Palliative Care
Care focused on comfort, support and quality of life.
Are they suffering when breathing becomes noisy, irregular or stops for periods?
Noisy or irregular breathing near death can be very upsetting to hear, but it does not always mean the person is suffering.
2 min readAt what stage might someone with early dementia still be able to access VAD?
A person with early dementia may only be able to access VAD if they still have capacity and meet all other legal criteria, which can be a narrow and uncertain window.
4 min readCan I give breakthrough morphine or other medicines myself?
Sometimes, yes, but only if the medicine has been prescribed for that person and you have clear instructions.
2 min readCan I refuse antibiotics, hospital transfer, tube feeding or other treatment in advance?
You may be able to refuse treatments in advance, but the document must meet your state or territory rules and be clear enough to guide care.
2 min readCan I refuse artificial nutrition or hydration?
A person may be able to refuse artificial nutrition or hydration, but the decision should be documented clearly and discussed with the treating team.
1 min readCan my palliative care doctor also be my VAD doctor?
A palliative care doctor may be able to be involved in VAD if they meet the legal requirements and choose to participate.
3 min readCan someone be sedated continuously until they die?
Yes, continuous palliative sedation until death can be used in some situations.
2 min readCan someone receive palliative care while pursuing VAD?
Yes, a person can usually receive palliative care while asking about or going through the VAD process.
2 min readCan someone with dementia access VAD?
Dementia does not automatically rule VAD in or out, but the person must meet all legal criteria and have decision-making capacity throughout the required steps.
4 min readDoes a syringe driver mean the person is about to die?
No, not always.
4 min readDoes morphine make someone die sooner?
No, morphine does not usually make someone die sooner when it is prescribed and used carefully for pain or breathlessness in palliative care.
4 min readDoes starting palliative care mean stopping treatment?
No.
4 min readHow can something that slows breathing be safe in somebody who is already dying?
Morphine and some other medicines can slow breathing if the dose is too high for that person.
5 min readHow do I actually get palliative care?
The most common way to get palliative care is to ask the person's GP, specialist, hospital team, community nurse or other health provider for a referral.
4 min readHow do I know when to give breakthrough medicines at home?
Give breakthrough medicine only when the person's written plan says it is needed for the symptom you are seeing.
2 min readIs it normal to feel relief as well as grief after a VAD death?
Yes, relief and grief can happen together after a VAD death, especially when someone had been suffering or the family had been under strain.
3 min readIs palliative sedation just VAD by another name?
No.
5 min readIs this person dying now, and what should I do?
They may be dying now if they are much sleepier or cannot be woken, are no longer eating or drinking, have changed breathing, have cool or mottled skin, pass very little urine, or seem confused, restless or less aware of you.
5 min readIs what I'm seeing normal dying, or are they suffering?
Some changes that look frightening can be part of normal dying.
4 min readThey've stopped eating and drinking. Are we starving or dehydrating them?
When someone is very close to death, stopping eating and drinking is usually part of the dying process.
5 min readWe've just been told the illness is terminal. What happens next?
Being told an illness is terminal means the treating doctor believes it cannot be cured and is likely to cause the person's death.
4 min readWhat are anticipatory medicines and why have they been prescribed?
Anticipatory medicines are medicines prescribed in advance in case symptoms happen suddenly, especially when someone is being cared for at home near the end of life.
4 min readWhat do we do tonight if they become breathless, agitated or in pain?
Use the person's written palliative care plan first.
4 min readWhat does dying from COPD look like?
Dying from COPD often involves worse breathlessness, less energy, more chest infections and flare-ups, and needing more help with daily life.
4 min readWhat does dying from dementia look like?
Dying from dementia usually looks like a long, gradual loss of abilities, followed by a clearer final decline.
4 min readWhat does dying from frailty look like?
Dying from frailty often looks like a slow loss of strength and reserve.
4 min readWhat does dying from heart failure look like?
Dying from heart failure can be gradual, sudden, or a mix of both.
