After more than 15 years of engagement in research on palliative sedation, we dare to pose that it is among the most challenging topics in end-of-life care. The first publications on palliative sedation appeared in this journal as early as 20 years ago. Chater et al.1 stressed the need for proper terminology and proposed to abandon the term “terminal sedation.” While palliative sedation has remained the most commonly used term ever since, it has also become clear that simply using a common term does not guarantee the use of a common concept, leave alone common practices. [...]