{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:26:54Z","timestamp":1787646414388,"version":"build-2736575974"},"reference-count":71,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"European Union\u2019s Horizon 2020 research and innovation programme","award":["825700"],"award-info":[{"award-number":["825700"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat&amp;#65533;Care"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Palliative sedation is a last-resort intervention designed to alleviate refractory suffering at the end of life. Healthcare professionals frequently encounter ethically complex situations when deciding whether and how to apply palliative sedation. Moral case deliberation supports healthcare professionals in discussing ethical issues in a structured way.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe healthcare professionals\u2019 perceptions of ethical issues about the practice of palliative sedation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This qualitative study was designed as part of the five-year Palliative Sedation project conducted in eight European countries (Belgium, Germany, Hungary, Italy, the Netherlands, Romania, Spain, and the United Kingdom).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty-two moral case deliberation sessions were held in 16 clinical sites with the participation of 231 healthcare professionals. During the sessions, healthcare professionals discussed relevant clinical cases where ethical questions arose regarding the practice of palliative sedation for the management of refractory symptoms. The sessions were audio-recorded and transcribed verbatim. Framework analysis was performed on the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ethical issues related to palliative sedation were centred on patient autonomy as a fundamental principle. Healthcare professionals identified several ethical concerns about mental capacity, deferring autonomy, and competing ethical principles. Most of the ethical issues arose in the context of decision-making, and participants often experienced moral distress in these challenging situations. Healthcare professionals agreed that shared decision-making represented the optimal approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Healthcare professionals have varying levels of understanding and address ethical issues differently. This study showed that palliative sedation is an ethically dense practice that requires moving beyond individualistic models of autonomy toward a more relational approach. Shared decision-making through timely and open communication enhances patient autonomy in the context of palliative sedation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26323524261474091","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T13:31:00Z","timestamp":1787405460000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare professionals\u2019 perceptions of ethical issues in palliative sedation: A moral case deliberation study in eight European countries"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6916-1118","authenticated-orcid":false,"given":"Csilla","family":"Busa","sequence":"first","affiliation":[{"name":"Institute of Primary Health Care"},{"name":"University of P\u00e9cs Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Pozsgai","sequence":"additional","affiliation":[{"name":"Institute of Primary Health Care"},{"name":"University of P\u00e9cs Medical School"},{"name":"University of P\u00e9cs Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6982-9181","authenticated-orcid":false,"given":"Sheila","family":"Payne","sequence":"additional","affiliation":[{"name":"Lancaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Harding","sequence":"additional","affiliation":[{"name":"Lancaster University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Mosoiu","sequence":"additional","affiliation":[{"name":"Transilvania University Brasov"},{"name":"Hospice Casa Sperantei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Van der Elst","sequence":"additional","affiliation":[{"name":"UH & KU Leuven"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Brunsch","sequence":"additional","affiliation":[{"name":"University Hospital Bonn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Koper","sequence":"additional","affiliation":[{"name":"Radboud University Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle","family":"van Gurp","sequence":"additional","affiliation":[{"name":"Radboud University Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alazne","family":"Belar","sequence":"additional","affiliation":[{"name":"Instituto Cultura y Sociedad"},{"name":"Universidad de Navarra"},{"name":"Instituto de Investigaci\u00f3n Sanitaria de Navarra (IdISNA), Palliative Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmine","family":"Grassi","sequence":"additional","affiliation":[{"name":"La Maddalena Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Hasselaar","sequence":"additional","affiliation":[{"name":"Radboud University Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3322-9122","authenticated-orcid":false,"given":"Agnes","family":"Csikos","sequence":"additional","affiliation":[{"name":"Institute of Primary Health Care"},{"name":"University of P\u00e9cs Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.09.022"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/spcare-2022-003651"},{"key":"e_1_3_7_4_2","first-page":"1113","article-title":"Systematic Review of Common Refractory Symptoms in the End-Of-Life Situation and Its Relation With Euthanasia","volume":"89","author":"Lucena A","year":"2024","unstructured":"Lucena A, Yuguero O. 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