Continuous deep sedation in medical practice: a descriptive study

Abstract

Context: Continuous deep sedation (CDS) until death can form an effective part of palliative care. In The Netherlands and Belgium, CDS is sometimes regarded as an alternative to euthanasia, and the involvement of palliative care specialists is low. Provision of CDS through opioids alone is not recommended.

Objectives: This study investigates the use of CDS in the United Kingdom.

Methods: A survey of 8,857 doctors, of whom 3,733 (42%) replied, with 2,923 reporting on their last patient who died.

Results: In total, 18.7% (17.3-20.1) of the doctors attending a dying patient reported the use of CDS. CDS was more likely when patients were younger or were dying of cancer. Specialists in care of the elderly were least likely to report the use of CDS; doctors in other hospital specialties were most likely to report its use. CDS was associated with a higher rate of requests from patients or relatives for a hastened death and with a greater incidence of other end-of-life decisions containing some intent to end life by the doctor. Doctors supporting legalization of euthanasia or physician-assisted suicide, or who were nonreligious, were more likely to report using CDS. There was palliative care team involvement in half of all CDS cases, and prescription of opioids alone for sedation occurred in one-fifth of the cases but was not reported by specialists in palliative care.

Conclusion: This study provides baseline data for monitoring future trends in the United Kingdom and highlights the need for a fuller understanding of the circumstances in which CDS occurs in particular care settings.