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L’Oréal-UNESCO For Women in Science Fellow (1 September 2013 – 30 November 2013)
How can cultural diversity in the use of palliative sedation be explained?
End-of-life care involves complex decisions for often severely suffering patients. An increasingly used last resort intervention is palliative sedation: bringing the patient into a state of unconsciousness to take away the perception of symptoms. While often praised as an indispensable technique to alleviate suffering, it is also criticized for depriving patients of the ability to communicate and its resemblance to euthanasia. Large variations between countries in the frequency and the clinical characteristics of sedation indicate that its use is not only determined by the severity of suffering, but also by other factors, which are hardly understood. I will develop a framework aimed at explaining the variance in this controversial end-of-life-treatment. The results can inform the development of culturally sensitive end-of-life care guidelines and policymaking.
1) Rietjens JA, van Delden JJ, Onwuteaka-Philipsen BD, Buiting HM, van der Maas PJ, van der Heide A. The use of continuous deep sedation for patients nearing death in the Netherlands: a descriptive study. BMJ 2008; 336:810-3.
2) Swart SJ, van der Heide A, van Zuylen L, Perez RSGM, Zuurmond WA, van der Maas PJ, van Delden JJH, Rietjens JA. Considerations of physicians regarding the depth of palliative sedation at the end of life. CMAJ 2012; 184: E360-6.
3) Rietjens JA, Voorhees JR, van der Heide A, Drickamer MA. Approaches to suffering at the end of life: the use of sedation in the USA and Netherlands. J Med Ethics. 2012 Sep 14. [Epub ahead of print]
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