Concerns about suffering usually arise as patients contemplate end of life. For most, an array of available therapies will alleviate suffering. However, for others, these therapies may not be adequate, despite impeccable assessment and management. In these circumstances, palliative sedation may be an option for the relief of suffering. As patients, families, and clinicians contemplate this option, controversies and concerns about hastening death, euthanasia, and limiting life-sustaining therapies can arise. This article explores some of these concerns.