Palliative sedation
- Procedure
Lowering a patient's consciousness with drugs to relieve an unbearable symptom that nothing else controls, at the end of life.
What it is
Palliative sedation is the intentional, proportionate lowering of the level of consciousness of a patient at the end of life to relieve one or more refractory symptoms: those that no other treatment controls without unacceptable effects. It can be intermittent or continuous, light or deep. Its goal is relief, not death: it is adjusted to the lightest level that controls the symptom. That is why it is distinguished from euthanasia and explained by the principle of double effect.
What it must include
- Common refractory symptoms: agitated delirium, breathlessness, pain, seizures, massive bleeding, severe existential distress (the last is more debated).
- The decision, its reasons, the consent and the monitoring plan must be written down.
- A team must be available to reassess the patient.
How it is done
- Confirm the symptom is refractory: a team experienced in palliative care rules out reversible causes and other options.
- Assess the prognosis and the patient's overall situation.
- Inform and obtain consent from the patient or, if they cannot decide, their representative; check for a DVA.
- Define the goal: which symptom is being relieved and which type of sedation will be used (intermittent or continuous).
- Start at the lightest useful level and adjust to comfort, not to a target of unconsciousness.
- Check comfort and symptoms often, and record every adjustment.
- Decide separately, with the patient or family, on artificial hydration and nutrition.
- Support the family throughout and after the death.
In clinical practice
- In delirium in the last days, treatable causes (drugs, urinary retention, uncontrolled pain) are sought before sedating.
- Palliative sedation does not require stopping other comfort measures or the family's presence.
- Explaining to the family that the patient is calm and not suffering reduces their distress.
Common mistakes
- Calling escalating doses aimed at death «sedation»: that is not palliative sedation.
- Sedating without treating reversible causes of the symptom.
- Starting with continuous deep sedation when light or intermittent sedation would do.
- Not documenting the consent or the reasons for the decision.
- Confusing palliative sedation with euthanasia when speaking with the family.
Test yourself
Think of the answer, then tap the question to see it.
What is a refractory symptom?
One that cannot be controlled by any other available treatment within a reasonable time and without unacceptable adverse effects.
What guides the depth of palliative sedation?
Proportionality: the lightest level that relieves the symptom is used, not a target of unconsciousness.
Which ethical principle explains why palliative sedation is not euthanasia?
The principle of double effect: the intention is relief; a possible unintended effect is not the aim of the act.
Does well-indicated palliative sedation shorten life?
Studies do not show that it shortens survival when used proportionately in patients at the end of life.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Palliative Sedation in Patients With Terminal Illness (StatPearls) (NCBI Bookshelf, 2026); WMA Declaration of Venice on End of Life Medical Care (World Medical Association, 2022).
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Representative model, for educational purposes only.