Background: Palliative sedation, a clinical practice, has been a topic of debate for over three decades. It involves the use of sedative medications to alleviate intractable symptoms at the end of life. However, the ethical implications of inducing unconsciousness in terminally ill patients remain a concern. This review aims to address these ethical considerations and guide clinical decision-making in the end of life. Methods: This systematic review exclusively examined full-text articles published in English between 2014 and 2024, adhering to the PRISMA 2020 guidelines. In order to guarantee the incorporation of high-quality sources, editorial pieces and review articles were excluded unless they were accompanied by a DOI. A exhaustive literature search was conducted using a variety of reputable databases, such as ScienceDirect, PubMed, and SagePub, to collect pertinent studies. Result: The study conducted a thorough review of more than 100 publications that were obtained from reputable databases, such as ScienceDirect, SagePub, and PubMed. Eight publications were identified as necessitating a more comprehensive examination subsequent to an initial screening. As a result, a comprehensive review of these selected studies was conducted to guarantee an exhaustive and rigorous assessment. Conclusion: Palliative sedation is a controversial intervention used to reduce consciousness in patients suffering at the end of life. It is considered an act of compassion, but ethical debates exist regarding its impact on survival and broader implications. Decision-making involves discussions between healthcare teams, patients, and families, and can be administered in various settings.