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Patients at the end-of-life may present with refractory symptoms which cannot be adequately relieved despite the use of all traditional means. When refractory symptoms lead to intolerable suffering, palliative sedation is a last recourse temporary or definitive treatment. While discussing ethical issues, clinical practice dimensions of palliative sedation are explored in this article.

Efficacy of treatments used in patients at the end-of-life must be evaluated according to ethical issues and specificities of the palliative population, i.e.: major vulnerability, difficulties to obtain informed consent, fragility of balance between research and clinical role, problems to evaluate risks and benefits of palliative care research. Improvements in the use of opioids have come from clinical research. Treatment of delirium has improved thanks to clinical trials conducted in cancer and AIDS patients. Emerging themes in palliative medicine now come with alleviating moral distress and utility of psychotherapeutic approach as well as the place of spirituality measured through quality-of-life evaluation.