What do you mean by "palliative sedation"? : Pre-explicative analyses as preliminary steps towards better definitions

Area of Science:

• Palliative Care
• Medical Ethics
• Clinical Research Methodology

Background:

• Sedation in palliative care is a complex and debated practice.
• Heterogeneous definitions and conceptual confusion contribute to research and ethical challenges.
• Existing literature lacks detailed understanding of definition discrepancies and their impact.

Purpose of the Study:

• To analyze how definitions of sedation in palliative care differ.
• To identify mechanisms through which these definitions create research ('data problem') and ethical ('ethical pre-emption') issues.
• To explore strategies for overcoming these definitional challenges.

Main Methods:

• Systematic literature search of 29 palliative care sedation guidelines from 14 countries.
• Decomposition of definitions to identify structural and content variations.
• Logical analysis to distinguish how definition elements contribute to the 'data problem' and 'ethical pre-emption'.

Main Results:

• Significant variations in definition structure and content were found.
• The 'data problem' arises from differing definitions, implicit concepts, and factual disagreements.
• The 'ethical pre-emption' problem stems from explicit or implicit normativity within definitions.

Conclusions:

• Systematically improving the content and structure of definitions can mitigate research challenges in palliative sedation.
• Recognizing distinct purposes of definitions is crucial for future research.
• The 'ethical pre-emption' issue may be resolved by correctly understanding definitions and their relation to good practice norms.