Bridging the Gap between Continuous Sedation until Death and Physician-Assisted Death: A Focus Group Study in Nursing Homes in Flanders, Belgium

The distinction between Continuous Sedation until Death (CSD) and Physician-Assisted Death (PAD) has become a topic of medical-ethical debate. We conducted six focus groups to examine how nursing home clinicians perceive this distinction. For some, the difference is clear, whereas others consider CSD a form of euthanasia. Another group situates CSD between pain relief and ending life. Arguments for these perspectives refer to the following themes: intention, dosage of sedative drugs, unconsciousness, and the pace of the dying process. Generally, CSD is considered easier to deal with emotionally, since it entails a gradual dying process. Nursing home clinicians have diverging perceptions of the relation between CSD and PAD; some consider CSD more than a purely palliative measure, but also as a means to hasten death.