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How do doctors know when someone is dying?

changes in their normal breathing pattern. noisy chest secretions. mottled skin and feeling cold to the touch.

mariecurie.org.uk - Signs that someone is in their last days or hours of life - Marie Curie

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Last days and hours of life

The last days or hours of a person's life are sometimes called the terminal phase. This is when someone is "actively dying". Everyone's experience of dying is different, and some people will die suddenly or unexpectedly. But there are often signs that can help you to recognise when someone is entering the terminal phase. These include:

getting worse day by day or hour by hour

becoming bed-bound for most of the day

extreme tiredness and weakness

needing help with all personal care

little interest in food or drink

difficulty swallowing oral medication

being less responsive and less able to communicate

sleepiness and drowsiness

reduced urine output

new urinary or faecal incontinence

delirium, with increased restlessness, confusion and agitation

changes in their normal breathing pattern

noisy chest secretions

mottled skin and feeling cold to the touch

the person telling you they feel like they're dying.

If you think someone is in their last days of life

It can be difficult to know whether someone is entering the last days of their life. If you're unsure, ask a more experienced colleague for advice.

Inform the person’s care team

If a patient shows signs that they're entering the terminal phase, speak to the district nurse, GP or palliative care team. They will speak to colleagues, the patient and the people around them to decide whether the patient is entering the last days of life and what care they need.

Consider reversible causes of decline

Some conditions can cause the signs and symptoms of dying but can be treated. Be aware of reversible causes of decline, which may include:

hypercalcaemia (high level of calcium in the blood)

renal (kidney) failure

infection

side effects of medicines such as strong painkillers.

If you think the patient may have any of these conditions, tell their GP or specialist nurse, who will arrange assessment and treatment. Keep monitoring the person regularly (at least every 24 hours) to make sure they're settled. Talk to the GP or district nurse if there are any changes in their symptoms.

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Communicate with the patient and those involved in their care

Even when someone has been living with a terminal illness for a while, it can be a shock for the patient and the people around them when they reach the last days of their life. It's important to be honest and reassuring when you're speaking to the patient and those important to them. The best person to speak to the patient and the people close to them is a health and social care professional who is confident and experienced. It can help if they have had time to build a relationship with the patient. If you do not feel comfortable doing this, ask a colleague to help. You can learn the communication skills needed to speak to patients at the end of life through training, experience and feedback from colleagues. Check whether the patient has recorded their wishes in a care plan or other document. If they haven't discussed their wishes with anyone, offer them the chance to do this as soon as possible. Some family members and friends may experience grief before the patient dies. This is called anticipatory grief.

Find out how you can help support family and friends.

Useful resources

You may find our guides on specific conditions, which include targeted information about signs of dying, useful:

Here are some useful resources from other organisations:

National Institute of Health and Social Care Excellence Guideline: Caring for dying adults in the last days of life National Institute of Health and Social Care Excellence Clinical Knowledge Summary: Palliative care-general issue: The terminal phase

Scottish Palliative Care Guidelines: End of Life Care

mariecurie.org.uk - Signs that someone is in their last days or hours of life - Marie Curie

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