Palliative sedation involves the intentional lowering of consciousness in the last phase of life to relieve refractory symptoms. Most ethical controversies concern the application of continuous deep sedation. After introducing terminology and prevalence, some ethical concepts underlying the European Association for Palliative Care (EAPC) framework for palliative sedation are described and discussed. After this, the rule of double effect is addressed. The debate about palliative sedation and (hidden) euthanasia is then introduced. This is followed by a reflection on (shared) decision-making for palliative sedation, particularly the role of informed consent and the possible emotional burden for family and professional caregivers. It is concluded that the medical-technical debate needs to be carefully balanced with a humane and ethical imperative to relieve the burden of unbearably suffering of patients, including patient and family involvement in decision-making.