Palliative Sedation is the Preferred Alternative Term to Terminal Sedation
The term "palliative sedation" has replaced "terminal sedation" in modern hospice and palliative care practice, as it more accurately reflects the therapeutic intent and avoids the misleading implication that the intervention hastens death. 1
Why the Terminology Matters
The shift from "terminal sedation" to "palliative sedation" is clinically and ethically significant:
- Palliative sedation emphasizes that the primary intent is symptom relief through controlled administration of sedative medications to induce decreased or absent awareness, not to hasten death 1
- The term preserves the moral sensibilities of patients, medical professionals, and families by clearly distinguishing this practice from euthanasia in its intentions, procedures, and results 1, 2
- Evidence demonstrates that palliative sedation does not shorten survival—median survival ranges from 7-27 days in sedated patients versus 4-40 days in non-sedated patients, with no statistically significant difference 1, 3
Clinical Context and Indications
Palliative sedation serves as a measure of last resort for managing refractory symptoms:
- Approximately 20-30% of terminally ill patients experience refractory symptoms requiring sedation 1
- The most common indications are agitated delirium (45-71%), dyspnea (21-36%), pain, and intractable vomiting 1, 4, 5
- The intervention is indicated only after all other reasonable treatments have been exhausted and symptoms remain inadequately controlled despite intensified management efforts 1
Levels of Palliative Sedation
The European Society for Medical Oncology guidelines distinguish different approaches:
- Proportional palliative sedation (PPS): Drugs titrated to the minimum effective dose needed for symptom control, allowing some level of consciousness to be maintained 1, 2, 5
- Conscious sedation: Ability to respond to verbal stimuli is retained, providing adequate relief without total loss of interactive function 1
- Continuous deep sedation: Reserved for the most severe refractory symptoms when lighter sedation proves inadequate 1, 2
- Intermittent palliative sedation (IPS): Used in non-emergency situations before attempting continuous sedation 1, 5
Common Pitfalls to Avoid
- Never use "terminal sedation" as it incorrectly implies the intent is to hasten death rather than relieve suffering 1, 2
- Do not confuse palliative sedation with euthanasia—they differ fundamentally in intent (symptom relief vs. causing death), procedure, and outcome 1, 2
- Avoid initiating deep sedation without first attempting lighter levels of sedation, except in emergency situations like massive hemorrhage or asphyxia 1
- Do not assume palliative sedation shortens life—multiple studies confirm it does not hasten death when properly administered 1, 3, 5