Palliative Sedation

The primary aim of palliative sedation is to relieve distress and suffering at the end-of-life. Palliative sedation is indicated for patients who have refractory symptoms at the end-of-life that are not adequately managed by standard medical therapies. Historically, this practice has been described as “terminal sedation,” and it is sometimes conflated with the concept of euthanasia, especially since physician aid-in-dying has become a legal practice in several states in the US (Oregon Death With Dignity Act, OR REV. STAT §127.800–127.995, 2015; Hedberg and New. Ann Intern Med. 167:579–583, 2017). In this chapter, the current guidelines and general practice principles of palliative sedation will be described. Ethical considerations will be reviewed; symptom management and applicable medications will be described; and the development of practice standards will be discussed. Finally, clinical and patient/family considerations will be discussed.