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 i) the concept of ‘routine’ sedation; ii) the relationship of sedation to ensuring a good dying and death; iii) the fundamental role of values in the use of sedation. This paper will consider the second of these. The use of sedation at the end of life was found to be motivated by healthcare professionals' desire to bring about good dying and death. This ‘good dying’ centred on symptom control and relief of distress with the aim of bringing about what was conceptualised as a ‘natural’ death, that is dying in sleep. Sedation was used to facilitate this process.
Conclusion This research provides the first empirical evidence of the normative basis to the use of sedation, which lies in the hospice construct of good dying and death. This has important implications for the specialty as it expands to provide care for patients with different illnesses and dying trajectories. Uncertainty about diagnosing dying raises challenges regarding the use of sedation, especially when continuous sedation is used until death. The desire to bring about good dying must be balanced by good decision-making in uncertainty.
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