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This is a Cross-Sectional Study study (also classified as: Validation Study).

December 4, 2025Open Access

Pediatric Palliative Sedation: Ethical Considerations and Nursing Role in Pakistan

Key Points

High moral distress occurs in 72.8% of oncology nurses due to ethical dilemmas surrounding pediatric palliative sedation.
The response rate was 90% from 162 out of 180 surveyed nurses, revealing significant concerns about inadequate training.
Palliative sedation training was reported by only 28.4% of surveyed nurses, indicating a critical need for education.
Multidisciplinary decision-making is strongly supported (94.4%), emphasizing the necessity for national guidelines in Pakistan.

Abstract

Pediatric palliative sedation (PPS) for refractory suffering at the end of life remains ethically complex and under-studied in low- and middle-income countries. This quantitative cross-sectional study aimed to explore nurses’ knowledge, attitudes, perceived ethical dilemmas, and self-reported competencies regarding pediatric palliative sedation in tertiary-care hospitals of Punjab, Pakistan. A validated self-administered questionnaire was distributed to 180 registered pediatric and oncology nurses; 162 completed responses were analyzed (response rate 90%). Results revealed moderate knowledge (M=62.4%, SD=14.2), predominantly positive attitudes toward proportionate sedation (M=3.98, SD=0.71 on 5-point Likert), but high perceived ethical conflict (72.8% frequently experienced moral distress). Only 28.4% reported formal training in PPS. Significant predictors of comfort with PPS were previous training (β=0.42, p

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