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Conclusion
Sedation for intractable symptoms is a controversial intervention. Lack of consensus on definitions, indications, and application, as well as an unfortunate association with euthanasia, maintains the confusion and controversy. Adoption of systematic processes for confirming the refractoriness of symptoms and for decision-making regarding the use of sedation may help to reassure patients, families, and clinicians that the intervention is appropriate, and improve the quality of care for patients with advanced disease and severe symptoms. Research is urgently needed to establish evidence-based guidelines for determining intractability in various settings, and for developing ‘best practice’ models of decision-making for sedation.
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