Raus Kasper, Brown Jayne, Seale Clive, Rietjens Judith A C, Janssens Rien, Bruinsma Sophie, Mortier Freddy, Payne Sheila, Sterckx Sigrid
Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, Ghent, Belgium.
BMC Med Ethics. 2014 Feb 20;15:14. doi: 10.1186/1472-6939-15-14.
Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.
This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology.
The participants' responses can be captured as different dimensions of 'closeness', i.e. the degree to which one feels connected or 'close' to a certain decision or event. We distinguished four types of 'closeness', namely emotional, physical, decisional, and causal. Using these four dimensions of 'closeness' it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility.
Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.
持续镇静越来越多地被用作缓解临终症状的一种方式。目前的研究表明，参与这种做法的一些医生、护士和亲属会经历情感和/或道德困扰。本研究旨在深入了解哪些因素可能影响专业护理人员和/或家庭护理人员应对此类困扰的方式。
本研究是一项国际定性访谈研究，涉及对英国、荷兰和比利时（无偏见研究）已故患者的医生、护士和亲属进行访谈，内容是他们最近参与的一例临终持续镇静病例。所有访谈均逐字转录，并通过使用开放编码贴近数据进行分析。接下来，将代码合并为更大的主题和代码类别，形成一个涵盖所有数据的四点方案。最后，我们将研究结果与其他研究结果进行比较，并结合伦理学和社会学理论进行探讨。
参与者的回答可以归纳为“亲近感”的不同维度，即一个人对某个决定或事件感到联系或“亲近”的程度。我们区分了四种类型的“亲近感”，即情感上的、身体上的、决策上的和因果关系上的。利用“亲近感”的这四个维度，可以描述医生、护士和亲属在参与持续镇静直至死亡的病例中的经历。更具体地说，它揭示了护理人员和亲属在持续镇静背景下日常的道德推理，以及这如何影响参与镇静的情感影响，以及对自身道德责任的认知。
本研究结果表明，据报道，各种因素会影响与持续镇静的亲近程度（从而影响护理人员感到道德责任的程度），其中一些因素有助于护理人员和亲属区分持续镇静和安乐死。
