# Listening Until the End: Best Practices and Guidelines for Auditory Care in Palliative Sedation in Europe

## TL;DR

This paper reviews European guidelines for palliative sedation to improve auditory care practices at the end of life, emphasizing the importance of preserving hearing even when patients appear unconscious.

## Contribution

The paper proposes new humanization strategies for integrating auditory care into palliative sedation protocols in Europe.

## Key findings

- Current guidelines lack explicit protocols for auditory care despite acknowledging the importance of environmental sound management.
- There is limited consensus on whether hearing is preserved during unconsciousness in palliative sedation.
- The paper suggests family education, therapeutic sound protocols, and staff training to address these gaps.

## Abstract

Background/Objectives: Auditory capacity plays a fundamental role in human emotional development from prenatal stages and persists as the last sensory modality to fade during terminal phases. In palliative sedation, uncertainty about preserved hearing—despite potential unconsciousness—underscores the need to evaluate current care recommendations for this critical sensory dimension. This review examines European guidelines to (i) assess auditory care integration in palliative sedation protocols and (ii) propose humanization strategies for sensory-preserving end-of-life care. Methods: Narrative review of evidence from the European Palliative Sedation Repository and the European Association for Palliative Care (EAPC). Results: Three key findings emerged: (i) lack of explicit protocols for auditory care despite acknowledging environmental sound management (e.g., music, family communication); (ii) limited consensus exists regarding hearing preservation during unconsciousness. Conclusions: Although auditory perception during palliative sedation remains scientifically uncertain, the precautionary principle warrants integrating auditory care into palliative sedation through (i) family education on potential hearing preservation; (ii) therapeutic sound protocols; and (iii) staff training in sensory-inclusive practices. This approach addresses current gaps in the guidelines while enhancing patient dignity and family support during end-of-life care. Further research should clarify auditory perception thresholds during sedation.