Abstract ♦ The authors examined continuous deep sedation (CDS), a variant of palliative sedation (PS) designed to mitigate intolerable suffering in terminally ill patients, including those with malignant diseases and other end-stage conditions. Widely recognized indications for PS include refractory pain, severe dyspnea, agitated delirium, seizures, and critical conditions necessitating emergency intervention, such as massive hemorrhage, terminal dyspnea, neurogenic or cardiogenic pulmonary edema, and intractable anxiety. Despite the extensive attention given to PS in both international and Hungarian professional literature, In Hungary lacks comprehensive, detailed professional protocols; theoretical knowledge remains inadequately disseminated, and competencies in this area are not clearly defined. The authors contend that PS does not reduce life expectancy, thereby aligning with the hospice principle that prohibits the artificial prolongation or hastening of death. It should be assessed within the framework of the principle of double effect. They underscore a clear distinction between PS, which is conducted within the scope of palliative care, and euthanasia, which is prohibited in Hungary.

Abstract ♦ Within the framework of the Palliative Sedation in the European Union (PalSed) project, part of the Horizon 2020 programme, a revision of the European Association for Palliative Care (EAPC) 2009 framework on palliative sedation was undertaken. The new framework, published by the EAPC in 2023, assigns a more prominent role to existential suffering compared to its position in the earlier document. The present study first outlines some key elements of the discourse on terminal sedation within the broader debate on end-of-life decision-making, thereby allowing the placement of the EAPC’s new definition of palliative sedation in this context. In the second step, we compare the previous and the new frameworks in order to clearly identify the essential changes. Finally, we briefly highlight those aspects of the interpretation of existential suffering that remain open and continue to call for urgent clarification in clinical practice.

Abstract ♦ The study examines the Hungarian practice of palliative sedation within the framework of the bioethical principle of justice, highlighting that this ultimate intervention for relieving refractory suffering has no alternative and therefore constitutes not only an option but an ethical obligation. The authors present the key clarifications of the 2023 EAPC guidelines—most notably the revised definition of refractoriness and the dual meaning of proportionality—and assess the Hungarian legal and professional regulatory environment in light of these developments. The analysis shows that although national legislation formally guarantees the right to pain and symptom relief, the absence of a specific procedural framework for palliative sedation creates substantial uncertainty in clinical practice. Limited hospice-palliative care capacities, significant regional disparities, and shortages in trained professionals further exacerbate inequalities in access to the intervention. The current state of the financing and coding system does not allow for tracking the use of palliative sedation, hindering effective resource planning. The study concludes that the uniform, transparent, and professionally sound application of palliative sedation can only be ensured if regulation clearly defines the indications, competencies, and documentation requirements of the procedure, and guarantees equitable access across the country.