Abstract ♦ Palliative sedation (PS) is an accepted clinical intervention for terminally ill patients suffering from refractory symptoms despite receiving conventional palliative care. It represents a highly valuable and useful treatement option providing optimal care for both the patient and family, as well as for the healthcare staff. Regarding the usage of PS specially in children, there is much less evidence available, the choice of medications, timing, and criteria for its administration vary not only between regions and countries but also within individual institutions, depending on the care setting (intensive vs. non-intensive units). In Hungary, the wider implementation of PS in pediatric care is hindered not only by the lack of standardized care model but also by the limited knowledge about its clinical application and its missing incorporation into medical education. In this study, we aim to explore the potential applications of pediatric PS, offering guidance for identifying eligible patients and determining the optimal timing and method of therapy. These recommendations can and should be adapted to institutional structures and available resources to improve end-of-life care for children.

Abstract ♦ Our study interprets pediatric palliative sedation not merely as a medical or technical intervention but as an ethical and relational event of care. The aim of the qualitative research was to explore how healthcare professionals involved in end-of-life care experience and interpret the discussions surrounding the initiation of sedation, the decision-making process itself, and the associated emotional and moral dilemmas. We conducted semi-structured interviews with eight professionals - four pediatricians and four nurses - and complemented these data with participant observations carried out in a pediatric hospice, analyzed using thematic coding. Our findings indicate that decisions regarding palliative sedation rarely follow clear or standardized clinical criteria. Professionals rely on subtle bodily cues, changes in symptoms, and continuous communication with the child and their family to determine when the intervention becomes necessary. The assessment of suffering emerges as an intersubjective process, shaped by the child’s communication or silence, the parents’ emotional capacity, and the professional responsibility of the medical team. The key to “successful care” lies in sensitive timing, gradual adjustment, transparent communication, and the establishment of a shared rhythm among all parties involved. Within pediatric end-of-life care, sedation thus serves not only to alleviate suffering, but also to preserve dignity and connectedness.

Abstract ♦ Hungary is also seeing the advance directive becoming increasingly well known. For it to be used truly effectively, it is necessary to be familiar with all the experiences that the birthplace of the advance directive — the United States — has accumulated in the course of its operation to date. As a first step, the study introduces the POLST (Physician Orders for Life-Sustaining Treatment) paradigm, which emerged in response to the criticisms directed at advance directives. This is followed by an outline of the paradigm shift that led to the development of POLST, together with an analysis of the solutions proposed by the POLST framework to address the critical concerns raised about advance directives. In the third step, it introduces the POLST document itself, and then provides a brief overview of the relationship between advance directives and POLST. Finally, the study reviews the practical experiences gained so far with POLST, identifying those factors that may potentially undermine its effectiveness and intended purpose.