Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer

Objectives: Palliative sedation is a symptom management method frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial literature on this subject however there has been little research into the experiences of hospice nurses when administering palliative sedation as a symptom measure for terminal restlessness experienced by cancer patients. Methods: Semi-structured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the South of England in the UK. A phenomenological approach and Colaizzi’s stages of analysis were used to develop themes from the data. Results: Facilitating a ‘peaceful death’ was the primary goal of the nurses where, through the administration of palliative sedation, they sought to enable and support patients to be: ‘comfortable’; ‘relaxed’; and ‘calm’ at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, ‘juggling the drugs’; ‘causing the death’; sedating young people; family ‘requesting’ sedation and believing hospice was a place where death is hastened. Significance of results: In UK hospices nurses frequently encountered ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation caused general discomfort for the nurses. Undertaking this aspect of care requires confidence and competence on the part of the nurses and working within a supportive hospice team is of fundamental importance to supporting this practice. Key words: terminal restlessness; palliative sedation; ethical dilemmas; peaceful death; hospice nurses