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Free papers 28–30 – Ethical issues
Routine sedation at the end of life
  1. Katie Frew1,
  2. Catherine Exley2,
  3. Julian Hughes3 and
  4. Paul Paes3
  1. 1Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  2. 2Newcastle University, Newcastle upon Tyne, UK
  3. 3Northumbria Healthcare NHS Foundation Trust, North Shields, UK

Abstract

Background Sedation is a controversial issue in palliative care. Previous research has explored aspects of administration, concerns of relatives and staff and also ethical issues, predominately in retrospective studies. These studies suggest that we require prospective observational research into the day to day use of sedation.

Aims The aim of this research was to describe the normative underpinnings of current hospice practice with respect to the use of sedation in palliative care.

Methods This is an ethnographic study of the use of sedation in a palliative care inpatient unit. The primary research methods were participant observation and indepth interviewing. Data was analysed taking a constructivist grounded theory approach.

Results Through data analysis 3 overarching concepts were developed. These were (1) the concept of ‘routine’ sedation; (2) the relationship of sedation to ensuring a good dying and death; (3) the fundamental role of values in the use of sedation. This paper will consider the first of these. A ‘routine’ form of sedation was observed in the fieldwork and developed into a conceptual model of how sedation was used in the hospice. This form of sedation enabled sedative drugs to be used with the acceptance of a reduction in patient consciousness when imminently dying. A model of the use of sedation in relation to the patient's dying trajectory and sequence of dying has been developed and forms the outcome for this part of the research study.

Conclusion Routine sedation is integral to the palliative care approach to the dying patient; this study delineates the ways in which this form of sedation becomes acceptable in the context of a UK hospice. This research contributes to the international debate about the use of sedation in palliative care and specifically, is the first study to identify a routine practice of sedation in the UK.

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