Current guidelines treat palliative sedation to unconsciousness as an effective medical treatment for terminally ill patients who need relief from severe symptoms, yet also restrict its use in ways that are extraordinary for medical treatments. A closer look at the kinds of cases in which palliative sedation is used suggests a way of adjusting the guidelines to resolve this seeming contradiction. Imagine a seventy-three-year-old man admitted to the hospital for abdominal pain and vomiting. He has a history of colon cancer; three years ago, doctors removed a portion of his bowel. Now, a CT scan shows that his bowel is obstructed. It also shows that the cancer has returned--he has evidence of tumors in his liver, throughout his abdomen, and even in his bones. His doctors predict that he will survive only a month or so. They start him on high doses of narcotics to control his pain, but the side effects--primarily nausea and muscle twitching--are intense and distressing. The drugs also keep his bowel obstruction from resolving.