How is paediatric palliative sedation practised across Europe?

The EAPC Children and Young People Reference Group is proud to share the results of an international survey on paediatric palliative sedation therapy. Initiated and coordinated by members of our group, this study provides the first broad overview of how this form of care is applied across Europe.

Why this survey?

Paediatric palliative sedation therapy can be a crucial intervention for children with refractory symptoms in the final stages of life. Yet until now, little has been known about how it is practised in reality. This survey offers valuable insights into how physicians approach medical decisions, ethical dilemmas, and the involvement of children and parents in the decision-making process.

How was the survey conducted?

Between October 2023 and February 2025, 348 paediatricians and other physicians from Belgium, Czechia, the Netherlands, Portugal, and Switzerland completed a questionnaire. Most participants were paediatricians, and more than three out of four had prior experience with palliative sedation. The questionnaire covered medical practice, decision-making, and ethical perspectives.

Key findings

• Medication use: Midazolam (85%) and opioids (78%) were most frequently administered. More specialised physicians also used agents such as dexmedetomidine and propofol.
• Involvement: Parents were almost always involved in decisions (93%). Competent children were involved in 77% of cases. The involvement of younger children varied considerably between countries and was influenced by the physician’s training.
• Indications: Nearly all physicians (99%) considered physical symptoms a valid reason for sedation. Agreement was lower for psychological suffering (69%), particularly when survival was expected to last weeks rather than days.
• Nutrition and hydration: 63% supported discontinuing artificial nutrition and hydration in the final days of life, but only 24% agreed when survival was expected to be longer. Differences were marked between countries, with the Netherlands and Czechia representing opposite ends of the spectrum.
• Ethical considerations: Only 29% believed sedation shortens the dying process, while 18% found it difficult to clearly distinguish it from euthanasia. More training was associated with greater confidence in making this distinction.

Why these results matter

The survey highlights both common ground and significant differences between countries. These differences reflect not only medical training but also culture, legislation, and healthcare systems. This highlights an urgent need for:

• International guidelines on paediatric palliative sedation therapy
• More training in paediatric palliative care for physicians
• Cross-country dialogue to share experiences and ethical perspectives

The results represent an important step towards improving end-of-life care for children and providing better support for professionals delivering this care. The full study will soon be published in BMC Palliative Care, in a special issue dedicated to palliative sedation. Once available, more detailed information will follow.