A decision to withhold or withdraw treatment is a common feature of medical practice when a person is approaching the end of life. The law that governs this practice differs depending on whether the person has capacity to make treatment decisions.
Adults who are in the last days of life are prescribed medicines in advance for symptoms that might happen in the future. This avoids a delay in getting medicines that might be needed quickly when symptoms develop. These medicines are prescribed based on the individual needs of the person.
For hospice patients who have trouble breathing, small amounts of well-controlled and regularly titrated morphine can help ease respiratory distress by decreasing fluid in the lungs and altering how the brain responds to pain.
End of life care can last for just a few days or weeks, but for many people it may continue for months or even years. ∎their environmental needs, such as their surroundings and community ∎their cultural, spiritual or religious beliefs and practices.
Decisions to withhold or withdraw life-sustaining medical treatment are common in end of life and palliative care. Sometimes they are made by the person themselves (if they have capacity), and sometimes they are made on behalf of the person (if they no longer have capacity).
The most commonly prescribed drugs include acetaminophen, haloperidol, lorazepam, morphine, and prochlorperazine, and atropine typically found in an emergency kit when a patient is admitted into a hospice facility.
Palliative care is for anyone living with a serious illness at any stage, including the day of diagnosis, while end-of-life care is for the last few weeks or months of life. Palliative care is intended to help patients live more comfortably with their ongoing condition.
Nearing the end of life
Everyone's experiences are different, but there are changes that sometimes happen shortly before a person dies. These include loss of consciousness, changes to skin colour, and changes to breathing.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
If the patient's experience of breathlessness does not improve, oxygen therapy should be stopped.
Opioid choice and syringe drivers
Morphine sulphate is the injectable opioid of choice in the majority of patients. Alternative opioids (when morphine is not tolerated or in patients with severe renal failure e.g. GFR< 30mL /min) include oxycodone or alfentanil.
End of life and palliative care aims to help you if you have a life-limiting or life-threatening illness. The focus of this type of care is managing symptoms and providing comfort and assistance. This includes help with emotional and mental health, spiritual and social needs.
The first organ system to “close down” is the digestive system. Digestion is a lot of work! In the last few weeks, there is really no need to process food to build new cells. That energy needs to go elsewhere.
The patient will commonly be started on a small dose of sedative (such as a benzodiazepine like midazolam or lorazepam). They may also be given an anti-psychotic (such as haloperidol). Medicines are usually given as injections or through a syringe pump (also known as a syringe driver).
Final Weeks of Life
Increase in the need to sleep, having to spend the large majority of the day in bed/resting. Difficulty eating or swallowing fluids. A decrease in the patient's ability to communicate and/or concentrate. A general lack of interest in things that used to interest them, and a strong feeling of apathy.
Body temperature can go down by a degree or more as death nears. Blood pressure will also decrease, contributing to reduced blood flow to the hands, feet, nose, and lips. You may notice the patient's skin turning pale, bluish, or mottled. Some people may fluctuate between being hot and cold.
As the moment of death comes nearer, breathing usually slows down and becomes irregular. It might stop and then start again or there might be long pauses or stops between breaths . This is known as Cheyne-Stokes breathing. This can last for a short time or long time before breathing finally stops.
End of life care should begin when you need it and may last a few days or months, or sometimes more than a year. People in lots of different situations can benefit from end of life care. Some of them may be expected to die within the next few hours or days. Others receive end of life care over many months.
It is important that the dying person and those important to them are aware that the benefits of giving assisted hydration are for relief of distressing symptoms of dehydration and that fluids are not being administered to prolong life, except when there is uncertainty about whether the person is dying or there is ...
As the process of dying continues, drips do not always help and can cause problems, as often the body does not need the same amount of fluid and cannot cope with it. Fluid from a drip may, for instance, build up in the lungs making breathlessness worse.