title: Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium.
abstract: BACKGROUND
  Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.
  
  
  METHODS
  This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology.
  
  
  RESULTS
  The participants' responses can be captured as different dimensions of 'closeness', i.e. the degree to which one feels connected or 'close' to a certain decision or event. We distinguished four types of 'closeness', namely emotional, physical, decisional, and causal. Using these four dimensions of 'closeness' it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility.
  
  
  CONCLUSIONS
  Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.
authors.affiliation: Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, Ghent, Belgium. Kasper.Raus@UGent.be.
authors.forename: Kasper
authors.initials: K
authors.lastname: Raus
authors.forename: Jayne
authors.initials: J
authors.lastname: Brown
authors.forename: Clive
authors.initials: C
authors.lastname: Seale
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.forename: Rien
authors.initials: R
authors.lastname: Janssens
authors.forename: Sophie
authors.initials: S
authors.lastname: Bruinsma
authors.forename: Freddy
authors.initials: F
authors.lastname: Mortier
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.forename: Sigrid
authors.initials: S
authors.lastname: Sterckx
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D017028:Caregivers / Q000941:ethics / Q000523:psychology*; D003657:Decision Making; D004644:Emotions; D005065:Euthanasia / Q000145:classification / Q000941:ethics*; D005260:Female; D006117:Grief; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D009426:Netherlands; D009726:Nurses / Q000523:psychology; D010166:Palliative Care / Q000941:ethics; D010820:Physicians / Q000523:psychology*; D024382:Professional Role / Q000523:psychology; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D006993:Hypnotics and Sedatives