title: The moral difference or equivalence between continuous sedation until death and physician-assisted death: word games or war games?: a qualitative content analysis of opinion pieces in the indexed medical and nursing literature.
abstract: Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical-ethical discussions in the opinion sections of medical and nursing journals. Some argue that CSD is morally equivalent to physician-assisted death (PAD), that it is a form of "slow euthanasia." A qualitative thematic content analysis of opinion pieces was conducted to describe and classify arguments that support or reject a moral difference between CSD and PAD. Arguments pro and contra a moral difference refer basically to the same ambiguous themes, namely intention, proportionality, withholding artificial nutrition and hydration, and removing consciousness. This demonstrates that the debate is first and foremost a semantic rather than a factual dispute, focusing on the normative framework of CSD. Given the prevalent ambiguity, the debate on CSD appears to be a classical symbolic struggle for moral authority.
authors.affiliation: Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium. samrys@vub.ac.be
authors.forename: Sam
authors.initials: S
authors.lastname: Rys
authors.forename: Reginald
authors.initials: R
authors.lastname: Deschepper
authors.forename: Freddy
authors.initials: F
authors.lastname: Mortier
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Douglas
authors.initials: D
authors.lastname: Atkinson
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
mesh_terms: D054810:Deep Sedation / Q000941:ethics*; D006801:Humans; D009014:Morals; D010166:Palliative Care / Q000941:ethics*; D036301:Qualitative Research; D012660:Semantics; D017236:Suicide, Assisted / Q000941:ethics*; D013561:Symbolism; D013727:Terminal Care / Q000941:ethics*