title: French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering.
abstract: OBJECTIVE
  Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially "existential suffering." This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable).
  
  
  METHODS
  We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians.
  
  
  RESULTS
  74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000). Significance of the results: The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.
authors.affiliation: Palliative care service, Department of medicine,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Beauverd
authors.affiliation: Palliative care service, Department of medicine,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Bernard
authors.affiliation: Palliative care service, Department of medicine,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Currat
authors.affiliation: Palliative care service, Department of medicine,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Ducret
authors.affiliation: Palliative care service, Department of medicine,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland.
authors.forename: R A
authors.initials: RA
authors.lastname: Foley
authors.affiliation: Palliative care service, Department of medicine,Centre Hospitalier Universitaire Vaudois,Lausanne,Switzerland.
authors.forename: G D
authors.initials: GD
authors.lastname: Borasio
authors.affiliation: Faculty of Nursing,Laval University,Quebec City,Canada.
authors.forename: D
authors.initials: D
authors.lastname: Blondeau
authors.affiliation: School of Social Work,Laval University,Quebec City,Canada.
authors.forename: S
authors.initials: S
authors.lastname: Dumont
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics; D054810:Deep Sedation / Q000941:ethics* / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000188:drug therapy* / Q000523:psychology; D010166:Palliative Care / Q000941:ethics* / Q000379:methods / Q000523:psychology; D010865:Pilot Projects; D011379:Prognosis; D013315:Stress, Psychological / Q000188:drug therapy* / Q000523:psychology; D013557:Switzerland; D013727:Terminal Care / Q000941:ethics* / Q000379:methods / Q000523:psychology; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives