Estimating the potential life-shortening effect of continuous sedation until death: a comparison between two approaches

• Published in: Journal of medical ethics 2014-07, Vol.40 (7), p.458-462
• Main Authors: Bruinsma, Sophie M, Rietjens, Judith A C, Swart, Siebe J, Perez, Roberto S G M, van Delden, Johannes J M, van der Heide, Agnes
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Analgesics, Opioid - therapeutic use; Anesthesia; Assisted suicide; Bioethics; Clinical ethics; Conscious Sedation - ethics; Conscious Sedation - methods; Data collection; Death; Dosage and administration; Estimate reliability; Ethics, Clinical; Family physicians; Female; Humans; Hypnotics; Hypnotics and sedatives; Hypnotics and Sedatives - therapeutic use; Life Expectancy; Male; Medical practice; Methods; Middle Aged; Nursing homes; Overestimates; Pain management; Palliative care; Palliative Care - ethics; Palliative Care - methods; Patients; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Questionnaires; Retrospective Studies; Sedatives; Terminal care
• ISSN: 0306-6800; 1473-4257
• DOI: 10.1136/medethics-2013-101459

Context In some cases, physicians estimate that continuous sedation until death may have a life-shortening effect. The accuracy of these estimations can be questioned. Aim The aim of this study is to compare two approaches to estimate the potential life-shortening effect of continuous sedation until death. Methods In 2008, 370 Dutch physicians filled out a questionnaire and reported on their last patient who received continuous sedation until death. The potential life-shortening effect of continuous sedation was estimated through a direct approach (question: Did continuous sedation, according to your estimation, hasten the patient’s death? If yes: by how much time?) and an indirect approach (estimated life expectancy minus duration of sedation). The intrarater agreement between both approaches was determined with a weighted κ. Results According to the direct approach, sedation might have had a life-shortening effect in 51% of the cases and according to the indirect approach in 84%. The intrarater agreement between both approaches was fair (weighted κ=0.38). In 10% of all cases, the direct approach yielded higher estimates of the extent to which life had been shortened; in 58% of the cases, the indirect approach yielded higher estimates. Conclusions The results show a discrepancy between different approaches to estimate the potential life-shortening effect of continuous sedation until death.