Supporting Your Family Member — Through Their Last Months

In the days before death, most people sleep more, eat and drink very little, and become less responsive. Breathing may become slower and irregular, and there may be a rattling sound caused by relaxed throat muscles — this is not a sign of distress. Hands and feet may feel cool. These changes are expected. Your palliative nurse can explain what each change means and what to do, and being present and speaking calmly matters more than doing anything specific.

Call the palliative care team's 24-hour number. This is exactly what it is there for. Most teams can advise over the phone and, if needed, visit at night. Do not wait until morning for pain that is distressing your loved one. If you cannot reach the palliative team, go to the nearest emergency department — tell them clearly that you are caring for someone at end of life and describe the symptom.

In advanced illness, loss of appetite is the body's natural response to what is happening, not a cause of it. Forcing food or fluids can cause nausea, bloating and discomfort. Small sips of water or ice chips, mouth swabs to keep lips moist, and sitting with them are more helpful and more comfortable than insisting on meals. Ask the palliative team to explain what is happening and what to offer. Not eating is not the same as being neglected.

Yes. Pain medicines — including opioids — are given at the dose that controls the symptom. Drowsiness is an expected effect at higher doses, and comfort is the priority. The medicine does not shorten life; uncontrolled pain and distress are far more harmful. ASCO and palliative care guidelines consistently state that adequate symptom control is an ethical and clinical requirement in end-of-life care. Keeping someone in pain to avoid drowsiness is not kindness.

Children understand more than most adults expect, and silence tends to create more fear than honest explanation. Use clear language — dying, death — rather than phrases like 'going to sleep' or 'going away', which can cause lasting confusion and anxiety. Tell them what is happening in terms they can understand, what will change, what will stay the same, and that they can ask questions at any time. A child counsellor, if available through your palliative team, can help with this.

Relief after a long and difficult illness is one of the most common feelings families describe, and almost all of them feel ashamed of it. It is not a sign that you did not love them enough. It is a natural human response to the end of suffering — theirs and yours. Grief, relief, love and exhaustion can all exist at the same time, and none of them cancels the others. A grief counsellor or palliative care social worker can help if these feelings become hard to carry.