Near-death state of the body. Signs of approaching death in an elderly person. Respiratory changes as death approaches

19.05.2015

Cancer before death: what should you be prepared for?

The end of life period is individual for each cancer patient. spreads so much in the body that it becomes uncontrollable. In this case, health care professionals often decide that further treatment is futile. However, patient care continues further, but with an emphasis on improving the quality of life. The main task is to make it as easy as possible last days sick.

Treatments and medications are aimed at controlling pain and other end-of-life symptoms. Patients and their families often want to know how long a person will live. This question is difficult to answer. For cancer before death, life expectancy depends on a number of factors, including the type of malignancy, its location, accompanying illnesses and their ability to influence the situation.

It is important to know :

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Cancer before death: symptoms, signs, sensations

People caring for a dying person need to be aware of the physical difficulties their person is experiencing. The caregiver should be alert to the occurrence of unusual cancer symptoms before death so that they can immediately seek qualified medical advice. medical care and alleviate the suffering of the patient. TO emergency situations relate:

• the patient feels new symptoms such as nausea, vomiting, uncontrollable conditions (severe anxiety or restlessness);
• increased pain that does not go away even after taking prescribed medications;
• the presence of breathing problems, discomfort, expressed by grimaces of pain or strong groaning;
• inability to urinate or have bowel movements;
• the depressed state of the patient, which even leads to topics about suicide.

How do cancer patients feel before death?

Some symptoms of the patient's condition may clearly indicate the approach of death, namely:

1. People often focus on the last weeks of life, seemingly forgetting the previous ones. This does not necessarily mean that patients become depressed. This situation may indicate decreased blood flow or oxygen levels in the brain, as well as psychological preparation to death.
2. Loss of interest in things that previously occupied them (TV shows, conversations with friends, pets, hobbies, etc.).
3. Some patients may have increased drowsiness, confusion after waking up, which is associated with a decrease in the functioning of the brain system.

Signs of cancer before death that relatives or guardians should be prepared for

1. Extreme restlessness, unwillingness to be alone. It is better for a person caring for a patient to be near the dying person in order to help in the next attack of panic or despair.
2. The pain can become so intense that it becomes difficult to control. In this case, massage or other methods of relaxation, as well as properly selected medications, can help.
3. Weakness and fatigue increase over time.
4. As soon as the body is affected malignant process, the patient's body needs less food. Loss of appetite is caused by the body's need to conserve energy expended on the use of food and liquid, as well as the inability normal operation digestive system.
5. Towards the end of life, people often have episodes of confusion or daydreams. They may get confused about time, place, and loved ones.
6. Sometimes patients report that they see or talk to loved ones who have died. People with cancer before death often talk about an exciting trip, emanating light, butterflies and other symbols that are hidden from prying eyes.

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Symptoms that indicate the process of dying

• Losing control bladder or intestines due to relaxation of the pelvic muscles. Therefore, a person needs to replace linen and personal hygiene products. You can place disposable diapers under the patient or wear diapers for adults.
• have reduced kidney function, and therefore consume less fluid. This leads to infrequent urination and a strong odor.
• The intervals between breathing shorten, become faster, or become cyclical. In this regard, there may appear different sounds, which indicate gathering in the upper respiratory tract saliva and other liquids. This condition may bother the caregiver, but it does not cause suffering to the patient. The situation can be alleviated by using a pillow under the head or a bolster, which allows the person to remain in an elevated position.
• The skin may take on a bluish tint. The dying person often feels cool because the blood flow slows down. This condition is not painful. However, the caregiver must warm the patient with a heating pad or electric blanket.

For information:

No one can stop the approach of death, but loved ones can do everything to ensure that the dying person does not feel alone in the last days of his life.

If you are dying or caring for someone who is dying, you may have questions about what the dying process will be like physically and emotionally. The following information will help you answer some questions.

Signs of approaching death

The process of dying is as diverse (individual) as the process of birth. Impossible to predict exact time death, and how exactly the person will die. But people facing death experience many of the same symptoms, regardless of the type of illness.

As death approaches, a person may experience some physical and emotional changes, such as:

Excessive drowsiness and weakness, at the same time periods of wakefulness decrease, energy fades.

Breathing changes, periods fast breathing are replaced by pauses in breathing.

Hearing and vision change, for example, a person hears and sees things that others do not notice.

Appetite worsens, the person drinks and eats less than usual.

Changes in urinary and gastrointestinal systems. Your urine may turn dark brown or dark red, and you may have bad (difficult) stools.

Body temperature changes, ranging from very high to very low.

