Symptoms
Changes, symptoms and medicines near the end 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.
4 min readCan a dying person feel the secretions in their throat?
A dying person may not feel throat secretions if they are deeply sleepy or unconscious, but comfort still needs to be checked.
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.
4 min readCan I give water to someone who is having trouble swallowing?
Water may be unsafe if a dying person is too sleepy or weak to swallow properly.
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.
4 min readDo I need to keep turning someone if moving them causes pain?
If turning causes pain near the end of life, ask the care team to adjust the plan so comfort comes first.
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 the death rattle mean the person is choking?
The death rattle usually means secretions are pooling in the throat, not that the person is choking in the usual sense.
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.
4 min readHow do I do mouth care for someone who is dying?
Mouth care can ease dryness and keep a dying person comfortable when they are eating and drinking very little.
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.
4 min readHow do I manage toileting when someone can no longer get out of bed?
Toileting in bed can be managed with continence aids, equipment, careful skin care and help from the care team.
4 min readHow do I prevent pressure sores when someone is dying?
Pressure sore prevention near death should protect skin while keeping the person as comfortable as possible.
4 min readHow long can pauses between breaths last when someone is dying?
Pauses between breaths near death can last several seconds and may become longer as death comes closer.
4 min readHow often should I turn someone who is dying in bed?
Turning someone who is dying should balance skin protection with comfort, pain, breathlessness and the person's wishes.
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 can I use for a very dry mouth at the end of life?
A very dry mouth near the end of life can often be eased with gentle mouth care, moist swabs and lip care.
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.
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.
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.
4 min readWhat happens when someone who is dying can no longer swallow their medicines?
When a dying person cannot swallow medicines, the care team can review what is still needed and use other routes for comfort medicines.
4 min readWhat is Cheyne-Stokes breathing?
Cheyne-Stokes breathing is a pattern where deeper breaths are followed by shallower breaths or pauses.
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 death rattle?
The death rattle is noisy breathing caused by saliva or secretions pooling when a dying person is too weak to clear their throat.
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.
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 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.
4 min readWhy are a dying person's hands and feet becoming cold?
Cold hands and feet near death often happen because blood flow to the skin and limbs is slowing.
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.
4 min readWhy do a dying person's eyes sometimes stay partly open?
A dying person's eyes may stay partly open because the eyelid muscles relax and blinking becomes less frequent.
4 min readWhy does a dying person sometimes have a fever?
Fever near the end of life can come from infection, inflammation, medicines or the body's changing temperature control.
4 min readWhy does a dying person's breathing suddenly change?
Breathing can change suddenly near death because the brain, muscles and circulation no longer control breathing in a steady way.
4 min readWhy does a dying person's jaw move with each breath?
Jaw movement with each breath can happen when a dying person's breathing muscles are very weak.
4 min readWhy does a dying person's mouth stay open?
A dying person's mouth may stay open because the face and jaw muscles relax as the body becomes weaker.
4 min readWhy does someone who is dying become incontinent?
Incontinence near death can happen because the person is weak, sleepy, less aware and losing muscle control.
4 min readWhy does someone who is dying stop being able to swallow tablets?
A dying person may stop swallowing tablets because they are weaker, sleepier and less able to swallow safely.
4 min readWhy has a dying person stopped passing much urine?
A dying person may pass very little urine because they are drinking less and their kidneys and circulation are slowing.
4 min readWhy is a dying person staring into the distance?
A dying person may stare into the distance because they are very tired, less aware, delirious, or unable to focus their eyes normally.
4 min readWhy is a dying person's skin becoming blotchy or purple?
Blotchy or purple skin near death often happens because circulation is slowing and blood is not reaching the skin evenly.
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.