As of 2013, approximately tens of millions of people a year were unable to resolve their needs of physical, psychological, or spiritual suffering at their time of death.
It is not considered a form of euthanasia or physician-assisted suicide, as the goal of palliative sedation is to control symptoms, rather than to shorten or end the person's life.
[3] The practice of palliative sedation has been a topic of debate and controversy as many view it as a form of slow euthanasia or mercy killing, associated with many ethical questions.
Palliative care is aimed to relieve suffering and improve the quality of life for people with serious and/or life-threatening illness in all stages of disease, as well as for their families.
[7] In general, palliative care focuses on managing symptoms, including but not limited to pain, insomnia, mental alterations, fatigue, difficulty breathing, and eating disorders.
[8] In order to initiate the care, self-reported information is considered the primary data to assess the symptoms along with other physical examinations and laboratory tests.
[15] If severe mental alterations or delirium is the concern for the person to make an informed decision, consent can be obtained in the early stage of the disease or upon the admission to the hospice facility.
In some extreme cases (i.e. for those whose life expectancy is hours or days at the most), palliative sedation is begun with the plan to not attempt to reawaken the person.
[18] Though people may receive palliative care, pharmacologically decreasing one's consciousness may be the only remaining option to help alleviate intolerable disease symptoms and suffering.
Though the interdisciplinary health care team is there to help each person make the most sound medical decision, the individual's judgement is considered to be the most accurate in deciding whether or not their suffering is manageable.
Medical conditions that had the most compelling reasons for palliative sedation were not only limited to intolerable pain, but include psychological symptoms such as delirium accompanied by uncontrollable psychomotor agitation.
Intermittent sedation is recommended by some authorities for use prior to continuous infusion to provide the person with some relief from distress while still maintaining interactive function.
[21][22][23] Benzodiazepines: These are a drug class that works on the central nervous system to tackle a variety of medical conditions, such as seizures, anxiety, and depression.
The main indications for midazolam in palliative sedation are to control delirium and alleviate breathing difficulties so as to minimize distress and prevent exacerbation of these symptoms.
Even though opioids tend to provide a comforting effect for recipients, there exists the risk of drug dependence and—to a lesser extent—substance use disorder and diversion of medications.
Therefore, the Clinical Practice Guidelines for Quality Palliative Care from the National Consensus Project recommends a comprehensive assessment of symptoms prior to initiating pharmacological therapy, ongoing monitoring to determine efficacy and any adverse effects, and educating the patient and family.
[16] A specialized rectal catheter can provide an immediate way to administer small volumes of liquids for people in the home setting when the oral route is compromised.
[33] However, once unconsciousness begins, as the person is no longer able to decide to stop the sedation or to request food or water, the clinical team can make decisions for the individual.
A living will made when competent, can, under UK law, give a directive that the person refuses "Palliative Care" or "Terminal Sedation", or "any drug likely to suppress my respiration.
[35]: 1.68 As of 2022, assisted suicide in the United States, otherwise known as medical aid in dying, is legal in ten jurisdictions (California, Colorado, District of Columbia, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, and Washington).
Despite differing setting, services, and staffing, the U.S. hospice care movement still sought to maintain the goals and philosophy of St. Christopher's model which centered on symptom control to allow the person to die with freedom, rather than attempting curative treatment.
This victory prompted the creation of National Hospice Week by President Reagan to take place from November 7–14 as a form of recognition to the vital impact nurses and caregivers have on these individuals and their families.
[60] In October 2010 Svenska Läkaresällskapet, the Swedish medical association, published guidelines which allowed for palliative sedation to be administered even with the intent of the terminally ill person not to reawaken.