Continuous Sedation until Death in Flemish nursing homes

General objective
Continuous Sedation until Death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, has increasingly become a common part of end of life care. At the same time, it has turned into a controversial topic in medical-ethical discussions. The possible use of CSD as a life shortening practice, either with or without the administration of Artificial Nutrition and Hydration (ANH), seems to be is most controversial aspect. This project investigates a number of moral aspects of CSD. It focuses on the setting of Flemish nursing homes, where CSD in combination with the withholding of ANH is often administered.

Specific objectives
1. Clarify the concept of CSD (and its combination with the withholding of ANH).
2. Describe how physicians and nurses of nursing homes morally justify decisions to CSD. Identify the factors that facilitate or constrain such decisions.
3. Describe if and how physicians and nurses see a moral difference between CSD and life ending acts.

Methods
1. Review of medical-ethical literature (study 1)
2. Qualitative research: focus group study with physicians and nurses of Flemish nursing homes (study 2)
3. Quantitative research: cross sectional survey among coordinating nursing home physicians and palliative care nurses (study 3)