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 the authors 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 three overarching concepts were developed. These were 1) the concept of ‘routine’ sedation; 2) the relationship of sedation to ensuring good dying and death; 3) the fundamental role of values in the use of sedation. This paper will consider the third of these. Decisions to use sedation were found in this research to be primarily motivated by values. These values related predominately to the nature of, and requirement to ensure, good dying and death in the hospice.
Conclusion Decisions to use sedation are highly evaluative decisions, especially at the end of life. These decisions fundamentally represent the palliative care core values regarding dying in a hospice. This is important as palliative care develops to incorporate patients with different diseases and dying trajectories and as it seeks to provide equity of care to different cultural and social groups. Values-based-practice is an approach which embraces the evaluative nature of decision-making and provides a set of practical tools which are centred on individual patients' values. Values-based practice is suggested as a model to equip those making decisions about sedation while retaining the ‘framework values’ of the palliative care approach.
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