ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation.

In patients with advanced cancer, a readiness to address pain and other intolerable symptoms is a medical and moral imperative [1]. This has been described by Roy as the ‘emancipation principle of palliative care’ which states: ‘(one should) spare no scientific or clinical effort to free dying persons from twisting and racking pain that invades, dominates, and shrivels their consciousness, that leaves them no psychic or mental space for the things they want to think and say, and do before they die.’ [2]. Indeed, there is a broad ethical consensus that, at the end of life, the provision of adequate relief of symptoms is an overriding goal, which must be pursued even in the setting of a narrow therapeutic index for the necessary palliative treatments [1, 3–12]. The provision of adequate relief of physical symptoms such as pain is a central aspect of medical care of all patients. In the care of patients with incurable illnesses that generate intense and prolonged patient suffering, this aspect of care assumes a critical significance.