End of Life Concerns Palliative Care Palliative or Terminal Sedation Overview By Angela Morrow, RN Angela Morrow, RN LinkedIn Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. Learn about our editorial process Updated on November 26, 2020 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Jenny A. Dhingra, MD Medically reviewed by Jenny A. Dhingra, MD Jenny A. Dhingra, MD, is board-certified in anesthesiologyy. She currently serves as the medical director at One Day Surgery which is part of Atrium Health in Charlotte, North Carolina, is a member of the American Society of Anesthesiologists, and an executive board member of The Dhingra Family Foundation. Learn about our Medical Expert Board Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by James Lacy Fact checked by James Lacy LinkedIn James Lacy, MLS, is a fact-checker and researcher. James received a Master of Library Science degree from Dominican University. Learn about our editorial process Print Despite even the best palliative care, some people can't get adequate relief from their suffering and may need what's known as palliative sedation to avoid 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 suffering person as comfortable as possible. When this effort isn't enough, palliative sedation may be an option. Westend61 / Getty Images Pain Management Sometimes symptoms are difficult to treat and don't seem to respond to any treatment. This outcome is sometimes seen in people 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 her decision-maker to use palliative sedation, a sedative medication is given and increased until the desired comfort level is achieved. Often, people undergoing palliative sedation maintain consciousness while sedated to a comfortable degree. But if you or your loved one still experiences intolerable symptoms, inducing unconsciousness may be an acceptable last resort. Medication Therapies Medications used to sedate someone may include anti-anxiety drugs such as Valium (diazepam) or 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 to ensure that the person being treated remains conscious for as long as possible. Side effects and reactions must also be monitored and observed, and it may take several different medications to provide appropriate relief. 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 approach is followed, death will usually occur within one week. One study indicates the average time is about 27 hours. Clinical Criteria These are some 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 patient's 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 requirement is what is referred to as an autonomous decision—one that is made by the person being affected, 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 5 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bobb B. A review of palliative sedation. Nurs Clin North Am. 2016 Sep;51(3):449-57. doi:10.1016/j.cnur.2016.05.008 Mercadante S, Porzio G, Valle A, et al. Palliative sedation in patients with advanced cancer followed at home: a systematic review. J Pain Symptom Manage. 2011;41(4):754-60. doi:10.1016/j.jpainsymman.2010.07.013 Schildmann EK, Schildmann J, Kiesewetter I. Medication and monitoring in palliative sedation therapy: a systematic review and quality assessment of published guidelines. J Pain Symptom Manage. 2015;49(4):734-46. doi:10.1016/j.jpainsymman.2014.08.013 Da costa miranda V, De souza fede AB, Martins FD, et al. Doctor, how long?. Eur J Cancer Care (Engl). 2011;20(1):50-5. doi:10.1111/j.1365-2354.2009.01144.x Zalonis R, Slota M. The use of palliative care to promote autonomy in decision making. Clin J Oncol Nurs. 2014;18(6):707-11. doi:10.1188/14.CJON.707-711 Additional Reading Bobb B. A Review of Palliative Sedation. Nurs Clin North Am. 2016;51(3):449-57. doi:10.1016/j.cnur.2016.05.008