Emotional changes, a person is not interested in the outside world and individual details Everyday life such as time and date.

A dying person may experience other symptoms depending on the disease. Talk to your doctor about what you can expect. You can also contact the program for helping the hopelessly ill, where all your questions regarding the dying process will be answered. The more you and your loved ones know, the more prepared you will be for this moment.

Excessive drowsiness and weakness associated with approaching death

As death approaches, a person sleeps more and it becomes more and more difficult to wake up. Periods of wakefulness are becoming shorter and shorter.

As death approaches, people caring for you will notice that you are unresponsive and that you are in very deep sleep. This condition is called coma. If you are in a coma, you will be tied to your bed and all your physiological needs(bathing, turning, feeding and urinating) will need to be supervised by someone else.

General weakness is a very common occurrence as death approaches. It is normal for a person to need assistance with walking, bathing, and going to the toilet. Over time, you may need help turning over in bed. Medical equipment, such as wheelchairs, a walker or a hospital bed can be of great help during this period. This equipment can be rented from a hospital or care center for the terminally ill.

Respiratory changes as death approaches

As death approaches, periods rapid breathing may be followed by periods of breathlessness.

Your breath may become wet and congested. This is called the "death rattle." Changes in breathing usually happen when you are weak and normal discharge your airways and lungs cannot escape.

Although noisy breathing may be a signal for your family, you will probably not feel pain and notice stagnation. Since the fluid is deep in the lungs, it is difficult to remove it. Your doctor may prescribe oral tablets(atropines) or patches (scopolamine) to reduce congestion.

Your loved ones may turn you on your other side to help the discharge come out of your mouth. They can also wipe this discharge with a damp cloth or special tampons (you can ask for it at a help center for the hopelessly ill or buy it at pharmacies).

Your doctor may prescribe oxygen therapy to relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

Changes in vision and hearing as death approaches

Visual impairment is very common in last weeks life. You may notice that your vision has become difficult. You may see or hear things that no one else notices (hallucinations). Visual hallucinations are common before death.

If you are caring for a dying person who is hallucinating, you need to reassure them. Acknowledge what the person sees. Denying hallucinations can be distressing to a dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in a deep coma. People who came out of comas said that they could hear the entire time they were in the coma.

Hallucinations

Hallucinations are the perception of something that is not actually there. Hallucinations can involve all the senses: hearing, seeing, smelling, tasting or touching.

The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that another person cannot see.

Other types of hallucinations include gustatory, olfactory and tactile.

Treatment for hallucinations depends on the cause.

ChangesappetiteWithapproachingof death

As death approaches, you are likely to eat and drink less. It's connected with general feeling weakness and slow metabolism.

Since food has such important social significance, it will be difficult for your family and friends to watch you not eat. However, changes in metabolism mean that you do not need the same amount of food and fluid as before.

You can consume small amounts of food and liquid as long as you are active and able to swallow. If swallowing is a problem for you, you can prevent thirst by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) soaked in water.

Changes in the urinary and gastrointestinal systems as death approaches

Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, the urine becomes very concentrated. Its quantity is also decreasing.

As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

You should tell your doctor if bowel movements occur less frequently than once every three days, or bowel movements cause you discomfort. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse your colon.

As you become increasingly weak, it is natural that you find it difficult to control bladder and intestines. They may put it in your bladder urinary catheter as a means of continuous drainage of urine. Also, the program for helping hopelessly ill patients can provide toilet paper or underwear (these can also be purchased at the pharmacy).

Changes in body temperature as death approaches

As death approaches, the area of ​​the brain responsible for regulating body temperature begins to function poorly. You may have a high fever and then feel cold within a minute. Your hands and feet may feel very cold to the touch and may even become pale and blotchy. Changes in skin color are called mottled skin lesions and are very common in the last days or hours of life.

The person caring for you can monitor your temperature by rubbing your skin with a wet, slightly warm washcloth or giving you the following medications:

Acetaminophen (Tylenol)

Ibuprofen (Advil)

Naproxen (Aleve).

Many of these medications are available in the form rectal suppositories if you have difficulty swallowing.

Emotional changes as death approaches

Just as your body prepares physically for death, you must prepare for it emotionally and mentally.

As death approaches, you may lose interest in the world around you and certain details of daily life, such as the date or time. You may withdraw into yourself and communicate less with people. You may only want to communicate with a few people. This kind of introspection can be a way of saying goodbye to everything you knew.

