Pediatric Palliative Sedation: Ethical Considerations and Nursing Role in Pakistan

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<0.001) and years of pediatric experience (β=0.31, p=0.002). Nurses strongly supported multidisciplinary decision-making (94.4%) and the need for national guidelines (96.9%). The study concludes that despite ethical acceptance of proportionate sedation aligned with WHO principles, lack of training and institutional protocols contribute to moral distress among Pakistani nurses. Urgent integration of PPS education in nursing curricula and development of context-specific guidelines is recommended.