[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Medical ethics](https://durgical.com/en/medical-ethics/) › [End of life and donation](https://durgical.com/en/medical-ethics/areas/end-of-life/) › Palliative sedation # Palliative sedation - Procedure Lowering a patient's consciousness with drugs to relieve an unbearable symptom that nothing else controls, at the end of life. Updated Nov 5, 2026 ## Key points - Indication: a refractory (not merely difficult) symptom in a patient at the end of life. - Proportionality: the lightest level of sedation that relieves the symptom. - Intention: to relieve, not to shorten life; studies do not show that it shortens survival. - It needs consent from the patient or, if they cannot give it, their representative, and a record in the medical record. - The World Medical Association accepts it as a last-resort measure for severe symptoms that do not respond to other palliation. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/medical-ethics/palliative-sedation/) ## Connections ## Related 4 - [The principle of double effect](https://durgical.com/en/medical-ethics/the-principle-of-double-effect/) - [Ley 1733 de 2014: palliative care](https://durgical.com/en/medical-ethics/ley-1733-de-2014-palliative-care/) - [Killing and letting die: euthanasia, assisted suicide and withdrawal compared](https://durgical.com/en/medical-ethics/killing-and-letting-die-euthanasia-assisted-suicide-and-withdrawal-compared/) - [Limiting life-sustaining treatment: withholding and withdrawing](https://durgical.com/en/medical-ethics/limiting-life-sustaining-treatment-withholding-and-withdrawing/) [← All of medical ethics](https://durgical.com/en/medical-ethics/) 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)](https://www.ncbi.nlm.nih.gov/books/NBK470545/) (NCBI Bookshelf, 2026); [WMA Declaration of Venice on End of Life Medical Care](https://www.wma.net/policies-post/wma-declaration-of-venice/) (World Medical Association, 2022). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/medical-ethics/palliative-sedation/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/palliative-sedation/