In the days before your death, you may enter a unique state of conscious awareness and communication that may be misinterpreted by your family and friends. You can talk about how you need to go somewhere - “go home” or “go somewhere.” The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

Events from your recent past may be mixed with distant events. You can remember very long ago events in great detail, but not remember what happened an hour ago.

You may be thinking about people who have already died. You may say that you heard or saw someone who has already died. Your loved ones may hear you talking to the deceased person.

If you are caring for a dying person, you may be upset or frightened by this strange behavior. You might want to return your loved one to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your loved one may fall into a state of psychosis, and this may be scary for you to watch. Psychosis occurs in many people before death. It may have one cause or be the result of several factors. Reasons may include:

Medicines such as morphine, sedatives, painkillers, or taking too much large dose medications that do not combine with each other.

Metabolic changes associated with high temperature or dehydration.

Metastasis.

Deep depression.

Symptoms may include:

Revival.

Hallucinations.

Unconscious state, which is replaced by revival.

Sometimes delirium tremens can be prevented with alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

Pain

Palliative care can help you relieve physical symptoms associated with your illness, such as nausea or difficulty breathing. Controlling pain and other symptoms is an important part of your treatment and improving your quality of life.

How often a person feels pain depends on their disease. Some fatal diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

A person can be so afraid of pain and others physical symptoms that he may be thinking about physician-assisted suicide. But the pain before death can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you cope with the pain of death. Be sure to ask for help. Ask a loved one to tell the doctor about your pain if you are unable to do so yourself.

You may want your family not to see you suffer. But it is very important to tell them about your pain if you cannot bear it so that they see a doctor immediately.

Spirituality

Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes a person’s relationship with higher powers or the energy that gives life meaning.

Some people don't think about spirituality often. For others, it is part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Connecting with religion often helps some people achieve comfort before death. Other people find solace in nature, in social work, strengthening relationships with loved ones or creating new relationships. Think about what can give you peace and support. What questions concern you? Seek support from friends, family, programs, and spiritual guides.

Caring for a dying relative

Control of pain and symptoms at the end of life

At the end of life, pain and other symptoms can be managed effectively. Talk to your doctor and loved ones about the symptoms you are experiencing. Family is an important link between you and your doctor. If you yourself cannot communicate with a doctor, your loved one can do this for you. There is always something that can be done to relieve your pain and symptoms so that you feel comfortable.

Physical pain

There are many painkillers available. Your doctor will choose the easiest and most atraumatic drug to relieve pain. Usually applied first oral medications, as they are easier to take and less expensive. If your pain is not severe, painkillers can be purchased without a doctor's prescription. These include drugs such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications as scheduled. Irregular use of medications is often the cause of ineffective treatment.

Sometimes pain cannot be controlled with over-the-counter medications. In this case, more effective forms of treatment are needed. Your doctor may prescribe painkillers such as codeine, morphine, or fentanyl. These medications can be combined with others, such as antidepressants, to help you get rid of your pain.

If you cannot take the pills, there are other forms of treatment. If you have problems swallowing, you can use liquid medicines. Medicines can also be in the form of:

Rectal suppositories. Suppositories can be taken if you have trouble swallowing or nausea.

Drops under the tongue. Just like nitroglycerin tablets or heart pain sprays, liquid forms Some substances, such as morphine or fentanyl, can be absorbed by the blood vessels under the tongue. Such drugs are given in very small quantity– usually just a few drops – and are effective way pain relief for people who have trouble swallowing.

Patches applied to the skin (transdermal patches). These patches allow painkillers, such as fentanyl, to pass through the skin. The advantage of patches is that you instantly receive the required dose of medication. These patches provide better pain control than pills. In addition, a new patch must be applied every 48 to 72 hours, and the tablets must be taken several times a day.

Intravenous injections (drips). Your doctor may prescribe treatment with a needle inserted into a vein in your arm or chest if your pain is very severe and cannot be controlled with oral, rectal, or transdermal treatments. Medicines can be given as a single injection several times a day, or continuously in small quantities. Just because you are connected to an IV does not mean your activities will be limited. Some people carry small portable pumps that provide them in small portions medications throughout the day.

Injections into the area spinal nerves(epidural) or under the spinal tissue (intrathecal). At acute pain Strong painkillers, such as morphine or fentanyl, are injected into the spine.

Many people who suffer from severe pain fear that they will become dependent on painkillers. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine to prevent dependence.

Painkillers can be used to manage the pain and help keep it at a tolerable level. But sometimes painkillers make you drowsy. You can only take Not a large number of medications and endure accordingly slight pain to stay active at the same time. On the other hand, maybe weakness doesn't matter to you. of great importance and you are not bothered by drowsiness caused by certain medications.

