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The Moral Difference or Equivalence Between Continuous Sedation Until Death and Physician-Assisted Death: Word Games or War Games?

A Qualitative Content Analysis of Opinion Pieces in the Indexed Medical and Nursing Literature

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Abstract

Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical–ethical discussions in the opinion sections of medical and nursing journals. Some argue that CSD is morally equivalent to physician-assisted death (PAD), that it is a form of “slow euthanasia.” A qualitative thematic content analysis of opinion pieces was conducted to describe and classify arguments that support or reject a moral difference between CSD and PAD. Arguments pro and contra a moral difference refer basically to the same ambiguous themes, namely intention, proportionality, withholding artificial nutrition and hydration, and removing consciousness. This demonstrates that the debate is first and foremost a semantic rather than a factual dispute, focusing on the normative framework of CSD. Given the prevalent ambiguity, the debate on CSD appears to be a classical symbolic struggle for moral authority.

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Competing Interests and Funding

This study was supported by a grant from the Fund for Scientific Research, Flanders, Belgium (G080309N). This funding source had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit for publication. All authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussel, Belgium

    Sam Rys, Reginald Deschepper & Johan Bilsen

  2. End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium

    Sam Rys, Reginald Deschepper, Freddy Mortier, Luc Deliens & Johan Bilsen

  3. Bioethics Institute Ghent, Ghent University, Ghent, Belgium

    Freddy Mortier

  4. Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Centre for Palliative Care, VU University Medical Center, Amsterdam, the Netherlands

    Luc Deliens

  5. Interfacultair Departement voor Taalonderwijs (ITO), Vrije Universiteit Brussel, Brussels, Belgium

    Douglas Atkinson

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  1. Sam Rys
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  2. Reginald Deschepper
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  3. Freddy Mortier
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  4. Luc Deliens
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  6. Johan Bilsen
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Correspondence to Sam Rys.

Appendix: Search Filters Used

Appendix: Search Filters Used

CINAHL

(((MH “Hospice and Palliative Nursing”)OR(“hospice and palliative nursing”)OR(MH “Palliative Care”)OR(“palliative care”)OR(MH “Hospice Care”)OR(“hospice care”)OR(MH “Terminal Care + ”)OR(“terminal care”)OR(MH “Terminally Ill Patients”)OR(“Terminally Ill Patients”)OR(MH “Critical Illness”)OR(“critical illness”)OR(MH “Critically Ill Patients”)OR(“critically ill patients”)OR(MH “Hospices”)OR(“hospices”)OR(MH “Hospice Patients”)OR(“hospice patients”)OR(MH “Hospice and Palliative Nurses Association”)OR(“hospice and palliative nurses association”)OR(MH “National Association for Home Care & Hospice”)OR(“national association for home care & hospice”)OR(MH “Dying Process (Saba CCC)”)or(MH “Dying-Death Measures (Saba CCC)”)or(MH “Dignified Dying (Iowa NOC)”)or(MH “Dying Care (Iowa NIC)”)OR(“end of life”)OR(“dying”)OR(“hospice”)OR(“palliative treatment”)OR(“palliative therapy”)OR(“palliative medicine”)OR(“hospice program”))AND((MH “Sedation”)OR(“sedation”)OR(MH “Hypnotics and Sedatives”)OR(MH “Conscious Sedation”)OR(“conscious sedation”)OR(MH “Narcotics”)OR(“narcotics”)OR(“deep sedation”)OR(“sedatives”)OR(“hypnotics”)OR(“controlled sedation”)))OR((“terminal sedation”)OR(“palliative sedation”)OR(“slow euthanasia”))

