Continuous Sedation until Death and Physician-Assisted Death: Different or Equivalent? A Focus Group Study in Nursing Homes in Flanders, Belgium

Sam Rys, Reginald Deschepper, Freddy Mortier, Luc Deliens, Johan Bilsen, European Association For Palliative Care (Redacteur)

Onderzoeksoutput: Meeting abstract (Journal)

Samenvatting

Introduction
Continuous Sedation until Death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, has become a controversial topic of ethical debate. Some argue that CSD is morally equivalent to Physician-Assisted Death (PAD),or that CSD is frequently misused to perform 'slow euthanasia', despite the fact that guidelines on CSD stress the distinction between these two practices. Given the increasing incidence rate of CSD in nursing homes in Flanders (Belgium), together with the low incidence of PAD in this setting, it is interesting to examine whether and to what extent nursing home clinicians consider these two practices to be different or equivalent.

Methods
Six focus groups were conducted including 10 physicians, 24 nurses, and 14 care assistants working in either public or catholic nursing homes of varying size. All discussions were transcribed and subsequently analyzed using a thematic content approach.

Results
For some clinicians, the distinction between CSD and PAD is clear, whereas others consider CSD a form of euthanasia. Another group takes an in-between stance: they situate CSD in a grey area between pain relief and ending life. The underlying 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, compared with PAD, since it results in a more gradual process of dying.

Discussion
This study highlights the lack of agreement among nursing home clinicians regarding the distinction between CSD and PAD. The opposing and frequently inconsistent arguments of clinicians used to claim a difference or equivalence between the two practices demonstrate that the framework of CSD -as proposed in the guidelines- is prone to abuse.
Originele taal-2English
Pagina's (van-tot)114-114
Aantal pagina's1
TijdschriftEuropean Journal of Palliative Care
StatusPublished - 2013
EvenementUnknown -
Duur: 1 jan 2013 → …

Bibliografische nota

European Association for Palliative Care

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