mortality follow-back study in Belgium. BMC Public Health, 9, Article 79. https://doi.org/10.1186/1471-2458-9-79
49.
Van GorpB. (2005). Where is the frame? Victims and intruders in the Belgian press coverage of the asylum issue. European Journal of Communication, 20(4), 484–507. https://doi.org/10.1177/0267323105058253
Van GorpB.VercruysseT. (2012). Frames and counter-frames giving meaning to dementia: A framing analysis of media content. Social Science & Medicine, 74(8), 1274–1281. https://doi.org/10.1016/j.socscimed.2011.12.045
52.
WirtzV.CribbA.BarberN. (2006). Patient-doctor decision-making about treatment within the consultation: A critical analysis of models. Social Science & Medicine, 62(1), 116–124. https://doi.org/10.1016/j.socscimed.2005.05.017
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
