Comfort and Care: Why is lorazepam given at the end of life?

October 5, 2025 •

4 min read

Lorazepam, also known by the brand name Ativan, is the second most-prescribed drug among hospice patients. This widespread use answers the question, 'Why is lorazepam given at the end of life?': it is an essential tool for providing comfort and managing distressing symptoms.

Quick Summary

Lorazepam is a key medication in hospice care, used to manage symptoms that cause distress. It effectively reduces anxiety, the sensation of breathlessness, agitation, and seizures, profoundly improving a patient's comfort and quality of life.

Key Points

Symptom Management: Lorazepam's primary role is to relieve distressing symptoms like anxiety, agitation, and breathlessness, not to hasten death.
Anxiety and Agitation: It is a first-line treatment for anxiety, panic, and restlessness, which are very common in terminally ill patients.
Dyspnea Relief: It is highly effective at reducing the anxiety associated with the sensation of breathlessness (dyspnea).
Mechanism of Action: Lorazepam works by enhancing the effects of the calming neurotransmitter GABA in the brain, slowing down the central nervous system.
Individualized Dosing: Doses are carefully tailored to each patient to achieve comfort with the minimum effective amount, balancing benefits and side effects.
Ethical Principle: Its use is guided by the doctrine of double effect, where the intent is to alleviate suffering, even if a secondary, unintended effect like sedation occurs.
Versatile Administration: It can be given orally, sublingually (under the tongue), or via injection, making it adaptable to a patient's changing condition.

Understanding Lorazepam and Its Role in Hospice

Lorazepam, known commonly as Ativan, is a type of medication called a benzodiazepine. These drugs work by slowing down the central nervous system, which produces a calming effect. In the context of palliative and hospice care—where the focus is on quality of life and comfort rather than curing a disease—lorazepam is an indispensable tool. Its primary goal is not to treat the underlying terminal illness but to manage the difficult symptoms that often accompany it, ensuring the patient's final days are as peaceful and comfortable as possible. It is recognized by the World Health Organization as an essential medicine in palliative care.

Primary Reasons for Using Lorazepam at the End of Life

Clinical teams use lorazepam to address several common and distressing symptoms that appear as an illness progresses. Its versatility makes it one of the most frequently used medications in this setting.

Managing Anxiety, Agitation, and Delirium

Anxiety, panic, and restlessness are extremely common in patients nearing the end of life. Lorazepam is highly effective at treating this emotional and physical anxiety by calming the brain. For patients with delirium, which can involve confusion and severe agitation, scheduled lorazepam has been shown to significantly reduce these episodes, promoting a state of calm. While other drugs like haloperidol may also be used, lorazepam is a frontline choice for managing anxiety-related symptoms.

Alleviating Dyspnea (Shortness of Breath)

A frightening and common end-of-life symptom is dyspnea, the subjective feeling of being unable to catch one's breath. While opioids like morphine are often the first-line treatment for the physical aspect of dyspnea, lorazepam plays a crucial role in managing the anxiety and panic that accompany it. Often, the sensation of breathlessness triggers a cycle of panic, which in turn worsens the dyspnea. Lorazepam helps break this cycle by reducing the patient's anxiety, making them feel more comfortable even if their respiratory function doesn't change. It is often used in combination with morphine for this purpose.

Controlling Seizures

As a powerful anticonvulsant, lorazepam is also used to control and prevent seizures, which can occur with certain terminal conditions. Its relatively fast action makes it effective for managing active seizures and providing comfort.

Other Symptomatic Relief

Beyond its main uses, lorazepam can also be part of a regimen to treat nausea and vomiting, particularly when associated with chemotherapy or anxiety. It also helps with insomnia, allowing patients to rest more comfortably.

Administration and Dosing in Hospice Care

Flexibility in administration is key at the end of life, as patients may lose the ability to swallow. Lorazepam can be given in several ways:

Oral (tablet): Swallowed if the patient is able.
Sublingual (under the tongue): An oral tablet can often be dissolved under the tongue for faster absorption into the bloodstream, bypassing the need to swallow. This method can take effect in as little as 5 to 10 minutes.
Intravenous (IV) or Subcutaneous (SC): Given by injection for rapid effect or when other routes are not possible.