3 min readWhat does dying from kidney failure look like?
Dying from kidney failure usually means the kidneys can no longer remove enough waste and extra fluid from the body.
3 min readWhat does dying from motor neurone disease look like?
Dying from motor neurone disease usually happens because the muscles needed for breathing become too weak.
2 min readWhat end-of-life choices do I still have if I cannot access VAD?
If VAD is not available to you, you may still have choices about palliative care, treatment refusal, place of care, advance care planning and symptom relief.
2 min readWhat happens if I become too sick to transfer to another facility for VAD?
If transfer becomes unsafe, the VAD team may need to explore local access, visiting practitioners, symptom care or whether the process can continue.
4 min readWhat happens if the family disagrees about treatment at the end of life?
If family members disagree about treatment at the end of life, the first step is usually a careful meeting with the treating team.
2 min readWhat if I want VAD but do not qualify?
If you want VAD but do not qualify, you can ask why, check review options, and still receive palliative care and other end-of-life support.
3 min readWhat is palliative sedation?
Palliative sedation is the careful use of sedating medicines to reduce a dying person's awareness so severe suffering can be relieved.
4 min readWhat is the difference between palliative care, palliative sedation, stopping treatment and VAD?
Palliative care, palliative sedation, stopping treatment and voluntary assisted dying are different.
2 min readWhat options exist if symptoms become intolerable despite treatment?
If symptoms feel intolerable, the first step is urgent specialist review because medicines, care plans, palliative sedation or VAD assessment may need to be discussed.
5 min readWhat should we organise after being told someone may only have months to live?
If someone may only have months to live, start with the supports that affect comfort, decision-making and safety: medical contacts, palliative care, medicines, home support, legal and financial documents, carer support, and the person's wishes for care.
2 min readWhat support is available for families after a VAD death?
Families after a VAD death can seek support from palliative care, VAD services, GPs, grief services, counselling, spiritual care and crisis lines.
5 min readWhat support is needed for someone to die at home?
Someone dying at home usually needs a planned mix of medical care, nursing support, practical help, equipment, medicines, after-hours advice and family or friend support.
4 min readWhen should I call 000 for someone receiving palliative care?
Call 000 when there is a life-threatening emergency or immediate danger.
4 min readWhen should I call the palliative care team?
Call the palliative care team when symptoms change, medicines are not working as expected, the care plan is unclear, equipment is not working, or you are worried about the person or your ability to keep caring safely.
4 min readWhen should I seek urgent medical advice?
Seek urgent medical advice when a symptom is severe, new, rapidly worsening, frightening, or not settling with the palliative care plan.
5 min readWhen should palliative care start?
Palliative care can start as soon as someone is diagnosed with a life-limiting illness, not only in the last days of life.
4 min readWho can refer someone to palliative care?
A GP, medical specialist or other health provider can usually refer someone to palliative care.
4 min readWho decides whether palliative sedation is used?
Palliative sedation is a medical treatment.
5 min readWhy are they hallucinating, picking at the sheets, trying to get out of bed or calling for dead relatives?
These behaviours can happen near the end of life.
4 min readWhy are they sleepier after medication?
People can become sleepier after medicines used in palliative care.
4 min readWhy did the morphine dose suddenly increase?
A sudden increase in morphine usually means the team is trying to catch up with pain, breathlessness or another distressing symptom that has changed.
2 min readWill my palliative care team judge me if I ask about VAD?
You can ask about VAD without having to justify your values, and your team should respond respectfully even if some staff do not participate.
2 min readWill my palliative care team still care for me if I ask about VAD?
A palliative care team should keep caring for you if you ask about VAD, although individual staff may have different roles or objections.
5 min readWould a feeding tube make someone stronger near the end of life?
Usually, a feeding tube does not make someone stronger when they are actively dying.
4 min readWould IV fluids help someone who is dying?
Sometimes IV fluids help in palliative care, but they do not usually help when a person is actively dying and the body is shutting down.