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

Abstract

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.

Existential suffering as a motive for assisted suicide: difficulties, acceptability, management and roles from the perspectives of Swiss professionals

“…The acceptability of palliative sedation for refractory existential suffering also raises controversial issues that have been explored in the literature recently. (4,12,13,32) A 2020 review (12) reports that “physicians do not hold clear views or agree if and when palliative sedation for existential suffering is appropriate” and that clinicians continue to be more favorable to palliative sedation for physical pain than for existential suffering. Ultimately, whether or not we are open to palliative sedation, it is our duty as clinicians, as stated by the SAMS (Swiss Academy of Medical Sciences) to have explored this suffering and to have proposed alternatives.…”

“…(11) This lack of consensus on what these approaches are and on how to manage existential suffering often leads to a feeling of helplessness in physicians and other health care professionals. (12–15)…”

“…(11) This lack of consensus on what these approaches are and on how to manage existential suffering often leads to a feeling of helplessness in physicians and other health care professionals. (12)(13)(14)(15) Other authors, mainly from the palliative care field, have already addressed this issue and have suggested the importance of being present for the patient, the use of psychoexistential approaches and the promotion of spiritual care. (6,(16)(17)(18)(19)(20)(21) A 2008 review (9) reported on eight "existentially-informed interventions" addressing existential concerns that have the potential to positively impact a person's well-being and overall quality of life at the end of life.…”

Ethics of sedation for existential suffering: palliative medicine physician perceptions - qualitative study

“…To understand the complexity of PS-ES, it is important to gain in-depth insight into palliative care physicians’ perceptions of PS-ES, since they are regularly confronted with patients’ refractory ES at the end of life in general9 and specifically because they have a key responsibility in decision-making regarding PS-ES. A systematic review revealed that there is still no consensus on physicians’ perceptions regarding PS-ES 10. A recent study on PS-ES indicates that physicians struggle with the definition, nature and assessment of ES and that it is difficult for them to establish clear criteria for decision-making processes of PS-ES 11…”

European Palliative Sedation Project

“…Also, the use of palliative sedation for patients with mainly existential suffering remains controversial. 5 The practice of palliative sedation, therefore, raises many practical and ethical dilemmas for clinicians and is often poorly understood by patients and families. Witnessing the ''intolerable'' suffering of others is distressing, both for family members and the clinical team.…”