Continuous sedation until death: moral justifications of physicians and nurses—a content analysis of opinion pieces

Abstract

Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical-ethical discussions in the opinion sections of medical and nursing journals. A content analysis of opinion pieces in medical and nursing literature was conducted to examine how clinicians define and describe CSD, and how they justify this practice morally. Most publications were written by physicians and published in palliative or general medicine journals. Terminal Sedation and Palliative Sedation are the most frequently used terms to describe CSD. Seventeen definitions with varying content were identified. CSD was found to be morally justified in 73 % of the publications using justifications such as Last Resort, Doctrine of Double Effect, Sanctity of Life, Autonomy, and Proportionality. The debate over CSD in the opinion sections of medical and nursing journals lacks uniform terms and definitions, and is profoundly marked by ‘charged language’, aiming at realizing agreement in attitude towards CSD. Not all of the moral justifications found are equally straightforward. To enable a more effective debate, the terms, definitions and justifications for CSD need to be further clarified.

Appendix: Search filters used

CINAHL

(((MH “Hospice and Palliative Nursing”)OR(“hospice and palliative nursing”)OR(MH “Palliative Care”)OR(“palliative care”)OR(MH “Hospice Care”)OR(“hospice care”)OR(MH “Terminal Care+”)OR(“terminal care”)OR(MH “Terminally Ill Patients”)OR(“Terminally Ill Patients”)OR(MH “Critical Illness”)OR(“critical illness”)OR(MH “Critically Ill Patients”)OR(“critically ill patients”)OR(MH “Hospices”)OR(“hospices”)OR(MH “Hospice Patients”)OR(“hospice patients”)OR(MH “Hospice and Palliative Nurses Association”)OR(“hospice and palliative nurses association”)OR(MH “National Association for Home Care and Hospice”)OR(“national association for home care and hospice”)OR(MH “Dying Process (Saba CCC)”)or(MH “Dying-Death Measures (Saba CCC)”)or(MH “Dignified Dying (Iowa NOC)”)or(MH “Dying Care (Iowa NIC)”)OR(“end of life”)OR(“dying”)OR(“hospice”)OR(“palliative treatment”)OR(“palliative therapy”)OR(“palliative medicine”)OR(“hospice program”))AND((MH “Sedation”)OR(“sedation”)OR(MH “Hypnotics and Sedatives”)OR(MH “Conscious Sedation”)OR(“conscious sedation”)OR(MH “Narcotics”)OR(“narcotics”)OR(“deep sedation”)OR(“sedatives”)OR(“hypnotics”)OR(“controlled sedation”)))OR((“terminal sedation”)OR(“palliative sedation”)OR(“slow euthanasia”)).

