Palliative Sedation for Existential Suffering: A Systematic Review of Argument-Based Ethics Literature

Rodrigues, Paulo Maria; Crokaert, Jasper; Gastmans, Chris

doi:10.1016/j.jpainsymman.2018.01.013

Cited by 59 publications

(46 citation statements)

References 78 publications

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“…A lack of robust conceptual and ethical arguments grounding PS-ES decision-making and practices clearly contributes to the controversial status of PS-ES and the absence of consensus among physicians 44. The abovementioned systematic review on ethical aspects of PS-ES14 revealed that implicit anthropological models and philosophical presuppositions underpin the ethical debate on PS-ES. However, considering the present systematic review of empirical evidence on physicians’ perceptions of PS-ES, it is revealed that philosophical presuppositions and ethical arguments remain mostly unclear and unexpressed.…”

Section: Discussionmentioning

confidence: 99%

“…Physicians have a primary, personal responsibility in clarifying the decision-making for patients, families and caregivers considering palliative sedation for existential suffering (PS-ES), and they play a key role in the discussions. A review of ethical aspects of PS-ES revealed that physicians’ anthropological models and philosophical presuppositions underpin the ethical debate on PS-ES 14…”

Section: Introductionmentioning

confidence: 99%

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Physicians’ perceptions of palliative sedation for existential suffering: a systematic review

Rodrigues

Menten

Gastmans

2019

BMJ Support Palliat Care

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BackgroundPalliative 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.AimTo gain deeper insight into physicians’ perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it.DesignSystematic 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 sourcesSeven 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.ResultsThe 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.ConclusionsTo 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physicians’ perceptions of palliative sedation for existential suffering: a systematic review

Rodrigues

Menten

Gastmans

2019

BMJ Support Palliat Care

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“…Against this background, the controversy is centered on the questions of whether different types of suffering can be distinguished (e.g., if the differentiation between ''physical'' and ''psycho-existential'' suffering is assumed to be a valid distinction) and whether the different types of suffering can be skillfully addressed in (palliative) medicine. 13 The question of symptoms eligible for palliative sedation is linked to the one of prerogative of interpretation. This is because it is assumed that some types of suffering can be assessed better from the outside (i.e., by health care professionals) than others.…”

Section: Suffering: a Challenging Concept In Palliative Sedationmentioning

confidence: 99%

“Suffering” in Palliative Sedation: Conceptual Analysis and Implications for Decision Making in Clinical Practice

Bozzaro

Schildmann

2018

Journal of Pain and Symptom Management

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Palliative sedation is an increasingly used and, simultaneously, challenging practice at the end of life. Many controversies associated with this therapy are rooted in implicit differences regarding the understanding of "suffering" as a prerequisite for palliative sedation. The aim of this study is to inform the current debates by a conceptual analysis of two different philosophical accounts of suffering-1) the subjective and holistic concept and 2) the objective and gradual concept-and by a clinical-ethical analysis of the implications of each account for decisions about palliative sedation. We will show that although the subjective and holistic account of suffering fits well with the holistic approach of palliative care, there are considerable challenges to justify limits to requests for palliative sedation. By contrast, the objective and gradual account fits well with the need for an objective basis for clinical decisions in the context of palliative sedation but runs the risk of falling short when considering the individual and subjective experience of suffering at the end of life. We will conclude with a plea for the necessity of further combined conceptual and empirical research to develop a sound and feasible understanding of suffering, which can contribute to consistent decision making about palliative sedation.

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“…Though relatively straightforward to distinguish, actually defining each dimension of suffering has proved more difficult, and in point of fact, existential suffering has so far defied a universally accepted definition 3. The authors of a recent systemic review concluded that existential suffering continues to have multiple definitions and that moreover, opinions are divided as to its very nature 4. Most current definitions of existential suffering make some reference to mortality, loss of autonomy and meaninglessness of life as being important components and/or manifestations of this form of suffering but fall short of making the final connection with a clear definition 5 6.…”

Section: Introductionmentioning

confidence: 99%

The nature of suffering and its relief: a proposal for a redefinition

Kioko

Meana

2019

BMJ Support Palliat Care

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Recent advances in our understanding of the nature of suffering and its different dimensions have exposed certain deficits in the current definition of suffering. These shortcomings have impacted negatively on the appropriate formulation of precise treatment objectives for each dimension of suffering within the overall framework of the goals of medicine. Existential suffering offers a clear example where the lack of a universally accepted definition has led to confusion regarding what should constitute appropriate relief for this particular dimension of suffering. In this thought piece, we propose a redefinition of suffering based on three elements: first, suffering refers to a specific state of a person (the essence of suffering); second, this state is characterised by a specific psychosomatic anguish reaction (the manifestation of suffering) and third, this reaction is in response to a perceived threat to the integrity of the person (the cause of suffering). The proposed definition allows for an important and clear distinction to be made between the primary and symptomatic relief of suffering and the role of medicine in each form of relief. The terms of the proposed definition and the distinction between primary and symptomatic relief provide useful tools for further research regarding the different dimensions of suffering and its relief.

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Palliative Sedation for Existential Suffering: A Systematic Review of Argument-Based Ethics Literature

Cited by 59 publications

References 78 publications

Physicians’ perceptions of palliative sedation for existential suffering: a systematic review

Physicians’ perceptions of palliative sedation for existential suffering: a systematic review

“Suffering” in Palliative Sedation: Conceptual Analysis and Implications for Decision Making in Clinical Practice

The nature of suffering and its relief: a proposal for a redefinition

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