Patients nearing death often experience distressing symptoms.1 2 Many patients and physicians are confronted with complex decisions about practices surrounding end of life care that can affect the mode of dying. As an option of last resort, sedating drugs can be used. Such drugs induce a state of decreased consciousness and take away the patient’s perception of symptoms. Sedation can be used intermittently or continuously until death, and the depth of the sedation can vary from a lowered state of consciousness to unconsciousness. All these varieties are covered by the term palliative sedation, but sedation to unconsciousness is also referred to as “terminal sedation.” Physicians, medical organisations, scientists, ethicists, legal experts, and politicians are debating its use, with discussions focusing on the most extreme use of sedation—that is, continuous deep sedation until death. An important aspect of the debate concern the conditions under which this practice is medically indicated3 4 5 6 7 8 and the way it is performed.8 9 10 11 On the basis of their expertise and an extensive literature review, an expert group recently recommended that to warrant sedation at the end of life, the patient’s condition should be irreversible and advanced, with death expected within at most one to two weeks.8 Further recommendations were that benzodiazepines should be the drug of first choice, that hydration should be offered to sedated patients only when the benefit will outweigh the harm, and that advice from palliative care specialists should be sought before sedation. (British Medical Journal)