The current palliative management of delirium involves (1) identification of reversible causes of delirium, (2) non-pharmacologic measures, and (3) pharmacologic interventions for palliation. Clinicians reserve pharmacologic interventions for cases of hyperactive delirium or refractory delirium. Specific pharmacologic agents treating delirium have typically involved using drugs from the neuroleptic class. Often families request sedation for their loved one, complicating neuroleptic choice. Early randomized controlled trials found that benzodiazepines cause worsening delirium. Other research showed that benzodiazepines and central nervous system depressants cause significant complications in the elderly leading to further avoidance. The avoidance of benzodiazepines continued as guidelines warned of their use in delirium except in the case of alcohol withdrawal. Recent randomized controlled trials suggest that benzodiazepines are effective when sedation is required as part of the delirium treatment strategy. There is also evidence for their benefit as breakthrough agents for delirium. As benzodiazepines are potent sedatives, clinicians need to carefully weigh the risks and benefits before prescribing benzodiazepines in patients with delirium and discuss the goals of care with family caregivers and patients (if possible). Identifying when to use, how to use, and what patients will benefit from benzodiazepines becomes essential.