For the majority of patients at the end of life, their symptoms can be relieved through good palliative care. Lowever, for an unfortunate few, these symptoms become intractable despite the best holistic interventions and in such cases terminal sedation is considered. The use of this intervention remains fraught with controversy, particularly around the subject of consent. A clinical scenario is used to propose that under such circumstances, given the physical and psychological stress to which these patients are subject, it is neither useful nor meaningful to ask for the patient’s informed consent. Instead, physicians caring for such patients should act in the patient’s best interests, in accordance with the Best Interest Principle, to alleviate such suffering.