Palliative Sedation

Palliative sedation is the continuous administration of medication to relieve severe, intractable symptoms. Palliative sedation induces a coma-like state when symptoms such as pain, nausea, breathlessness, or delirium cannot be controlled while a patient is conscious. This state is maintained until death occurs.

People experiencing severe pain and suffering at the end of life may be eligible to be sedated to the point that they become unaware of their symptoms. Palliative sedation involves the use of high doses of sedatives specifically to relieve the symptoms of suffering. It is designed to render patients unconscious, but not to end their lives. Patients usually die without pain from the secondary effects of sedation to unconsciousness, such as dehydration or pneumonia.

Although most symptoms at the end of life can be treated well, some patients experience continuous pain, agitation, delirium, and restlessness that cannot be adequately treated. For these people, palliative sedation can often be the only palliative care option to relieve their suffering.

Palliative sedation is done rarely, and almost always is done in an in-patient setting. This type of sedation is ordered by a patient’s physician or hospice provider. The sedating medication can be given to the patient in several ways: through an IV (intravenous), under the skin (subcutaneous), or rectally. This can be done in the home, hospital, or care facility.

Patients diagnosed with a terminal illness and especially those enrolled in hospice should have a straightforward conversation with their physician or hospice provider about the option of palliative sedation early on, when patients can communicate clearly and understand their options. A close friend or family member as well as the client’s Health Care Surrogate should be involved in these discussions.

Also referred to ‘terminal sedation,’ palliative sedation is the continuous administration of medication to relieve severe, intractable symptoms.

One should ask questions such as:

“If my pain/breathlessness become unbearable, will your hospice be willing to sedate me to unconsciousness, if that is what is required to manage my pain/breathlessness?”

Eligibility for palliative sedation is determined by the provider, not the patient. Palliative sedation is not provided for existential suffering such as poor quality of life, or loss of dignity.

Palliative Sedation

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