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Palliative sedation to unconsciousness is an important tool in the armamentarium of palliative medicine. For patients whose illnesses are terminal and end stage, palliative sedation to unconsciousness can ameliorate such intractable symptoms as delirium, pain, dyspnea, nausea, and vomiting. It is medically and ethically acceptable under specific, relatively rare circumstances. Because palliative sedation to unconsciousness is intended to be maintained until the patient’s death, it should be used only as a therapy of last resort for relief of severe, unrelenting clinical symptoms after the failure of other aggressive interventions, including psycho-social support. It is important to ensure that patients are indeed at the end stage of a terminal illness and that other forms of symptom-specific treatment are not effective. It is most appropriate as part of a multi- disciplinary mode of palliative care that addresses the whole patient in the context of that patient’s family system, spiritual beliefs and values. It is not appropriate for suffering that is mainly existential.
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