The main thing is to take medications on a specific schedule, and not just when “the need arises.” But even if you take medication regularly, you may sometimes feel severe pain. These are called "breakthrough pain." Talk to your doctor about what medications you should always have on hand to help manage breakthrough pain. And always tell your doctor if you stop taking your medicine. Stopping suddenly can cause serious side effects and severe pain. Talk to your doctor about ways to relieve pain without using drugs. Alternative medical therapy can help some people relax and get rid of pain. You can combine traditional treatment With alternative methods, such as:

Acupuncture

Aromatherapy

Biofeedback

Chiropractic

Imaging

Healing Touch

Homeopathy

Hydrotherapy

• Magnetotherapy

• Meditation

For more detailed information, see section Chronic pain

Emotional stress

During the period when you are learning to cope with your illness, short-term emotional stress is normal occurrence. Depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be treated even if you have a terminal illness. Antidepressants in combination with counseling from a psychologist will help you cope with emotional distress.

Talk to your doctor and family about your emotional distress. Although feelings of grief are a natural part of the dying process, this does not mean you have to endure severe emotional pain. Emotional distress can increase physical pain. They can also have a negative impact on your relationships with loved ones and prevent you from saying goodbye to them properly.

Other symptoms

As death approaches, you may experience other symptoms. Talk to your doctor about any symptoms you may experience. Symptoms such as nausea, fatigue, constipation or shortness of breath can be managed with medication, special diets and oxygen therapy. Have a friend or family member describe your symptoms to a doctor or emergency services worker. It can be helpful to keep a journal and write down all your symptoms.

If you are dying or caring for someone who is dying, you may have questions about what the dying process will be like physically and emotionally. The following information will help you answer some questions.

Signs of approaching death

The process of dying is as diverse (individual) as the process of birth. It is impossible to predict the exact time of death and how exactly a person will die. But people facing death experience many of the same symptoms, regardless of the type of illness.

As death approaches, a person may experience some physical and emotional changes, such as:

• Excessive drowsiness and weakness, at the same time periods of wakefulness decrease, energy fades.

• Breathing changes, periods of rapid breathing are replaced by pauses in breathing.

• Hearing and vision change, for example, a person hears and sees things that others do not notice.

• Appetite worsens, the person drinks and eats less than usual.

• Changes in the urinary and gastrointestinal systems. Your urine may turn dark brown or dark red, and you may have bad (difficult) stools.

• Body temperature changes, ranging from very high to very low.

• Emotional changes, the person is not interested in the outside world and certain details of everyday life, such as time and date .

A dying person may experience other symptoms depending on the disease. Talk to your doctor about what you can expect. You can also contact the program for helping the hopelessly ill, where all your questions regarding the dying process will be answered. The more you and your loved ones know, the more prepared you will be for this moment.
Excessive drowsiness and weakness associated with approaching death

As death approaches, a person sleeps more and it becomes more and more difficult to wake up. Periods of wakefulness are becoming shorter and shorter.

As death approaches, your caregivers will notice that you are unresponsive and that you are in very deep sleep. This condition is called coma. If you are in a coma, you will be confined to a bed and all your physiological needs (bathing, turning, eating and urinating) will have to be supervised by someone else.

General weakness is a very common occurrence as death approaches. It is normal for a person to need assistance with walking, bathing, and going to the toilet. Over time, you may need help turning over in bed. Medical equipment such as wheelchairs, walkers or a hospital bed can be of great help during this period. This equipment can be rented from a hospital or care center for the terminally ill.

*
Respiratory changes as death approaches
*
As death approaches, periods of rapid breathing may be followed by periods of breathlessness.

Your breath may become wet and congested. This is called the "death rattle." Changes in breathing usually happen when you are weak and normal secretions from your airways and lungs cannot be released.

Although noisy breathing may be a signal to your family, you probably won't feel any pain or notice any congestion. Since the fluid is deep in the lungs, it is difficult to remove it. Your doctor may prescribe oral tablets (atropine) or patches (scopolamine) to relieve congestion.

Your loved ones may turn you on your other side to help the discharge come out of your mouth. They can also wipe this discharge with a damp cloth or special tampons (you can ask for it at a help center for the hopelessly ill or buy it at pharmacies).

Your doctor may prescribe oxygen therapy to relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

*
Changes in vision and hearing as death approaches
*
Deterioration of vision is very common in the last weeks of life. You may notice that your vision has become difficult. You may see or hear things that no one else notices (hallucinations). Visual hallucinations are common before death.

