Availability and Access to Palliative Sedation Medications in Ecuador: A National Survey of Palliative Care Physicians

Palliative sedation is a key intervention to relieve refractory suffering at the end of life; however, its implementation depends on access to essential medications. This study aimed to evaluate the availability and access to palliative sedation medications and to identify associated barriers among physicians affiliated with the Ecuadorian Association of Palliative Care (ASECUP). A quantitative, cross-sectional study was conducted using a structured, validated questionnaire administered to 82 eligible ASECUP-affiliated physicians. Descriptive and bivariate analyses were performed to assess associations between medication availability and institutional variables. Midazolam was the most frequently used medication (82.0%); however, availability was inconsistent, with only 54.9% reporting constant access. The main barriers identified were regulatory restrictions (53.7%), distribution problems (36.6%), and the absence of clear access policies (41.5%). Administrative difficulties were also common: 40.2% of participants reported modifying clinical protocols due to medication shortages, and 48.8% observed adverse clinical consequences. Significant disparities were found according to the type of institution and level of care, as indicated by chi-square p-values (institution type: p = 0.002; level of care: p < 0.001), with lower medication availability in public and primary care settings. These findings indicate that access to palliative sedation medications in Ecuador is limited by structural and systemic barriers rather than economic factors alone. Improving access requires system-level interventions, including stronger regulatory frameworks, optimized supply chains, and integration of palliative care across all levels of the health system. Ensuring continuous and equitable access to essential medications is essential to reduce preventable suffering and guarantee dignified end-of-life care.