This article examines the complexities of managing symptoms with medication in palliative care, emphasizing the importance of correct decisions to minimize harm. It highlights the challenges in medication management, including assessment, medication choice, dose, and anticipatory prescribing. The role of patients, carers, and professionals in the process is discussed, along with the need for clear communication and coordination across different care settings. The article underscores the significance of patient and family education, technology, teamwork, and support to ensure effective symptom management at the end of life.