If you are caring for a dying person who is hallucinating, you need to reassure them. Acknowledge what the person sees. Denying hallucinations can be distressing to a dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in a deep coma. People who came out of comas said that they could hear the entire time they were in the coma.

*
Hallucinations
*
Hallucinations are the perception of something that is not actually there. Hallucinations can involve all the senses: hearing, seeing, smelling, tasting or touching.

The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that another person cannot see.

Other types of hallucinations include gustatory, olfactory and tactile.

Treatment for hallucinations depends on the cause.

*
Changes in appetite as death approaches

As death approaches, you are likely to eat and drink less. This is associated with a general feeling of weakness and a slower metabolism.

Since food has such important social significance, it will be difficult for your family and friends to watch you not eat. However, changes in metabolism mean that you do not need the same amount of food and fluid as before.

You can consume small amounts of food and liquid as long as you are active and able to swallow. If swallowing is a problem for you, you can prevent thirst by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) soaked in water.
Changes in the urinary and gastrointestinal systems as death approaches

Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, the urine becomes very concentrated. Its quantity is also decreasing.

As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

You should tell your doctor if you have bowel movements less than once every three days or if your bowel movements cause you discomfort. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse your colon.

As you become increasingly weak, it is natural that you will have difficulty controlling your bladder and bowels. A urinary catheter may be placed in your bladder as a means of long-term urine drainage. The terminally ill program may also provide toilet paper or underwear (they can also be purchased at the pharmacy).
Changes in body temperature as death approaches

As death approaches, the area of ​​the brain responsible for regulating body temperature begins to function poorly. You may have a high fever and then feel cold within a minute. Your hands and feet may feel very cold to the touch and may even become pale and blotchy. Changes in skin color are called mottled skin lesions and are very common in the last days or hours of life.

The person caring for you can monitor your temperature by rubbing your skin with a wet, slightly warm washcloth or giving you the following medications:
Acetaminophen (Tylenol)
Ibuprofen (Advil)
Naproxen (Aleve).
Aspirin.

Many of these medications are available in the form of rectal suppositories if you have difficulty swallowing.
Emotional changes as death approaches

Just as your body prepares physically for death, you must prepare for it emotionally and mentally.

As death approaches, you may lose interest in the world around you and certain details of daily life, such as the date or time. You may withdraw into yourself and communicate less with people. You may only want to communicate with a few people. This kind of introspection can be a way of saying goodbye to everything you knew.

In the days before your death, you may enter a unique state of conscious awareness and communication that may be misinterpreted by your family and friends. You can talk about how you need to go somewhere - “go home” or “go somewhere.” The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

Events from your recent past may be mixed with distant events. You can remember very long ago events in great detail, but not remember what happened an hour ago.

You may be thinking about people who have already died. You may say that you heard or saw someone who has already died. Your loved ones may hear you talking to the deceased person.

If you are caring for a dying person, you may be upset or frightened by this strange behavior. You may want to bring your loved one back to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your loved one may fall into a state of psychosis, and this may be scary for you to watch. Psychosis occurs in many people before death. It may have one cause or be the result of several factors. Reasons may include:
Medicines such as morphine, sedatives and painkillers, or taking too much of a medicine that doesn't work well together.
Metabolic changes associated with high temperature or dehydration.
Metastasis.
Deep depression.

Symptoms may include:
Revival.
Hallucinations.
Unconscious state, which is replaced by revival.

Delirium tremens can sometimes be prevented by using alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

Pain

Palliative care can help you relieve physical symptoms associated with your illness, such as nausea or difficulty breathing. Controlling pain and other symptoms is an important part of your treatment and improving your quality of life.

How often a person feels pain depends on their disease. Some fatal diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

A person may become so afraid of pain and other physical symptoms that they may consider physician-assisted suicide. But the pain before death can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you cope with the pain of death. Be sure to ask for help. Ask a loved one to tell the doctor about your pain if you are unable to do so yourself.

You may want your family not to see you suffer. But it is very important to tell them about your pain if you cannot bear it so that they see a doctor immediately.

Spirituality

Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes a person's relationship with higher powers or energy that gives meaning to life.

Some people don't think about spirituality often. For others, it's part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Connecting with religion often helps some people achieve comfort before death. Other people find solace in nature, social work, strengthening relationships with loved ones, or creating new relationships. Think about what can give you peace and support. What questions concern you? Seek support from friends, family, programs, and spiritual guides.

