[Palliative Sedation - Despite Guidelines a Difficult Process of Decisions].

A distinction needs to be made between intermediate and continuous sedation as well as between minimal, moderate and deep sedation. To gain ethical acceptance it is crucial that for palliative sedation (PS) minimally required doses are administered to decrease suffering. Intermittent PS is used for decreasing physical symptoms, whereas deep continuous PS is used to minimize intolerable suffering or psychological symptoms. Precise medical indication and education of patient and relatives are pre-requirements to any PS. Midazolam is often applied for PS. Each PS requires frequent monitoring and personal assistance.