Continuous Sedation until Death in Flemish Nursing Homes: Justifications and Objections of Physicians and Nurses

Sam Rys, Reginald Deschepper, Freddy Mortier, Luc Deliens, Johan Bilsen

Onderzoeksoutput: Meeting abstract (Journal)

Samenvatting

Aims: Continuous Sedation until Death (CSD), the act of
reducing or removing the consciousness of an incurably ill
patient until death, is a prevalent practice in end-of-life care in
Flemish nursing homes. Nevertheless, there is a clear lack of
research on the experiences and perspectives of nursing home
physicians and nurses regarding this far-reaching treatment.
This study aims to explore and describe the circumstances
under which they consider CSD to be justified, as well as the
factors that influence their decisions on CSD.
Methods: Six focus groups were conducted including
10 physicians and 39 nurses working in either public or
catholic nursing homes of varying size. One focus group
included only physicians, two included only nurses,
while the remaining three groups were a mix of both. All
discussions were transcribed and subsequently analyzed
using a thematic content approach.
Results: Both physicians and nurses stress that respecting
the decisions of the patient is a matter of major concern in
deciding for CSD. Life expectancy of the patient, which they
find hard to estimate, is considered less relevant than severe
suffering (even if this is mainly existential distress). The main
objective is to provide a comfortable context for dying, even
if this means the hastening of death. Dementia is regarded as
an important constraining factor, as it impedes the evaluation
of suffering. Finally, the influence of family members may
further complicate the decision making process; during the
administration of CSD, physicians and nurses often feel
pressure from the patient's family to hasten death.
Conclusion: The conditions under which nursing home
physicians and nurses consider CSD to be justified are not
entirely congruent with guidelines on CSD. Subjective
opinions and personal ethics appear to play a significant
role in the decision making process on CSD.
Originele taal-2English
Pagina's (van-tot)627-627
Aantal pagina's1
TijdschriftPalliative Medicine
Volume26
StatusPublished - 2012
EvenementUnknown -
Duur: 1 jan 2012 → …

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