responsive or unresponsive to stimuli and
sleep for longer periods.
5. Skin changes: The skin may become cool
to the touch, pale or mottled, and appear
moist or clammy.
6. Circulatory changes: Blood pressure may
drop significantly, and the pulse may become
irregular or weaker.
Palliative care is an approach to medical care
that focuses on improving the quality of life
for patients with incurable illnesses. The goal
of palliative care is to improve the quality of
life for patients and their families by
managing pain and other symptoms,
addressing psychological and spiritual needs,
and providing emotional support. Palliative
care is an interdisciplinary approach, which
means that it involves a team of healthcare
professionals, including doctors, nurses,
social workers, chaplains, and others.
Whilst palliative care can support patients
and families throughout their advanced
illness care process, end-of-life decisions
usually take place in the last phase of life.
At the same time, it can be difficult to assess
when someone is dying. As a society, we are
less familiar with recognising the signs of
dying. However, palliative care staff are
more familiar with common signs and
symptoms. These might include:
1. Physical decline: As the body prepares for
death, there may be noticeable physical
changes such as decreased appetite,
weakness, difficulty swallowing, and
increasing fatigue.
2. Breathing changes: Irregular breathing
patterns, changes in the rate and sound of
breathing, and periods of shallow breathing
or stopped breathing are common in the
dying process.
3. Changes in consciousness: The person may
become more drowsy, confused, and
disoriented as the body's systems begin to
shut down.
4. Decreased responsiveness: The person
may withdraw from others, become less
It is important to note that everyone's dying
experience is unique, and not all individuals
will exhibit all of these signs. The health care
team are there to support the patient and
their family so communication with the
healthcare team can help to understand the
individual's specific situation and they can
provide support.
Symptoms like pain, delirium, and dyspnea
are often present in patients nearing death
and can cause a lot of distress. In some cases
these symptoms become refractory, which
means that treatment options are exhausted
because they fail, the results are not
available in due time, or the risk-benefit ratio
is no longer acceptable to the patient. In
such cases, palliative sedation can be
considered as a last resort palliative care
option. Palliative sedation has been defined
in different ways but core components
involve the deliberate lowering of the
consciousness of a patient in the last phase
of life, by sedative medication. (1) It is
estimated that palliative sedation precedes
10-18% of all deaths in European countries,
although with considerable differences. (2,3)
Palliative care and
the dying phase
Palliative sedation as a
measure of last resort
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