Care of the Patient at End of Life and After-Death Care
Recognizing active dying
Look for the last-days pattern: decreasing oral intake and urine output, mottling and cool extremities, Cheyne-Stokes breathing, terminal secretions, increasing sleep, restlessness, and changes in level of consciousness. These are expected, not emergencies. Explaining them in advance prevents panicked calls.
Comfort-focused management
Continue analgesics and anxiolytics - stopping opioids at the end of life causes suffering, not a hastened death. Stop or deprescribe burdensome interventions (fingersticks, routine vitals, statins, antihypertensives, enteral feeding) with documented rationale. Palliative sedation for refractory symptoms is proportionate to the symptom, requires informed consent from the patient or surrogate, and is ethically distinct from euthanasia because the intent is relief of suffering, not death. Withdrawing and withholding life-sustaining treatment are ethically equivalent.
After death
Pronounce death per policy, document time and findings, notify the family, the attending, and the hospice per program policy. Provide postmortem care while honoring cultural and religious rituals, allow family time with the body, and address autopsy, tissue and organ donation, and body disposition. Secure medications and arrange safe disposal. Initiate the bereavement plan and notify the team.
Traps
Equating palliative sedation with assisted dying; suctioning terminal secretions; drawing labs on a dying patient 'to see what's going on'; forgetting the death notification and documentation timeline; assuming the family must leave the room.
Rule of thumb. When a new symptom appears in the final days, ask first: is this dying, or is it something reversible - a full bladder, an impaction, pain, or a medication effect?