Palliative or Terminal Sedation Overview

Alleviating Suffering When All Else Fails

Despite even the best palliative care, some patients can't get adequate relief from their suffering and may need what's known as palliative sedation to avoid agony and distress.

Before sedation is considered, the team of people caring for you or your loved one - often known as the palliative care team - will look at many possible options to help relieve suffering, such as aggressive symptom management (using any and all medications and treatments that may help) and mental support to help with emotional concerns.

The goal is to make the patient as comfortable as possible. When this effort isn't enough, palliative sedation may be an option.

Sometimes symptoms are difficult to treat and don't seem to respond to any treatment. This is sometimes seen in patients who have cancer and experience severe pain. Despite high doses of pain medications, some pain just can't be relieved. Other symptoms may cause severe distress as well - frequent and severe nausea and vomiting, uncontrollable tremors or seizures, and severe breathlessness are just a few examples of distressing conditions. In these cases, sedation may be the only way to get adequate relief.

Once the decision has been made - by a physician in cooperation with the patient or their decision maker - to use palliative sedation, a sedative medication is given and increased until the desired comfort level is achieved. Often, patients are able to maintain consciousness while sedated to a comfortable degree.

But if a patient is still experiencing intolerable symptoms, inducing unconsciousness may be an acceptable last resort.

Medications used to cause sedation may include anti-anxiety drugs, such as Valium and Phenobarbitol, and pain medications. The feeling of sedation may range from a gentle calm sensation to complete unconsciousness.

Generally, the lowest amount of sedative medication that has the desired effect of relieving suffering is used. This may mean that the patient remains conscious for as long as possible.

If inducing an unconscious state is the only way to relieve suffering, it may be tried as a temporary solution with the medical staff allowing the sedatives to wear off to reassess the patient's comfort level. It may be decided that the only way to ensure comfort is to maintain complete sedation until death occurs. If this is done, death will usually occur within one week. One study indicates the average time is about 27 hours.

See "Does Palliative Sedation Cause Death?" for more information on sedation and death.

There are typically three criteria that a patient's case should meet before palliative sedation is considered:

  • alternative means of alleviating suffering have been ineffective or have produced intolerable side effects
  • the goal of sedation must be to alleviate suffering, not end the patients life or hasten death
  • the patient must be close to death already, so sedation would not significantly shorten survival

Palliative sedation is never done without the patient's or his appointed decision maker's consent.

This is what is referred to as an autonomous decision -- one that is made by the patient, or a surrogate, based on his or her personal values, beliefs and goals. The requirement for healthcare providers to secure this permission ensures that the decision, if chosen, is made in line with the individual's personal wishes and without the influence of a doctor's personal ethics regarding the matter.


Bernard Lo, MD; Gordon Rubenfeld, MD, MSc. "Palliative Sedation in Dying Patients". JAMA. 2005;294:1810-1816.

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