Caring for a dying relative

Physician-assisted suicide

Physician-assisted suicide refers to the practice of medical professionals assisting a person who voluntarily chooses to die. This is usually done by prescribing a lethal dose of medication. Although the doctor is indirectly involved in the death of a person, he is not the direct cause of it. Oregon is currently the only state to have legalized physician-assisted suicide.

A person with a terminal illness may consider suicide with the assistance of a physician. Among the factors that can cause such a decision are severe pain, depression and fear of dependence on other people. A dying person may consider himself a burden to his loved ones and not understand that his family wants to provide him with their help as an expression of love and sympathy.

Often, a person with a terminal illness will consider physician-assisted suicide when their physical or emotional symptoms do not receive effective treatment. Symptoms associated with the dying process (such as pain, depression or nausea) can be controlled. Talk to your doctor and family about your symptoms, especially if your symptoms bother you so much that you think about dying.

Control of pain and symptoms at the end of life

At the end of life, pain and other symptoms can be managed effectively. Talk to your doctor and loved ones about the symptoms you are experiencing. Family is an important link between you and your doctor. If you yourself cannot communicate with a doctor, your loved one can do this for you. There is always something that can be done to relieve your pain and symptoms so that you feel comfortable.

Physical pain

There are many painkillers available. Your doctor will choose the easiest and most atraumatic drug to relieve pain. Oral medications are usually used first because they are easier to take and less expensive. If your pain is not severe, painkillers can be purchased without a doctor's prescription. These include drugs such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications as scheduled. Irregular use of medications is often the cause of ineffective treatment.

Sometimes pain cannot be controlled with over-the-counter medications. In this case, more effective forms of treatment are needed. Your doctor may prescribe painkillers such as codeine, morphine, or fentanyl. These medications can be combined with others, such as antidepressants, to help you get rid of your pain.

If you cannot take the pills, there are other forms of treatment. If you have trouble swallowing, you can use liquid medications. Medicines can also be in the form of:

*
Rectal suppositories. Suppositories can be taken if you have trouble swallowing or nausea.
Drops under the tongue. Just like nitroglycerin tablets or heart pain sprays, liquid forms of some substances, such as morphine or fentanyl, can be absorbed by the blood vessels under the tongue. These medications are given in very small quantities - usually just a few drops - and are an effective way to control pain for people who have trouble swallowing.

*
Patches applied to the skin (transdermal patches). These patches allow painkillers, such as fentanyl, to pass through the skin. The advantage of patches is that you instantly receive the required dose of medication. These patches provide better pain control than pills. In addition, a new patch must be applied every 48 to 72 hours, and the tablets must be taken several times a day.

*
Intravenous injections (drips). Your doctor may prescribe treatment with a needle inserted into a vein in your arm or chest if your pain is very severe and cannot be controlled with oral, rectal, or transdermal treatments. Medicines can be given as a single injection several times a day, or continuously in small quantities. Just because you are connected to an IV does not mean your activities will be limited. Some people carry small, portable pumps that provide small amounts of medication throughout the day.

*
Injections into the area of ​​the spinal nerves (epidural) or under the tissue of the spine (intrathecal). For acute pain, strong painkillers such as morphine or fentanyl are injected into the spine.
*
Many people who suffer from severe pain fear that they will become dependent on painkillers. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine to prevent dependence.

Painkillers can be used to manage the pain and help keep it at a tolerable level. But sometimes painkillers make you drowsy. You can only take a small amount of medication and therefore endure little pain and still remain active. On the other hand, perhaps weakness is not a big deal for you and you are not bothered by drowsiness caused by certain medications.

The main thing is to take medications on a specific schedule, and not just when “the need arises.” But even if you take medications regularly, you may sometimes feel severe pain. These are called "breakthrough pain." Talk to your doctor about what medications you should always have on hand to help manage breakthrough pain. And always tell your doctor if you stop taking your medicine. Stopping suddenly can cause serious side effects and severe pain. Talk to your doctor about ways to relieve pain without using drugs. Alternative medical therapy can help some people relax and get rid of pain. You can combine traditional treatment with alternative methods, such as:

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Acupuncture
Aromatherapy
Biofeedback
Chiropractic
Imaging
Healing Touch
Homeopathy
Hydrotherapy
Hypnosis
Magnetotherapy
Massage
Meditation
Yoga

For more detailed information, see the Chronic Pain section.

Emotional stress

While you are learning to cope with your illness, short-term emotional distress is normal. Depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be treated even if you have a terminal illness. Antidepressants in combination with counseling from a psychologist will help you cope with emotional distress.

