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Deciding about continuous deep sedation: physicians’ perspectives

A focus group study

Department of Public Health, Erasmus MC, Rotterdam j.rietjens{at}erasmusmc.nl

HM Buiting

Department of Public Health, Erasmus MC, Rotterdam

HRW Pasman

Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam

PJ van der Maas

Department of Public Health, Erasmus MC, Rotterdam

JJM van Delden

Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht

A van der Heide

Department of Public Health, Erasmus MC, Rotterdam

Although guidelines restrict the use of continuous deep sedation to patients with refractory physical symptoms and a short life-expectancy, its use is not always restricted to these conditions. A focus group study of physicians was conducted to gain more insight in the arguments for and against the use of continuous deep sedation in several clinical situations. Arguments in favour of continuous deep sedation for patients with a longer life-expectancy were that the overall clinical situation is more relevant than life-expectancy alone, and that patients’ wishes should be followed. Continuous deep sedation for patients with predominantly emotional/existential suffering was considered appropriate when physicians empathize with the suffering. Further, some physicians indicated that they may consider the use of sedation in the context of a euthanasia request. Arguments were that the option of continuous deep sedation is a better alternative; it may comfort some patients when their thoughts about potential future suffering become unbearable. Further, some considered continuous deep sedation as less burdening or a bother to perform. We conclude that physicians’ decision-making about continuous deep sedation is characterized by balancing the interests of patients with their own feelings. Accordingly, the reasons for its use are not unambiguous and need further debate.

Key Words: continuous deep sedation • decision-making • end-of-life care • euthanasia

This version was published on July 1, 2009

Palliative Medicine, Vol. 23, No. 5, 410-417 (2009)
DOI: 10.1177/0269216309104074


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