Abstract
BackgroundAccording to the European Association for Palliative Care, decisions regarding palliative sedation should not be made in response to requests for assisted dying, such as euthanasia or assisted suicide. However, several studies show that continuous deep sedation until death (CDSUD) – a particular form of sedation – has been considered as an alternative to these practices in some countries. In Switzerland, where assisted suicide is decriminalized and CDSUD is not legally regulated, no studies have comprehensively investigated their relation. Our study aimed to identify and describe the experience among palliative care physicians of CDSUD as a potential alternative to assisted suicide in the French-speaking part of Switzerland.MethodsWe performed an exploratory multicentre qualitative study based on interviews with palliative care physicians in the French-speaking part of Switzerland and conducted linguistic and thematic analysis of all interview transcripts. The study is described in accordance with COREQ guidelines.ResultsWe included 10 interviews conducted in four palliative care units. Our linguistic analysis shows four main types of sedation, which we called ‘rapid CDSUD’, ‘gradual CDSUD’, ‘temporary sedation’ and ‘intermittent sedation’. CDSUD (rapid or gradual) was not considered an alternative to assisted suicide, even if a single situation has been reported. In contrast, ‘temporary’ or ‘intermittent sedation’, although not medically indicated, was sometimes introduced in response to a request for assisted suicide. This was the fact when there were barriers to an assisted suicide at home (e.g., when transfer home was impossible or the patient wished not to burden the family).ConclusionThese preliminary results can guide clinical, ethical, linguistic and legal reflection in this field and be used to explore this question more deeply at the national and international levels in a comparative, interdisciplinary and multiprofessional approach. They can also be useful to update Swiss clinical guidelines on palliative sedation in order to include specific frameworks on various sedation protocols and sedation as an alternative to assisted suicide. Potential negative impacts of considering palliative sedation as an alternative to assisted suicide should be nuanced by open and honest societal debate.
Highlights
In palliative medicine, sedation is an important and necessary therapy for selected patients with otherwise refractory distress [1,2,3]
The European Association for Palliative Care (EAPC) defines this practice as “the monitored use of medications intended to induce a state of decreased or absent awareness in order to relieve the burden of otherwise intractable suffering” [1]
It’s impossible for me’. [...] So, there are many reasons which make that that the option ‘assisted suicide’ is aborted. [...] As assisted suicide can’t be carried out, we naturally look for an alternative...” “[...] on the one hand, yes, that’s a kind of alternative
Summary
Sedation is an important and necessary therapy for selected patients with otherwise refractory distress [1,2,3]. Continuous deep sedation until death (CDSUD) is a particular form of palliative sedation. And clinically, it should be considered as an exceptional therapy of last resort in very particular medical situations, when all other therapy (drug and non-drug treatments) has been ineffective, and only when the patient is in the very terminal stages of irreversible disease with an expected prognosis of hours or days [1, 3,4,5]. Several studies show that continuous deep sedation until death (CDSUD) – a particular form of sedation – has been considered as an alternative to these practices in some countries.
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