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Ethics of sedation for existential suffering: palliative medicine physician perceptions - qualitative study
  1. Paulo Rodrigues1,
  2. Jozefien Ostyn2,
  3. Sarah Mroz3,
  4. Axelle Ronsse2,
  5. Johan Menten4 and
  6. Chris Gastmans2
  1. 1 ETHICS EA 7446, Université Catholique de Lille, Lille, France
  2. 2 Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Leuven, Belgium
  3. 3 Vrije Universiteit Brussel, Brussel, Belgium
  4. 4 Radiation-Oncology and Palliatiev Care, UZ Gasthuisberg, Leuven, Belgium
  1. Correspondence to Professor Paulo Rodrigues, Faculté de théologie, Université catholique de Lille, Lille, France; paulo.rodrigues{at}


Objectives Palliative sedation for existential suffering (PS-ES) is considered a controversial practice to control refractory suffering at the end of life. This study aims to explore Belgian palliative care physicians’ perceptions regarding the ethics of PS-ES.

Methods This nationwide qualitative study follows a Grounded Theory approach. We conducted semistructured interviews with 25 palliative care physicians working in 23 Belgian hospitals and hospices (Flanders, Brussels, Wallonia). We analysed the data using the Qualitative Analysis Guide Of Leuven and we followed the Consolidated Criteria for Reporting Qualitative Research guidelines.

Results The data revealed that Belgian palliative care physicians have difficulty characterising ES and distinguishing it from other types of suffering. They express mixed attitudes towards PS-ES and employ a wide range of ethical arguments in favour and against it, which are mainly linked to the four principles of biomedical ethics.

Conclusion Since there is a lack of consensus among Belgian palliative care physicians about PS-ES, further research is needed to clarify their attitudes. A better understanding of physicians’ underlying presuppositions can provide more insight into their perceptions of ES and PS-ES and provide further insight for establishing good practices in ES management at the end of life.

  • ethics
  • end of life care
  • terminal care

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors All authors were involved in the conception and design of this study. PR, SM and AR carried out all qualitative data collection. Data analysis and interpretation were performed by JO, PR and CG, and they also wrote the paper. All authors were involved in critically revising the article. All authors approved the final version of the manuscript. CG is the guarantor of the study.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.