Continuous palliative sedation: more than a taboo, a reality in words

Abstract

 Introduction: Continuous palliative sedation (CPS) is defined as the administration of medications to relieve physical or psychological suffering (refractory symptoms) that cannot be alleviated by other means, through a progressive and predictably irreversible decrease in consciousness in a patient whose death is expected to occur soon. This therapy is considered clinically, communicatively, ethically, legally, and emotionally complex, as reflected by the inconsistencies that persist in the literature regarding its definition, the diversity of refractory symptoms, individual needs, and precise indications. Objectives: To analyze the professional and ethical challenges faced by palliative care specialists in the use of CPS through a more personalized approach, valuing their perspectives. Methods: A qualitative approach was employed, specifically focus group discussions, as CPS is a complex phenomenon requiring a holistic understanding. Three focus groups were conducted (two with two informants and one with three, from various specialties, totaling seven physicians). Results: A phenomenological interpretive analysis was used, employing processes of description, interpretation, and comparison to consolidate the data into four categories based on the study objectives: experiences with CPS, clinical approach, environment, and professional and ethical impact. Conclusion: The findings reveal that physicians perceive CPS as a viable tool for alleviating refractory physical suffering in terminally ill patients, without the intention of hastening death. However, they recognize the multifactorial complexity of this practice, which can influence the quality of sedation. Therefore, it is imperative to intensify research, develop robust educational resources, and update clinical guidelines to address the challenges faced by interprofessional teams.