Dosing in a palliative setting is highly individualized. The principle is to start with a low dose and increase gradually as needed. The clinical team, led by a hospice medical director, determines the appropriate dose and frequency to effectively manage symptoms while minimizing side effects. The goal is always to use the lowest effective dose to maintain patient comfort.

Comparison of Benzodiazepines in End-of-Life Care

Lorazepam is not the only benzodiazepine used in hospice. Midazolam is another common choice, and they differ in key ways.


Feature	Lorazepam (Ativan)	Midazolam (Versed)
Onset of Action	Slower (15-30 min IM)	Faster (IM/nasal is quicker than IM lorazepam)
Duration of Action	Longer	Shorter
Metabolism	Metabolized mainly by the liver via glucuronidation, making it a better option for patients with impaired liver function from other causes.	Metabolized by the CYP3A4 enzyme system in the liver; can be affected by other drugs and liver impairment.
Primary Hospice Use	Preferred for sustained management of anxiety, seizures where longer action is desired, and agitation.	Preferred for rapid sedation, managing acute agitation, and when a shorter duration is beneficial.

Risks, Side Effects, and Ethical Considerations

The primary intent of giving lorazepam at the end of life is to relieve suffering, not to hasten death. This is guided by an ethical principle known as the doctrine of double effect. The intended effect is providing comfort (e.g., relieving panic from dyspnea). A potential, foreseen, but unintended secondary effect might be sedation or respiratory depression. This is considered an ethically acceptable part of compassionate end-of-life care.

Common side effects include drowsiness, weakness, dizziness, and unsteadiness. In elderly patients, there is a heightened risk of falls, confusion, and paradoxical reactions where the patient becomes more agitated. The medical team carefully weighs the benefit of symptom relief against these potential risks. Concerns like long-term dependence or addiction are not a clinical focus in the end-of-life context.

Conclusion

Ultimately, the question 'Why is lorazepam given at the end of life?' has a clear answer: to provide peace and comfort. It is a potent, versatile, and essential medication that allows clinicians to effectively manage some of the most difficult and frightening symptoms that can arise in the final stages of life. By alleviating anxiety, agitation, breathlessness, and seizures, lorazepam helps ensure that a patient's final journey is one of dignity and tranquility, which is the core mission of palliative and hospice care.

For more information on palliative care principles, visit the Center to Advance Palliative Care (CAPC).

Disclaimer: This information is for general knowledge and should not be taken as medical advice. Consult with a healthcare professional before making any decisions about medical treatment.

Frequently Asked Questions

No, the intention of giving lorazepam in hospice is to relieve distressing symptoms like severe anxiety or agitation, not to hasten death. This practice is supported by the ethical principle of double effect, where the goal is comfort, and any unintended secondary effect like sedation is accepted in the pursuit of relieving suffering.

In hospice care, lorazepam is primarily used to treat anxiety, agitation, insomnia, and the panic associated with shortness of breath (dyspnea). It is also effective for managing seizures and can be used to help with nausea and vomiting.

Yes, Ativan is the brand name for the generic medication lorazepam. They are the same drug.

The most common side effects in elderly patients are drowsiness, dizziness, weakness, and unsteadiness, which can increase the risk of falls. Confusion and paradoxical reactions (increased agitation) can also occur.

The dosage is highly individualized and determined by the hospice medical team. They start with a low dose and adjust it as needed to achieve symptom control and comfort while minimizing side effects. The patient's condition, age, and other medications are all taken into account.

Morphine and lorazepam treat different aspects of shortness of breath. Morphine helps with the physical sensation of breathlessness, while lorazepam treats the anxiety and panic that often accompany it. They are frequently used together for more complete symptom relief.

While lorazepam can be habit-forming, the risk of addiction and dependence is not a primary clinical concern in the context of end-of-life care. The focus is on providing comfort and relieving distressing symptoms in a patient's final days or weeks.