What is palliative sedation and when is it indicated?

• A. Deliberate lowering of consciousness to relieve refractory distress when other measures fail
• B. Sedation should be used only for sleep, regardless of distress
• C. Sedation is never appropriate in palliative care
• D. Sedation is the same as general anesthesia

Answer: (A)

Palliative sedation is the deliberate lowering of a patient’s level of consciousness to relieve refractory distress in the setting of advanced illness, when all other reasonable measures have failed. It is used only to relieve unmanageable symptoms—such as severe pain, intractable dyspnea, or agitation/delirium—that do not respond to optimized therapies, and it is considered when death is near. It is not about helping someone sleep or about routine sedation; it is specifically about relieving refractory suffering at the end of life. It differs from general anesthesia in intent and context: the goal is comfort and relief of intolerable symptoms, not to perform a procedure. Ethical use involves multidisciplinary input and, when possible, informed discussion with the patient and family, with careful monitoring of the level and duration of sedation, which may be continuous until death or for a defined period depending on circumstances.