What Is Palliative Sedation (PS)?

PS is the deliberate sedation (a druginduced sleep) of a terminally ill patient whose pain or other symptoms (such as a smothering shortness of breath) cannot be controlled with expected or extraordinary doses of usual medications. Barbiturates, such as Phenobarbital, are commonly used for the sedation.

Palliative Sedation may be offered as a temporary measure where, after being comfortably asleep for a period of time, the sedation is partially withdrawn to assess if the symptoms remain. If the symptoms are better, the sedation is stopped, but if they are not, then the PS can be resumed until death occurs. Or, depending on patient/family choice, PS can be initiated as a final and permanent measure (Palliative Sedation to Unconsciousness), where the patient is kept asleep until he dies. Patients and families must understand this is their choice and should be based on their goals. It is neither PhysicianAssisted Suicide nor Euthanasia.

The ethical issue involved here is related to the intent of this practice, and is called the “Principle of Double Effect”: if the only way to control one’s pain is to induce a state of sleep, then it is an acceptable treatment. The intent is not to cause death, but to relieve suffering.