Administration of Continuous Palliative Sedation in Adults at the End of Life
August 2026
The Collège des médecins du Québec (CMQ) has recently replaced the Quebec Clinical Practice Guideline on Palliative Sedation at the End of Life, which had been jointly developed with the Société québécoise des médecins de soins palliatifs (SQMDSP), with a series of short practice guidance sheets. The hyperlinks to this document that were included in the INESSS National Medical Protocol (NMP) have therefore been updated to reflect these changes.
April 2022
Survey – What did you think of:
- the Report: Continuous Palliative Sedation
- the NMP (National Medical Protocol): Continuous Palliative Sedation
These publications stem from a request by the Collège des médecins du Québec (CMQ), supported by the Société québécoise des médecins de soins palliatifs (SQMDSP) and the Ministère de la Santé et des Services sociaux (MSSS), to develop a National Medical Protocol (NMP) for the administration of continuous palliative sedation (CPS) at the end of the life. This protocol complements the Quebec clinical practice guideline jointly developed by the CMQ and the SQMDSP. The most recent version of that guideline should be consulted for additional information regarding the decision-making process, the legislative and ethical considerations surrounding CPS, as well as the assessment of life expectancy.
CPS is intended to relieve intolerable and refractory symptoms in a person at the end of life by inducing a state of deep sedation that is maintained until death. The NMP clarifies several important aspects of the management of these patients, including the level of sedation that should be targeted to ensure comfort and the medications used in this context. A clinical decision-making algorithm has been developed to support clinicians in selecting the appropriate sedative agent and dosage to achieve adequate sedation and symptom relief as quickly as possible. Finally, testimonials collected during the project highlighted the importance of adequately preparing and supporting family members and loved ones. This consideration is emphasized throughout the protocol to raise clinicians’ awareness of this major issue, particularly when care is provided in the home setting.
These efforts also led to the development of a preprinted individual prescription form designed to facilitate prescribing and information sharing among professionals involved in the provision of continuous palliative sedation (CPS). This form is available both as a ready-to-use PDF document and as an editable version, allowing healthcare institutions to adapt it to their needs, including the addition of a customized logo.
A TUTORIAL is available to support you in the use of this National Medical Protocol (only available in French).
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