ABSTRACT
In terminally ill patients care focuses on comfort and symptom control to improve the quality of life. In patients with a short life expectancy, however, the focus switches to quality of dying. Palliative sedation is the deliberate lowering of consciousness so that the patient no longer experiences discomfort of refractory symptoms. Sedation can be intermittent or continuous. The intake of food and liquid in this period is controversial. The rule of thumb should be that any medical act may not create a risk for suffering or complications. Artificial feeding or hydrating may be considered when the patient or the relatives demand this except in case of deep sedation. However, the treating physician should always weight the potential benefits against the possible harm and suffering.
When considering the need for artificial hydration, it should be respected that patients at the end of life usually have reduced food and liquid intake requirements. Liquid administration may cause fluid retention resulting in nausea, vomiting, aspiration, oedema and increased secretions, and generate unwanted effects.
Palliative sedation has the objective to control symptoms and improve the quality of dying without facilitating this dying. Each decision should be taken with this objective in mind.