Talk to your doctor and family about your emotional distress. Although feelings of grief are a natural part of the dying process, this does not mean you have to endure severe emotional pain. Emotional suffering can make physical pain worse. They can also have a negative impact on your relationships with loved ones and prevent you from saying goodbye to them properly.

Other symptoms

As death approaches, you may experience other symptoms. Talk to your doctor about any symptoms you may experience. Symptoms such as nausea, fatigue, constipation or shortness of breath can be managed with medications, special diets and oxygen therapy. Have a friend or family member describe your symptoms to a doctor or emergency services worker. It can be helpful to keep a journal and write down all your symptoms.

Ten signs that death is near. Video

None of us can predict exactly when death will occur. However, doctors and nurses who deal with seriously ill patients know that approach is accompanied by certain symptoms. Signs of impending death vary from person to person, and not all of the symptoms listed below are "must-haves." But there is still something in common...

1. Loss of appetite

The body's need for energy becomes less and less. A person may begin to resist eating and drinking or only eat certain foods (for example, cereal). First of all, a dying person refuses meat, since it is difficult for a weakened body to digest it. And then the most favorite foods no longer cause any appetite. At the end of his life, it happens that the patient is even physically unable to swallow what is in his mouth.

3. Physical weakness

Due to loss of appetite and the resulting lack of energy, the dying person cannot do even the simplest things - for example, he cannot roll over on his side, raise his head, or draw juice through a straw. All you can do is try to provide him with maximum comfort.

4. Brain fog and disorientation

Organs begin to fail, including the brain. A person may stop understanding where he is and who is next to him, start talking nonsense, or rush around the bed. You need to remain calm. Each time you approach a dying person, call yourself by name and speak to him extremely gently.

5. Difficult

7. Urinary problems

Since little water enters the body, and the kidneys are working worse and worse, the dying person really “walks little”, and concentrated urine has a brownish or reddish tint. This is why hospices often place a catheter in a terminally ill patient's last days of life. Due to kidney failure, the amount of toxins in the blood increases, which contributes to the dying person’s quiet fall into a coma and a peaceful death.

8. Leg swelling

When the kidneys fail, body fluids, instead of being eliminated, accumulate in the body - most often in the legs. Because of this, many people swell before death. Nothing can be done here, and it makes no sense: swelling is side effect approaching death, not the cause of it.

Death can be different, sometimes it is sudden in the midst of complete well-being, such death is usually sudden, bright and tragic, but there is another death, this is death that quietly creeps up and, as if humbly waiting at the head of its moment, is the death of seriously decrepit old men and women, such a death is of little interest and much less has been written about her than about her first friend. Sooner or later, we will all have to face death because “contra vim mortis non est medicamen in hortis”, sometimes death has to be met not in the intensive care unit, which is burning around the clock with all the lights, but at home, with the family, of course, this is in any case a very difficult event , but you shouldn’t completely lose your head, reveling in your experiences, but on the contrary, you should make the last days and hours of your loved one as comfortable as possible, how to recognize the signs that the end is near and help the dying person in these last difficult stages of his journey .

No one can predict when death will occur, but people on duty, often encounter people spending their last days in this world, are well aware of the symptoms of approaching death, the symptoms of the fact that there are only a few days and hours left of a human being.

Loss of appetite
In a gradually fading person, energy needs decrease more and more over time, the person begins to refuse food and drink, or take only small amounts of neutral simple food (for example, porridge). From more rough food Usually they refuse first. Even once-favorite dishes do not bring the same pleasure. Just before death, some people are simply unable to swallow food.

What to do: do not try to force feed a person, listen to the wishes of the dying person, even if you are deeply upset by his refusal to eat. Periodically offer the dying person pieces of ice, fruit ice, sips of water. Wipe soft cloth moisturized warm water lips and skin around the mouth, treat your lips with hygienic lipstick so that your lips do not dry out, but remain moist and elastic.

Increased fatigue and drowsiness
The dying person can spend most of the day sleeping, since the metabolism fades, and the reduced needs for water and food contribute to dehydration; the dying person wakes up more difficult; weakness reaches such a degree that the person perceives everything around him completely passively.

What to do: let the dying person sleep, do not force him to stay awake, do not disturb him, everything you say he can hear, it is assumed that hearing is preserved even if the person is unconscious, in a coma or other forms of impaired consciousness.

Strong physical exhaustion
A decreasing metabolism produces less and less energy, there is so little of it left that it becomes very difficult for a dying person not only to turn over in bed, but even to turn his head; even taking a sip of liquid through a straw can cause great difficulties for the patient.

