title: Similarities and differences between continuous sedation until death and euthanasia - professional caregivers' attitudes and experiences: a focus group study.
abstract: BACKGROUND
  According to various guidelines about continuous sedation until death, this practice can and should be clearly distinguished from euthanasia, which is legalized in Belgium.
  
  
  OBJECTIVE
  To explore professional caregivers' perceptions of the similarities and differences between continuous sedation until death and euthanasia.
  
  
  METHODS
  Qualitative data were gathered through focus groups. Questions pertained to participants' perceptions of continuous sedation. The focus groups were recorded and transcribed verbatim. Analyses were conducted by a multidisciplinary research team using constant comparison analyses.
  
  
  METHODS
  We did four focus groups at Ghent University Hospital: two with physicians (n = 4 and n = 4) and two with nurses (n = 4 and n = 9). The participants could participate if they were ever involved in the use of continuous sedation until death.
  
  
  RESULTS
  Although the differences and similarities between continuous sedation until death and euthanasia were not specifically addressed in the questions addressed in the focus groups, it emerged as an important theme in the participants' accounts. Many caregivers elaborated on the differences between both practices, particularly with regard to patients' preferences and requests, decision-making and physicians' intentions. However, some stated that the distinction between the two sometimes becomes blurred, especially when the sedating medication is increased disproportionally or when sedation is used for patients with a longer life expectancy.
  
  
  CONCLUSIONS
  The differences and similarities between continuous sedation until death and euthanasia is an issue for several Flemish professional caregivers in their care for unbearably suffering patients at the end of life. Although guidelines strictly distinguish both practices, this may not always be the case in Flemish clinical practice.
authors.affiliation: End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium. Livia.Anquinet@vub.ac.be
authors.forename: Livia
authors.initials: L
authors.lastname: Anquinet
authors.forename: Kasper
authors.initials: K
authors.lastname: Raus
authors.forename: Sigrid
authors.initials: S
authors.lastname: Sterckx
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001530:Belgium; D017028:Caregivers / Q000523:psychology*; D003657:Decision Making; D054810:Deep Sedation; D005065:Euthanasia / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods / Q000523:psychology*
chemical_list: D006993:Hypnotics and Sedatives