Factors Influencing Attitudes Towards Palliative Sedation: A Survey of New Zealanders

Abstract

Palliative sedation (PS) is a contentious intervention that can bring relief from unbearable suffering by reducing the patients’ level of consciousness. However, despite the controversial nature of PS relatively little is known about people’s attitudes towards it. The systematic literature review that was conducted highlighted this lack of knowledge. This review included 27 empirical studies examining attitudes towards PS. Its findings suggest that although most people support PS, the practice does raise ethical concerns for many. The context in which PS is administered and demographic characteristics were found to be associated with peoples’ attitudes. The aim of the current study was to explore peoples’ attitudes towards PS and to examine how various factors influence these attitudes. Individuals residing in New Zealand were invited to complete a questionnaire containing eight vignettes depicting different PS scenarios. The vignettes depicting PS scenarios that varied in how and why PS was administered. The effect of the term used to refer to PS and other variables, including attitudes towards death and demographic variables, were also assessed to explore their effect on attitudes towards PS. Results from 196 completed questionnaires indicate that a majority of people regard PS as justifiable and acceptable. Continuous deep sedation until death in response to distress was regarded as the least justifiable and acceptable of the eight scenarios. The type of symptom being palliated, the way in which sedation was administered, and the extent to which the patients’ consciousness was reduced influenced the perceive justifiability and acceptability of PS. Qualitative findings revealed additional factors that influenced attitudes. Terminology used also had an impact: PS was more likely to be viewed as unacceptable when referred to as “terminal sedation” than when referred to as “palliative sedation”. Overall, there appears to be a high degree of support for PS. There are however a range of factors that influence how supportive people are of PS. In particular, the term used to refer to PS warrants consideration.