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How defining clinical practices may influence their evaluation: the case of continuous sedation at the end of life

Kasper Raus (UGent) and Sigrid Sterckx (UGent)
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Abstract
Rationale, aims and objectivesContinuous sedation at the end of life is an end-of-life practice that has gained considerable attention in the international literature. Nevertheless, significant confusion persists, even on how to label or define the practice. Several different terms and definitions exist, and these are often non-neutral and indicative of one's normative position on sedation at the end of life. This is problematic for two reasons. First, the use of such value-laden terms or definitions of continuous sedation may make it difficult, if not impossible, to agree on the facts surrounding continuous sedation. Second, including normative criteria in a definition can lead one to make disguised circular or tautological statements. MethodsThis paper identifies commonly used terms and definitions and demonstrates how particular elements present in these are value-laden and can influence the ethical evaluation of continuous sedation at the end of life. ResultsTwo commonly used terms, palliative sedation' and terminal sedation', have been strongly criticized. We propose to use another, more descriptive term, namely continuous sedation at the end of life'. As regards the different definitions of sedation, some are general, but most contain very specific elements, thereby clearly limiting the number of cases that are covered by the definition. Some definitions of sedation include the intention one should (not) have, the possible indications for the practice, and the type of patients the practice should be reserved for. ConclusionIncluding value-laden elements in the very definition of a clinical practice runs the risk of pre-empting a proper normative debate about the practice. We explain why this is the case and why it is problematic, and we propose an alternative, descriptive, definition that seeks to avoid these problems.
Keywords
PALLIATIVE SEDATION, CONTINUOUS DEEP SEDATION, TERMINAL SEDATION, UNTIL DEATH, DECISION-MAKING, BELGIUM, CARE, EUTHANASIA, PHYSICIANS, COUNTRIES, continuous sedation, definition, evaluation of practice, palliative sedation

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Citation

Please use this url to cite or link to this publication:

Chicago
Raus, Kasper, and Sigrid Sterckx. 2016. “How Defining Clinical Practices May Influence Their Evaluation: The Case of Continuous Sedation at the End of Life.” Journal of Evaluation in Clinical Practice 22 (3): 425–432.
APA
Raus, K., & Sterckx, S. (2016). How defining clinical practices may influence their evaluation: the case of continuous sedation at the end of life. JOURNAL OF EVALUATION IN CLINICAL PRACTICE, 22(3), 425–432.
Vancouver
1.
Raus K, Sterckx S. How defining clinical practices may influence their evaluation: the case of continuous sedation at the end of life. JOURNAL OF EVALUATION IN CLINICAL PRACTICE. 2016;22(3):425–32.
MLA
Raus, Kasper, and Sigrid Sterckx. “How Defining Clinical Practices May Influence Their Evaluation: The Case of Continuous Sedation at the End of Life.” JOURNAL OF EVALUATION IN CLINICAL PRACTICE 22.3 (2016): 425–432. Print.
@article{7105144,
  abstract     = {Rationale, aims and objectivesContinuous sedation at the end of life is an end-of-life practice that has gained considerable attention in the international literature. Nevertheless, significant confusion persists, even on how to label or define the practice. Several different terms and definitions exist, and these are often non-neutral and indicative of one's normative position on sedation at the end of life. This is problematic for two reasons. First, the use of such value-laden terms or definitions of continuous sedation may make it difficult, if not impossible, to agree on the facts surrounding continuous sedation. Second, including normative criteria in a definition can lead one to make disguised circular or tautological statements. 

MethodsThis paper identifies commonly used terms and definitions and demonstrates how particular elements present in these are value-laden and can influence the ethical evaluation of continuous sedation at the end of life. 

ResultsTwo commonly used terms, palliative sedation' and terminal sedation', have been strongly criticized. We propose to use another, more descriptive term, namely continuous sedation at the end of life'. As regards the different definitions of sedation, some are general, but most contain very specific elements, thereby clearly limiting the number of cases that are covered by the definition. Some definitions of sedation include the intention one should (not) have, the possible indications for the practice, and the type of patients the practice should be reserved for. 

ConclusionIncluding value-laden elements in the very definition of a clinical practice runs the risk of pre-empting a proper normative debate about the practice. We explain why this is the case and why it is problematic, and we propose an alternative, descriptive, definition that seeks to avoid these problems.},
  author       = {Raus, Kasper and Sterckx, Sigrid},
  issn         = {1356-1294},
  journal      = {JOURNAL OF EVALUATION IN CLINICAL PRACTICE},
  keyword      = {PALLIATIVE SEDATION,CONTINUOUS DEEP SEDATION,TERMINAL SEDATION,UNTIL DEATH,DECISION-MAKING,BELGIUM,CARE,EUTHANASIA,PHYSICIANS,COUNTRIES,continuous sedation,definition,evaluation of practice,palliative sedation},
  language     = {eng},
  number       = {3},
  pages        = {425--432},
  title        = {How defining clinical practices may influence their evaluation: the case of continuous sedation at the end of life},
  url          = {http://dx.doi.org/10.1111/jep.12503},
  volume       = {22},
  year         = {2016},
}

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