PubMed

((“palliative care”[mesh] OR (“care”[All Fields] AND “palliative”[All Fields]) OR “care palliative”[All Fields] OR (“palliative”[All Fields] AND “care”[All Fields]) OR “palliative care”[All Fields] OR (“therapy”[All Fields] AND “palliative”[All Fields]) OR “therapy palliative”[All Fields] OR (“palliative”[All Fields] AND “therapy”[All Fields]) OR “palliative therapy”[All Fields] OR (“palliative”[All Fields] AND “treatment”[All Fields]) OR “palliative treatment”[All Fields] OR (“treatment”[All Fields] AND “palliative”[All Fields]) OR “treatment palliative”[All Fields] OR (“palliative”[All Fields] AND “treatments”[All Fields]) OR “palliative treatments”[All Fields] OR (“treatments”[All Fields] AND “palliative”[All Fields]) OR “treatments palliative”[all fields] OR (“palliative”[All Fields] AND “surgery”[All Fields]) OR “palliative surgery”[All Fields] OR (“surgery”[All Fields] AND “palliative”[All Fields]) OR “surgery palliative”[All Fields] OR (“palliative”[All Fields] AND “medicine”[All Fields]) OR “palliative medicine”[All Fields] OR (“medicine”[All Fields] AND “palliative”[All Fields]) OR “medicine palliative”[all fields] OR “terminal care”[mesh] OR (“terminal”[all fields] AND “care”[all fields]) OR “terminal care”[all fields] OR (“Care”[All Fields] AND “Terminal”[All Fields]) OR “Care Terminal”[All Fields] OR “hospice care”[mesh] OR (“care”[All Fields] AND “hospice”[All Fields]) OR “care, hospice”[All Fields] OR (“hospice”[All Fields] AND “care”[All Fields]) OR “hospice care”[All Fields] OR (“hospice”[All Fields] AND “programs”[All Fields]) OR “hospice programs”[All Fields] OR (“programs”[All Fields] AND “hospice”[All Fields]) OR “programs Hospice”[All Fields] OR (“hospice”[All Fields] AND “program”[All Fields]) OR “hospice program”[All Fields] OR (“program”[All Fields] AND “hospice”[All Fields]) OR “program hospice”[All Fields] OR (“bereavement”[All Fields] AND “care”[All Fields]) OR “bereavement care”[All Fields] OR (“care”[All Fields] AND “bereavement”[All Fields]) OR “care bereavement”[All Fields] OR “critical illness”[mesh] OR (“critical”[All Fields] AND “illness”[All Fields]) OR “critical illness”[All Fields] OR (“illness”[All Fields] AND “critical”[All Fields]) OR “illness critical”[All Fields] OR (“critical”[All Fields] AND “illnesses”[All Fields]) OR “critical illnesses”[All Fields] OR (“illnesses”[All Fields] AND “critical”[All Fields]) OR (“critically”[All Fields] AND “ill”[All Fields]) OR “critically ill”[All Fields] OR (“Ill”[All Fields] AND “Critically”[All Fields]) OR “terminally ill”[mesh] OR (“terminally”[All Fields] AND “ill”[All Fields]) OR “terminally ill”[All Fields] OR (“ill”[All Fields] AND “terminally”[All Fields]) OR “hospices”[mesh] OR “hospices”[All Fields] OR “hospice”[All Fields] OR “end of life”[All Fields] OR “dying”[All Fields]) AND (“conscious sedation”[mesh] OR (“conscious”[All Fields] AND “sedation”[All Fields]) OR “conscious sedation”[All Fields] OR (“sedation”[All Fields] AND “conscious”[All Fields]) OR “sedation conscious”[All Fields] OR (“sedation”[All Fields] AND “moderate”[All Fields]) OR (“moderate”[All Fields] AND “sedation”[All Fields]) OR “moderate sedation”[All Fields] OR “deep sedation”[mesh] OR (“deep”[All Fields] AND “sedation”[All Fields]) OR “deep sedation”[All Fields] OR (“sedation”[All Fields] AND “deep”[All Fields]) OR “sedation, deep”[All Fields] OR (“deep”[All Fields] AND “sedations”[All Fields]) OR “deep sedations”[All Fields] OR (“sedations”[All Fields] AND “deep”[All Fields]) OR “hypnotics and sedatives”[mesh] OR (“hypnotics”[All Fields] AND “sedatives”[All Fields]) OR “hypnotics and sedatives”[All Fields] OR (“sedatives”[All Fields] AND “hypnotics”[All Fields]) OR “sedatives and hypnotics ”[All Fields] OR “sedatives”[All Fields] OR “Hypnotics”[All Fields] OR “Narcotics”[All Fields] OR (“controlled”[All Fields] AND “sedation”[All Fields]) OR “controlled sedation”[All Fields] OR (“Sedation”[All Fields] AND “Controlled”[All Fields]) OR “sedation controlled”[All Fields])) OR ((“terminal”[All Fields] AND “sedation”[All Fields]) OR “terminal sedation”[All Fields] OR (“sedation”[All Fields] AND “terminal”[All Fields]) OR (“Palliative”[All Fields] AND “Sedation”[All Fields]) OR “palliative sedation”[All Fields] OR (“Sedation”[All Fields] AND “Palliative”[All Fields]) OR (“slow”[All Fields] AND “euthanasia”[All Fields]) OR “slow euthanasia”[All Fields] OR (“euthanasia”[All Fields] AND “slow”[All Fields])) AND (“humans”[MeSH Terms] AND (Editorial[ptyp] OR Letter[ptyp] OR Comment[ptyp]) AND English[lang])

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Rys, S., Deschepper, R., Mortier, F. et al. The Moral Difference or Equivalence Between Continuous Sedation Until Death and Physician-Assisted Death: Word Games or War Games?. Bioethical Inquiry 9, 171–183 (2012). https://doi.org/10.1007/s11673-012-9369-8

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  • DOI: https://doi.org/10.1007/s11673-012-9369-8

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