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

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.