Background: Palliative sedation (PS) is an important intervention which is used to relieve refractory symptoms in patients who are terminally ill. Despite its clinical relevance, there is a limited data on its prevalence and practice patterns among palliative care physicians in Saudi Arabia. This study aims to assess the prevalence, indications, attitudes, and challenges associated with PS among certified palliative care consultants in the Kingdom. Methods: A descriptive cross-sectional study was conducted among certified palliative care consultants who were practicing across Saudi Arabia. Data were collected using a self-administered online questionnaire and analyzed using SPSS version 23. Descriptive statistics summarized demographic and practice characteristics, while chi-square and Fisher’s exact tests examined associations between consultant factors and PS use. Results: A total of 37 palliative care consultants participated. Most were aged 35–44 years (59.5%) and fellowship-trained (94.6%). The prevalence of palliative sedation use was 64.9% (n=24). Among those who used PS, the most common indications were dyspnea (58.3%), delirium (54.2%), and pain (41.7%). Midazolam was used by all consultants practicing PS (100%). In the past 12 months, 58.3% had administered PS, with most using it 1–3 times. Major barriers included family resistance (83.8%) and lack of guidelines (51.4%). No demographic or professional factors were significantly associated with PS use (p>0.05). Conclusion: PS is widely utilized and accepted without any ethical issue among palliative care consultants in Saudi Arabia. However, challenges related to family dynamics, variable practical experience, and lack of the standardized protocols highlight the need for the national guidelines, enhanced training, and improved communication strategies to support consistent and ethical PS practice across clinical settings. Keywords: Palliative sedation; Palliative care; End-of-life care; Refractory symptoms; Saudi Arabia