What to do: Try to maintain a comfortable position for the patient and help him if necessary.

Confusion or disorientation
Growing functional impairment many organs, not bypassing the brain, consciousness begins to change, usually, with one speed or another, its depression sets in, the dying person may cease to be aware of where he or she is, who surrounds him, may speak or respond less readily, may communicate with people who are not or cannot be in the room, may speak nonsense, confuse the time, day, year, may lie motionless on the bed, or may become restless and fidget with the bed linen.

What to do: remain calm yourself and try to calm the dying person, speak softly to the person and let him know who is currently at his bedside or when you approach him.

Difficulty breathing, shortness of breath
Respiratory movements become erratic, jerky, a person may experience difficulty breathing, so-called pathological types breathing, for example, Cheyne-Stokes breathing - a period of increasing loud respiratory movements, followed by decreasing ones in depth, after which a pause (apnea) occurs, lasting from five seconds to a minute, followed by another period of deep, loud, increasing respiratory movements. Sometimes excess fluid in the airways creates a loud bubbling sound during breathing movements, sometimes called the "death rattle."

What to do: prolonged apnea (pause between breathing movements) or loud bubbling sounds can be alarming, however, the dying person may not even be aware of this type of change, focus on ensuring overall comfort, changing position can help, for example, placing another pillow under the back and head can give exalted position or turn his head slightly to the side, moisten his lips with a damp cloth and apply chapstick to his lips. If a large amount of sputum is released, try to facilitate its passage through the mouth. naturally, because its artificial suction can only increase its separation, a humidifier in the room can help, in some cases oxygen is prescribed, in any case, remain calm, try to calm the dying person.

Social alienation
As irreversible changes gradually increase in the body, the dying person gradually begins to lose interest in the people around him, the dying person may stop communicating completely, mutter nonsense, stop answering questions, or simply turn away.
A few days before completely plunging into oblivion, the dying person may surprise his relatives with an unusual surge of mental activity, again begin to recognize those present, communicate with them, respond to speech addressed to him; this period can last less than an hour, and sometimes even a day .

What to do: in any case, remember that all these are natural manifestations of the dying process and are not at all a reflection of your relationship, maintain physical contact with the dying person, touch, continue to communicate with him if appropriate, and try not to expect any answer from him instead, cherish the episodes of sudden clarity when they happen, as they are almost always fleeting.

Changed urination pattern
The dying person's need for food and fluids decreases, blood pressure- part of the dying process (which, due to the latter, does not need constant correction until normal level, as well as some other symptoms), urine becomes small, it becomes concentrated - deep brownish, reddish, or tea-colored.
Control over natural functions may subsequently be completely lost during the dying process.

What to do: according to instructions medical personnel, a urinary catheter may be placed to monitor urine output and facilitate its removal, although this is usually not necessary in the final hours. The onset of kidney failure leads to the accumulation of “toxins” in the circulating blood and contributes to a peaceful coma before death occurs. And, simply, lay down fresh film.

Swelling of the hands and feet
Progressive renal failure leads to the accumulation of fluid in the body, it usually accumulates in tissues located away from the heart, that is, usually in the fatty tissue of the hands and, especially, feet, this gives them a somewhat puffy, swollen appearance.

What to do: usually this no longer requires special measures (prescribing diuretics) since they are part of the dying process, and not its cause.

Coldness in the tips of the fingers and toes
In the hours to minutes before death, peripheral blood vessels narrow in an attempt to maintain blood circulation in the vital important organs- heart and brain, with a progressive decrease in blood pressure. During spasm peripheral vessels, extremities (fingers and toes, as well as the hands and feet themselves) become noticeably colder, nail beds become pale or bluish.

What to do: at this stage, the dying person may already be in oblivion, in otherwise, a warm blanket can help support comfortable conditions, the person may complain about the weight of the blanket covering their legs, so free them as much as possible.

Skin spots
On the skin, which was previously uniformly pale, clearly visible variegation and spots of a purple, reddish, or bluish tint appear - one of the final signs near death- the result of circulatory disorders in the microvasculature (venules, arterioles, capillaries), often such spotting is first found on the feet.

What to do: no special actions need to be taken.

The symptoms described are the most general signs approaching natural death, they can vary in the order of occurrence and be observed in different combinations in different people, in the case when the patient is in the intensive care unit and intensive care, in conditions artificial ventilation, and multicomponent intensive drug therapy the dying process may be completely different, but here in general outline the process of natural death is described.

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