Wishes to Die of Palliative Cared People in Serious Illness

Franziska Rau

Communication and legitimation: moral dilemmas of palliative sedation from the perspective of palliative care specialists

Palliative sedation (PS) is generally accepted as a method of reducing pain using mind-attenuating drugs for symptoms that cannot be controlled in any other way. However, in certain clinical constellations - for example, together with the termination of life-sustaining measures - or applied in a deep-continuous form, this therapy is quite controversial. There is evidence that the boundaries with euthanasia can sometimes become blurred in practice. Even if an increasing tendency of using PS in dying patients can be observed in some European countries (for Germany, there are no representative data so far demonstrating such a development), a controversial ethical debate regarding a morally acceptable approach to PS remains.

Qualitative studies have already examined the emotional impact on those involved in sedation and the ethical reasoning of physicians and nurses involved in the form of deep continuous sedation in three European countries. However, these results cannot be readily transferred to Germany, as we have a different legal framework regarding euthanasia, which presumably influences the handling of PS. To our knowledge, no qualitative studies exist in Germany to date that examine the moral conflicts - if they exist - from the perspective of practicing palliative care specialists.

Therefore, in the context of this study, using an empirical-ethical research approach, I would like to clarify whether and if so, in which legitimation conflicts palliative specialists and nurses are involved to what they attribute them and how they interpret them. How do such conflicts affect communication about PS? How do they understand their role as palliative physicians and how do their own ideas about dying influence their approach to PS?

Ten to twelve semi-structured interviews with palliative care specialists are planned. The physician perspective will also be compared with the perspective of nurses. In selecting the subjects, we want to follow the principles of Theoretical Sampling as much as possible. The interviews will be recorded and analyzed using the method "Interpretative Phenomenological Analysis" according to J.A. Smith.

Supervision: Prof. Christoph Rehmann-Sutter