Dr Martyna Tomczyk and Prof Ralf J Jox, researchers in the ethics of palliative care at the Institute of Humanities in Medicine, Lausanne University Hospital in Switzerland, with the invaluable help of Mrs Cécile Jaques, a medical librarian at the same hospital, present a part of their recent project on ethical challenges in palliative sedation of adults, which is funded by a grant from the Pallium Foundation (Canton of Vaud, Switzerland).
According to the European Association for Palliative Care (EAPC), sedation is an important cornerstone of palliative therapy in patients with otherwise refractory distress. However, it remains one of the most highly complex and debated medical practices in the context of palliative care. Clinically, there are some types of palliative sedation. However, consistent terminology and definitions are lacking to date, which is a source of much ambiguity, confusion, and controversy in clinical practice, research and education.
In the past three decades, several clinical practice guidelines (CPGs) and position statements have been developed by international, national, or regional scientific societies across the world, and systematic reviews of some of these texts have been performed. However, the published reviews essentially focus on the purely medical issues of palliative sedation. Although the decision-making process inevitably raises several ethical questions and requires multiprofessional and interdisciplinary discussion, little is known of the ethical issues of this practice.
Do CPGs for palliative sedation address the ethical challenges of this practice? If so, how exactly do they do this? Do they present them with or without a proposal for solutions? Are they interested in all forms of palliative sedation or just a few? Which exactly? Finally, do they explicitly specify the ethical challenges of this therapy for cancer and non-cancer patients?
These are the main research questions that we are exploring in depth through our systematic review of CPGs. More specifically, the aim of our review is to identify systematically, transparently, and comprehensively the full spectrum of potential ethical challenges of all forms of palliative sedation for adults as presented in CPGs. Our study also aims to determine whether CPGs explicitly specify the ethical challenges of this therapy for cancer and non-cancer patients and, if so, exactly how they do this. To the best of our knowledge, no studies have yet investigated this topic.
This review will be of interest to palliative care practitioners of all backgrounds, as well as to researchers, educators in palliative care, and medical ethicists. Our review will provide an initial evidence base for dealing adequately with the ethical issues of this complex but necessary palliative care therapy. We hope that better understanding of the ethical issues of each type of palliative sedation will help reduce the gap and strengthen the methodological rigour of future ethical reflections in this field. Our findings could also have important implications for education in the ethics of palliative care at all levels.
Would you like to contribute to this research?
We would be very grateful to anyone who would like to help by sharing information on the CPGs for palliative sedation in her/his country. If you would like to contribute to this research, please contact Dr Martyna Tomczyk by email.
More about the authors…
Martyna Tomczyk, PhD, is a researcher in the ethics of palliative care at the Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Switzerland. Read more and contact her via Orcid, LinkedIn and via the university website (in French).
Ralf J Jox, MD, PhD, is Chair in Geriatric Palliative Care, Palliative and Supportive Care Service, and also works at the Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Switzerland. Read more and contact him via the university website.
Cécile Jaques, MSc, is a medical librarian at Lausanne University Hospital and University of Lausanne, Switzerland. Read more and contact her here.
RESOURCES AND FURTHER READING
- Palliative Sedation – An EU Horizon2020 Research Project that brings together leading scientists, clinicians and innovators in the fields of palliative care, indicator development, implementation research, and health policy research.
- EAPC Palliative Sedation Task Force. (Includes a link to the Palliative Sedation webinar that took place in June 2021).
- Read more posts on the EAPC blog about Palliative Sedation in general and specifically the Palliation Sedation Horizon 2020 project.
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