Summary 　緩和ケアを受ける患者に高頻度に起こるせん妄は，転倒・転落をはじめさまざまなインシデントにつながることが多い。患者の身体抑制をなるべく行わない緩和ケアにおいて，患者の尊厳と安全対策のジレンマに日々頭を悩ませている。 　当病棟では，せん妄スクリーニングツール（DST）導入の前後で転倒する患者の減少がみられたことから，せん妄症状を早期に発見し対策を講じることにより，せん妄による危険行為は減少しているといえる。しかし，終末期せん妄など予防が難しい場合も多く，それには医療チームでの取り組みと家族の理解・協力が欠かせない。家族や患者との対話を重ねながら，患者にとって最期の時間を安全かつ有意義に過ごすことができる療養環境を提供していきたいと願う。 Delirium, which occurs frequently in patients receiving palliative care, often leads to various incidents, including falls. The dilemma between the dignity of patients and safety measures is a major challenge for palliative care, in which suppression of patient behavior should be avoided as much as possible. The number of patient falls has decreased after the introduction of Delirium Screening Tool （DST）, and it is now possible to prevent dangerous behaviors due to delirium by detecting delirium symptoms early and taking action. However, prevention is difficult in some cases, including terminal delirium. In such cases, efforts of medical teams as well as understanding and cooperation of families are essential. It is desired to provide a care environment in which patients can spend their last hours safely and meaningfully by continuing talks with patients and their families.