Palliative Sedation

The decision to use palliative sedation is not simply a decision to make a dying patient sleepy. It is a decision that suffering remains intolerable after an experienced team has exhausted realistic treatments, and that a carefully proportioned reduction in awareness is the least harmful route to comfort. The sequence is: verify refractoriness, correct reversible contributors, clarify consent and goals, select the least depth and least continuous approach that can work, then reassess comfort. In Canada, this practice sits within an interprofessional plan, provincial scope and prescribing requirements, and local organisational policy. Continuous deep sedation is a narrow last-resort intervention for a patient who is imminently dying; lighter or intermittent sedation may be appropriate when there is time to reassess. Palliative sedation does not replace analgesia, routine symptom care, or decisions about hydration and nutrition. Appropriately administered sedation has not been shown to shorten survival in terminally ill patients.