{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:48:05Z","timestamp":1782287285400,"version":"3.54.5"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e9 Catholique de Lille"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Bioethical Inquiry"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    The principle of double effect is often invoked to interpret clinical intentions in palliative sedation (PS), considering that intended effect may differ from foreseen effect. Despite clarifications, intentions concerning patient consciousness remain ambiguous. Moreover, little is known about how non-palliative care specialists understand and apply these intentions.\n                    <jats:italic>Methods<\/jats:italic>\n                    This study aims to explore physicians\u2019 intentions regarding PS, with a particular focus on the relationship between their intentions and patients\u2019 consciousness. This qualitative study is based on twelve semi-structured interviews with physicians from a university hospital in France. The methodology combined hierarchical evocation, clinical vignettes, and semi-structured interviews.\n                    <jats:italic>Results<\/jats:italic>\n                    The study reveals considerable heterogeneity in physicians\u2019 intentions regarding patient unconsciousness. The distinction between intended and foreseen effects was often poorly understood. References to the doctrine of double effect were rare, whereas the principle of proportionality was more frequently acknowledged.\n                    <jats:italic>Conclusion<\/jats:italic>\n                    This study reveals important discrepancies between specialized frameworks and the conceptual models of clinical reasoning. We particularly highlighted the inadequacy of the principle of double effect to enable an explicit evaluation of the ethical significance of induced unconsciousness and proposed a more integrated approach to palliative sedation, grounded in contemporary evidence, and proportionality.\n                  <\/jats:p>","DOI":"10.1007\/s11673-026-10578-0","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:08:25Z","timestamp":1782284905000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Unconsciousness the Intention? Physicians\u2019 Perspectives on Palliative Sedation Outside Specialized Palliative Care: A Qualitative Study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3255-7650","authenticated-orcid":false,"given":"Charles","family":"Midol","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"issue":"9","key":"10578_CR1","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1111\/bioe.12792","volume":"34","author":"H Arima","year":"2020","unstructured":"Arima H. 2020. Continuous deep sedation and the doctrine of double effect: Do physicians not intend to make the patient unconscious until death if they gradually increase the sedatives? Bioethics 34(9): 977\u2013983.","journal-title":"Bioethics"},{"issue":"5","key":"10578_CR2","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1136\/jme-2025-110912","volume":"52","author":"H Arima","year":"2025","unstructured":"\u2014\u2014\u2014. 2025. Double- effect sedation: do physicians not intend a decrease in consciousness when it is caused by drugs that can also reduce specific\u00a0symptoms? Journal of Medical Ethics 52(5): 292\u2013299.","journal-title":"Journal of Medical Ethics"},{"issue":"6","key":"10578_CR3","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1089\/jpm.2011.0157","volume":"15","author":"JA Billings","year":"2012","unstructured":"Billings, J.A., and L.R. Churchill. 2012. Monolithic moral frameworks: How are the ethics of palliative sedation discussed in the clinical literature? Journal of Palliative Medicine 15(6): 709\u2013713.","journal-title":"Journal of Palliative Medicine"},{"issue":"22","key":"10578_CR4","doi-asserted-by":"publisher","first-page":"5720","DOI":"10.3390\/cancers14225720","volume":"14","author":"JT Boland","year":"2022","unstructured":"Boland, J.T. 2022. Effect of opioids on survival in patients with cancer. Cancers 14(22): 5720.","journal-title":"Cancers"},{"issue":"6","key":"10578_CR5","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1177\/02692163241234800","volume":"38","author":"V Braun","year":"2024","unstructured":"Braun, V., and V. Clarke. 2024. Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: A review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG). Palliative Medicine 38(6): 608\u2013616.","journal-title":"Palliative Medicine"},{"issue":"1","key":"10578_CR6","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1186\/s12904-024-01606-0","volume":"23","author":"MI Carrasco-Zafra","year":"2024","unstructured":"Carrasco-Zafra, M.I., R. Oca\u00f1a-Riola, R. G\u00f3mez-Garc\u00eda, et al. 2024. Palliative sedation at the end of life: Prevalence, characteristics and possible determinants. BMC Palliative Care 23(1): 278.","journal-title":"BMC Palliative Care"},{"issue":"3","key":"10578_CR7","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s11017-018-9453-0","volume":"39","author":"TA Cavanaugh","year":"2018","unstructured":"Cavanaugh, T.A. 2018. Proportionate palliative sedation and the giving of a deadly drug: The conundrum. 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Nevertheless, the study adheres to the principle of ethical research in the\n                      Declaration of Helsinki\n                      and all necessary steps were taken to ensure compliance with the\n                      General Data Protection Regulation\n                      , the European regulatory framework that standardizes data processing practices across the European Union (Lille Catholic Institute, n\u00b0339). The study received ethics approval (BRC-2026-A01396-45) from the Agence Nationale de S\u00e9curit\u00e9 du M\u00e9dicament et des produits de sant\u00e9 (ANSM), the French national authority responsible for overseeing clinical research and LCI 339 issued to the Lille Catholic Institute by the Commission Nationale de l'Informatique et des Libert\u00e9s (CNIL), the independent body responsible for data protection and privacy compliance in France.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Written informed consent was obtained prior to the interview. Audio files and other data were anonymized by replacing the name of the participant with a number.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent"}}]}}