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French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering

Published online by Cambridge University Press:  17 June 2013

M. Beauverd ,
M. Bernard ,
T. Currat ,
S. Ducret ,
R.A. Foley ,
G.D. Borasio ,
D. Blondeau  and
S. Dumont
M. Beauverd*
Affiliation:
Palliative care service, Department of medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
M. Bernard
Affiliation:
Palliative care service, Department of medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
T. Currat
Affiliation:
Palliative care service, Department of medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
S. Ducret
Affiliation:
Palliative care service, Department of medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
R.A. Foley
Affiliation:
Palliative care service, Department of medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
G.D. Borasio
Affiliation:
Palliative care service, Department of medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
D. Blondeau
Affiliation:
Faculty of Nursing, Laval University, Quebec City, Canada
S. Dumont
Affiliation:
School of Social Work, Laval University, Quebec City, Canada
*
Address correspondence and reprint requests to: Michel Beauverd, Palliative Care Service, Centre Hospitalier Vaudois (CHUV), Hôpital Nestlé, Avenue Pierre Decker 5, 1011 Lausanne, Switzerland. E-mail: michel.beauverd@chuv.ch
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Abstract

Objective:

Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially “existential suffering.” This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable).

Methods:

We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians.

Results:

74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000).

Significance of the results:

The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.

Keywords

Palliative sedationExistential sufferingEnd-of-life decision makingSwitzerland
Type
Original Articles
Information
Palliative & Supportive Care , Volume 12 , Issue 5 , October 2014 , pp. 345 - 350
Copyright
Copyright © Cambridge University Press 2013 

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