Open Access Research article

Continuous sedation until death: the everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium

Kasper Raus12*, Jayne Brown3, Clive Seale4, Judith AC Rietjens25, Rien Janssens6, Sophie Bruinsma5, Freddy Mortier12, Sheila Payne7 and Sigrid Sterckx12

Author Affiliations

1 Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, Ghent, Belgium

2 End of Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, Belgium

3 School of Nursing and Midwifery, De Monfort University, The Gateway, Leicester, UK

4 Department of Sociology and Communications, Brunel University, Uxbridge, Middlesex, UK

5 Department of Public Health, Erasmus MC, Dr. Molewaterplein 50, Rotterdam, The Netherlands

6 Department of Medical Humanities, VU Medical Centre, Van der Boechorststraat 7, Amsterdam, The Netherlands

7 International Observatory on End of Life Care, Lancaster University, Furness College, Lancaster, UK

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BMC Medical Ethics 2014, 15:14  doi:10.1186/1472-6939-15-14

Published: 20 February 2014



Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress.


This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology.


The participants’ responses can be captured as different dimensions of ‘closeness’, i.e. the degree to which one feels connected or ‘close’ to a certain decision or event. We distinguished four types of ‘closeness’, namely emotional, physical, decisional, and causal. Using these four dimensions of ‘closeness’ it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility.


Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.