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Physicians’ perceptions of palliative sedation for existential suffering: a systematic review
  1. Paulo Rodrigues1,
  2. Johan Menten2 and
  3. Chris Gastmans2
  1. 1 ETHICS 7446 - Centre d'éthique médicale, Université Catholique de Lille, Lille, France
  2. 2 Interfaculty Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
  1. Correspondence to Dr Paulo Rodrigues, ETHICS 7446 - Centre d'éthique médicale, Universite Catholique de Lille, Lille 59800, France; paulusrod{at}


Background Palliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians’ perceptions do not converge in a clear position and current clinical practice guidelines do not agree either regarding this kind of intervention.

Aim To gain deeper insight into physicians’ perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it.

Design Systematic review of qualitative, quantitative and mixed-methods studies following the Peer Review Electronic Search Strategies and Preferred Reporting Items for Systematic Reviews and Meta-analyses protocols; quality appraisal and thematic synthesis methodology.

Data sources Seven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles published in English, French, German, Dutch, Spanish, Italian or Portuguese that focused on physicians’ perceptions of PS-ES.

Results The search yielded 17 publications published between 2002 and 2017. Physicians do not hold clear views or agree if and when PS-ES is appropriate. Case-related and individual-related factors that influenced physicians’ perceptions were identified. There is still no consensus regarding criteria to distinguish between necessary and sufficient conditions for invoking PS-ES. Some alternatives to PS-ES were identified.

Conclusions To date, there is still no consensus on physicians’ perceptions of PS-ES. Further research is necessary to understand factors that influence physicians’ perceptions and philosophical-ethical presuppositions underlying this perceptions.

  • systematic review
  • palliative sedation
  • palliative care
  • existential suffering
  • physicians
  • attitude
  • ethics

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  • Contributors Study concept and design, acquisition of data, title/abstract/full-text screening, analysis and interpretation of data: PR and CG; drafting of the manuscript, critical revision of the manuscript and approval: PR, CG and JM; Study supervision: CG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.