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The most fundamental task of palliative medicine, and indeed of medicine in general, is to relieve suffering^{( 1 , 2 )}. Among terminally ill patients whose primary goal is comfort, severe suffering occurs occasionally that is refractory to standard palliative interventions. Controlled sedation, sometimes to unconsciousness, may be the only effective means of relieving suffering in these unusual situations.

Patients and their families fearful of severe, refractory terminal suffering may feel quite relieved when informed that palliative sedation is available as an option should all standard interventions fail. Thus, clinicians who are fully prepared to provide sedation for refractory terminal suffering often will be able to comfort fearful patients simply by discussing it with them^{( 3 )}. Few patients will actually require palliative sedation to unconsciousness.

While there is consensus in the literature about the need for and permissibility of sedation for refractory suffering of a terminally ill patient, there remains debate about nomenclature, about the definition of palliative sedation, and about the ethics of specific practices. Rather than offering a thorough review of the literature, this chapter will provide guidance for palliative sedation based upon a synthesis of current debates.