The Dying Process
What families may notice as death becomes closer.
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.
2 min readCan I decide not to return to hospital?
A person with capacity can usually decide not to return to hospital, but they need a clear home care and emergency plan.
3 min readCan someone be sedated continuously until they die?
Yes, continuous palliative sedation until death can be used in some situations.
5 min readCan someone really die at home with proper medical support?
Yes.
4 min readCan someone seem better shortly before they die?
Yes, some people seem briefly better before death, but the whole pattern usually matters more than one good spell.
4 min readCan someone who is unconscious still hear me?
A dying person who cannot respond may still be able to hear or sense calm voices and touch.
5 min readDo I need to call 000 or the police after an expected death at home?
Usually, no.
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 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.
5 min readHow can I tell if someone is dying?
You may be able to tell someone is dying by looking at the whole pattern of change.
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 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 tell my children that someone they love is dying?
Tell children the truth in clear, gentle words.
5 min readHow early should I start the VAD process?
If voluntary assisted dying (VAD) may matter to you, ask for information early.
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.
6 min readIs a VAD death usually peaceful?
Many families and clinicians expect a voluntary assisted dying (VAD) death to be calm, planned and private.
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.
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 readMy loved one is dying. What does that mean for intimacy between us?
Intimacy can still matter when someone is dying, but it may need to change with energy, privacy, symptoms, consent and comfort.
4 min readShould children visit someone who is dying?
Children can visit someone who is dying if they want to, the visit is safe, and they are prepared for what they may see.
4 min readShould I call an ambulance if someone is expected to die at home?
Not automatically.
4 min readShould I keep talking to someone who is unconscious and dying?
Yes, if it feels right, keep speaking calmly to a dying person who cannot answer.
4 min readShould I make someone who is dying eat?
No. Although it might come from a place of love and care, let them decide for themselves if they want to eat.
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.
7 min readWhat actually happens on the day of a VAD death?
On the day of a voluntary assisted dying (VAD) death, the person either takes the VAD medication themselves or, where the law allows it and the required approvals are in place, an authorised practitioner gives it to them.
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 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.
5 min readWhat happens if my GP objects to VAD?
Your GP may be allowed to object to voluntary assisted dying (VAD) and choose not to take part.
7 min readWhat happens if someone loses capacity before completing the VAD process?
If a person loses decision-making capacity before completing the voluntary assisted dying (VAD) process, they usually cannot continue to access VAD.
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.
5 min readWhat happens immediately after someone dies at home?
If the death was expected, there is usually no need to call `000` or the police straight away.
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.
5 min readWhat help is available if I have to stop working to care for someone who is dying?
If you need to stop work or reduce hours to care for someone who is dying, help may include workplace leave, flexible work discussions, Centrelink carer payments, Carer Gateway support, respite, social work help and financial counselling.
4 min readWhat is a terminal rally?
A terminal rally is a short period where a dying person seems more awake, settled or energetic before declining again.
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 terminal lucidity?
Terminal lucidity means a short return of clearer thinking or communication in someone who is close to death.
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.
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.
4 min readWhat should children expect when they visit someone who is dying?
Children should be told, in plain words, what may be different before they visit someone who is dying.
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 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 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 has someone who is dying suddenly become more awake and energetic?
A short burst of energy near death can happen, but it usually does not mean the illness is reversing.
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.
6 min readWill VAD hurt?
Voluntary assisted dying (VAD) is intended to cause death after the person takes or is given a prescribed VAD substance.
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.