Second thoughts about palliative sedation

‘When I use a word,’ Humpty Dumpty said, ‘it means just what I choose it to mean—neither more nor less’. ‘The question is,’ said Alice, ‘whether you can make words mean so many different things’. (Carroll L 1872. Alice through the looking glass) Palliative sedation is a term used to describe the use of sedative drugs in dying patients to induce a state of decreased or absent awareness (unconsciousness) in order to relieve intolerable suffering from refractory symptoms.1 ,2 Perhaps, for many of us, this conjures up an image of an agitated patient who is rendered unconscious in the last hours of life as a result of the need for repeated doses of sedative drugs. However, in the literature, ‘palliative sedation’ is used more broadly, sometimes as an umbrella term for all levels and patterns of sedation in those close to death.3 ,4 For example, a systematic review about palliative sedation includes a report of sedatives prescribed to 68/102 patients at some point in the last week of life,5 for whom ‘sublingual lorazepam tablets and clonazepam drops were commonly used and efficacious’. (This is the source …