Death and dying: the last days, the family, and after death

To assess recognition of the last days of life, comfort care and anticipatory medicines, communication with the person and the family, and the care of the body and the family after death.

Mr Joseph Walsh, 79, metastatic lung cancer, admitted for symptom control. The team has agreed with him and his wife that he is now in the last days of life; a do-not-attempt-resuscitation decision is documented and anticipatory medicines are prescribed. He is drowsy, breathing has become irregular with secretions, and his mouth is dry. His wife asks you: "Is he in pain? How long has he got? Should I call our son home from Australia?"

You are required to assess and manage his comfort, answer his wife honestly and kindly, say what happens when he dies and what care you give afterwards, and know the documentation and the legal steps.

1. Name the signs of the last days: increasing drowsiness, reduced intake, changes in breathing (irregular, Cheyne-Stokes, secretions), mottled cool skin, withdrawal
2. Assess comfort: pain by expression and posture, breathlessness, agitation, secretions, nausea; use the anticipatory medicines as prescribed and say the four symptoms they cover
3. Mouth care every hour or two, lips moistened, sips or sponges if he can swallow safely, position for breathing and secretions, skin and pressure care gently, catheter or pads as needed
4. Explain why clinically assisted hydration is an individual decision: reduced intake is part of dying, fluids can worsen secretions, mouth care treats thirst
5. Answer the wife’s questions honestly: pain is assessed and treated; time is uncertain, often hours to days at this stage; if the son wants to come, sooner is better
6. Offer presence: a chair, open visiting, chaplaincy or her own faith, a quiet room, food and rest for her, what she can do for him (hold his hand, talk, moisten his lips)
7. Say what happens at death and after: breathing stops, no pulse, pupils fixed; a doctor or registered nurse where policy allows verifies death and records the time; the family is given time
8. Care after death: wash and dress him with dignity and his family’s wishes, remove devices unless the coroner is involved, identity bands, respect religious and cultural practice, belongings listed and returned
9. Know the steps: medical certificate of cause of death, when the coroner must be notified (sudden, unexplained, within 24 hours of admission, procedure-related), the family registers the death; a post-mortem needs consent unless coroner-directed
10. Bereavement support: information leaflet, the hospital bereavement service, who to contact, follow-up call; and care for yourself and the team

Throughout: communicate in an accurate, clear and effective manner; demonstrate a level of competence essential for safe practice.