PubMed

((“palliative care”[mesh] OR (“care”[All Fields] AND “palliative”[All Fields]) OR “care palliative”[All Fields] OR (“palliative”[All Fields] AND “care”[All Fields]) OR “palliative care”[All Fields] OR (“therapy”[All Fields] AND “palliative”[All Fields]) OR “therapy palliative”[All Fields] OR (“palliative”[All Fields] AND “therapy”[All Fields]) OR “palliative therapy”[All Fields] OR (“palliative”[All Fields] AND “treatment”[All Fields]) OR “palliative treatment”[All Fields] OR (“treatment”[All Fields] AND “palliative”[All Fields]) OR “treatment palliative”[All Fields] OR (“palliative”[All Fields] AND “treatments”[All Fields]) OR “palliative treatments”[All Fields] OR (“treatments”[All Fields] AND “palliative”[All Fields]) OR “treatments palliative”[all fields] OR (“palliative”[All Fields] AND “surgery”[All Fields]) OR “palliative surgery”[All Fields] OR (“surgery”[All Fields] AND “palliative”[All Fields]) OR “surgery palliative”[All Fields] OR (“palliative”[All Fields] AND “medicine”[All Fields]) OR “palliative medicine”[All Fields] OR (“medicine”[All Fields] AND “palliative”[All Fields]) OR “medicine palliative”[all fields] OR “terminal care”[mesh] OR (“terminal”[all fields] AND “care”[all fields]) OR “terminal care”[all fields] OR (“Care”[All Fields] AND “Terminal”[All Fields]) OR “Care Terminal”[All Fields] OR “hospice care”[mesh] OR (“care”[All Fields] AND “hospice”[All Fields]) OR “care, hospice”[All Fields] OR (“hospice”[All Fields] AND “care”[All Fields]) OR “hospice care”[All Fields] OR (“hospice”[All Fields] AND “programs”[All Fields]) OR “hospice programs”[All Fields] OR (“programs”[All Fields] AND “hospice”[All Fields]) OR “programs Hospice”[All Fields] OR (“hospice”[All Fields] AND “program”[All Fields]) OR “hospice program”[All Fields] OR (“program”[All Fields] AND “hospice”[All Fields]) OR “program hospice”[All Fields] OR (“bereavement”[All Fields] AND “care”[All Fields]) OR “bereavement care”[All Fields] OR (“care”[All Fields] AND “bereavement”[All Fields]) OR “care bereavement”[All Fields] OR “critical illness”[mesh] OR (“critical”[All Fields] AND “illness”[All Fields]) OR “critical illness”[All Fields] OR (“illness”[All Fields] AND “critical”[All Fields]) OR “illness critical”[All Fields] OR (“critical”[All Fields] AND “illnesses”[All Fields]) OR “critical illnesses”[All Fields] OR (“illnesses”[All Fields] AND “critical”[All Fields]) OR (“critically”[All Fields] AND “ill”[All Fields]) OR “critically ill”[All Fields] OR (“Ill”[All Fields] AND “Critically”[All Fields]) OR “terminally ill”[mesh] OR (“terminally”[All Fields] AND “ill”[All Fields]) OR “terminally ill”[All Fields] OR (“ill”[All Fields] AND “terminally”[All Fields]) OR “hospices”[mesh] OR “hospices”[All Fields] OR “hospice”[All Fields] OR “end of life”[All Fields] OR “dying”[All Fields]) AND (“conscious sedation”[mesh] OR (“conscious”[All Fields] AND “sedation”[All Fields]) OR “conscious sedation”[All Fields] OR (“sedation”[All Fields] AND “conscious”[All Fields]) OR “sedation conscious”[All Fields] OR (“sedation”[All Fields] AND “moderate”[All Fields]) OR (“moderate”[All Fields] AND “sedation”[All Fields]) OR “moderate sedation”[All Fields] OR “deep sedation”[mesh] OR (“deep”[All Fields] AND “sedation”[All Fields]) OR “deep sedation”[All Fields] OR (“sedation”[All Fields] AND “deep”[All Fields]) OR “sedation, deep”[All Fields] OR (“deep”[All Fields] AND “sedations”[All Fields]) OR “deep sedations”[All Fields] OR (“sedations”[All Fields] AND “deep”[All Fields]) OR “hypnotics and sedatives”[mesh] OR (“hypnotics”[All Fields] AND “sedatives”[All Fields]) OR “hypnotics and sedatives”[All Fields] OR (“sedatives”[All Fields] AND “hypnotics”[All Fields]) OR “sedatives and hypnotics “[All Fields] OR “sedatives”[All Fields] OR “Hypnotics”[All Fields] OR “Narcotics”[All Fields] OR (“controlled”[All Fields] AND “sedation”[All Fields]) OR “controlled sedation”[All Fields] OR (“Sedation”[All Fields] AND “Controlled”[All Fields]) OR “sedation controlled”[All Fields])) OR ((“terminal”[All Fields] AND “sedation”[All Fields]) OR “terminal sedation”[All Fields] OR (“sedation”[All Fields] AND “terminal”[All Fields]) OR (“Palliative”[All Fields] AND “Sedation”[All Fields]) OR “palliative sedation”[All Fields] OR (“Sedation”[All Fields] AND “Palliative”[All Fields]) OR (“slow”[All Fields] AND “euthanasia”[All Fields]) OR “slow euthanasia”[All Fields] OR (“euthanasia”[All Fields] AND “slow”[All Fields])) AND (“humans”[MeSH Terms] AND (Editorial[ptyp] OR Letter[ptyp] OR Comment[ptyp]) AND English[lang]).