The use of pain relief in palliative care “always requires a careful discernment and great prudence”. Pope Francis said this in a message sent to the International Congress entitled “Palliative Care: Everywhere and by everyone. Palliative care in every region. Palliative care in every religion or belief” organised by the Pontifical Academy for Life in Rome today and tomorrow. In the message – signed by the Cardinal Secretary of State, Pietro Parolin, and read out at the start of the session by Mgr. Renzo Pegoraro, Chancellor of the Pontifical Academy for Life – Pope Francis focused on pain relief. “Pope Pius XII – he explained – had clearly legitimized, by distinguishing it from euthanasia, the administration of analgesics to alleviate unbearable pain that is not otherwise treatable, even if, in the phase of imminent death, they may cause a shortening of life”. Today, the Pope admitted, “after many years of research, the shortening of life is no longer a frequent side effect, but the same question emerged with new drugs, which act on the state of consciousness and make different forms of sedation possible”. For the Pontiff, “the ethical criterion does not change, but the use of these procedures always requires careful discernment and great prudence.  Indeed, they are very demanding for the sick, for the family, and for carers: with sedation, especially when protracted and deep, the relational and communicative dimension that we have seen is crucial in accompanying palliative care is cancelled. It is therefore always at least partially unsatisfactory, so it must be considered as an extreme remedy, after having carefully examined and clarified the indications”.