Palliative Sedation to Alleviate Intractable Distress of the Dying Patient

Patients who are dying can experience physical and emotional suffering, such as anxiety, agitated depression, or insomnia. Physicians often administer nonopioid drugs to alleviate such symptoms (ordinary sedation). However, in some instances, suffering is severe and refractory to conventional treatment, and further palliative sedation is medically indicated. In a review of palliative sedation options, palliative care specialists distinguish treatment for refractory symptoms as either proportionate palliative sedation (PPS) or palliative sedation to unconsciousness (PSU).

With PPS, sedation at the lowest possible level is administered to relieve suffering, and increases in dosage are tied to persistent signs and symptoms of distress. Unconsci…