• Jane Seymour, Judith Rietjens, Sophie Bruinsma, Luc Deliens, Sigrid Sterckx, Freddy Mortier, Jayne Brown, Nigel Mathers, Agnes van der Heide, and UNBIASED consortium.
• School of Health Sciences, Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, University of Nottingham, Queen's Medical Centre, Nottingham, UK jane.seymour@nottingham.ac.uk.
• Palliat Med. 2015 Jan 1; 29 (1): 48-59.

BackgroundExtensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses.MethodsQualitative case studies using interviews.SettingHospitals, the domestic home and hospices or palliative care units.ParticipantsIn all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients.ResultsUK respondents reported a continuum of practice from the provision of low doses of sedatives to control terminal restlessness to rarely encountered deep sedation. In contrast, Belgian respondents predominantly described the use of deep sedation, emphasizing the importance of responding to the patient's request. Dutch respondents emphasized making an official medical decision informed by the patient's wish and establishing that a refractory symptom was present. Respondents employed rationales that showed different stances towards four key issues: the preservation of consciousness, concerns about the potential hastening of death, whether they perceived continuous sedation until death as an 'alternative' to euthanasia and whether they sought to follow guidelines or frameworks for practice.ConclusionThis qualitative analysis suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the United Kingdom, Belgium and the Netherlands.© The Author(s) 2014.

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