Providing Comfort at the End of Life
Comfort care is an essential part of medical care at the end of life. It is care that helps or soothes a person who is dying. The goal is to prevent or relieve suffering as much as possible while respecting the dying person’s wishes.
You are probably reading this because someone close to you is dying. Is it a parent or grandparent, your husband or wife, a favorite aunt or uncle, your best friend? You wonder what will happen. You want to know how to give comfort, what to say, what to do. At the same time, you’re possibly unsure about what is needed, worried about doing the wrong thing, or afraid of being there—or not being there—at the moment of death.
You might be giving day-to-day care to the dying person, chosen to make health care decisions, or a close family member or friend who wants to help. You would like to know how to make dying easier—how to help ensure a “good death,” with treatment consistent with the dying person’s wishes.
Comfort needs near the end of life:
• Physical Comfort
• Mental and Emotional Needs
• Spiritual Issues
• Practical Tasks
A “good death” might mean something different to you than to someone else. Your sister might want to know when death is near so she can have a few last words with the people she loves and take care of personal matters. Your husband might want to die quickly and not linger. Perhaps your mother has said she would like to be at home when she dies, while your father wants to be in a hospital where he can receive treatment for his illness until the very end. Some people want to be surrounded by family and friends; others want to be alone. Of course, often one doesn’t get to choose, but having your end-of-life wishes followed, whatever they are, and being treated with respect while dying are common hopes.
Generally speaking, people who are dying need care in four areas—physical comfort, mental and emotional needs, spiritual issues, and practical tasks. In this chapter you will find a number of ways you can be of help to someone who is dying. Always remember to check with the health care team to make sure these suggestions are appropriate.
There are ways to make a person who is dying more comfortable. Discomfort can come from a variety of problems. For each there are things you or a health care provider can do, depending on the cause. For example, a dying person can be uncomfortable because of:
• Breathing problems
• Skin irritation
• Digestive problems
• Temperature sensitivity
What about morphine?
Morphine is an opiate, a strong drug used to treat serious pain. Sometimes, morphine is also given to ease the feeling of shortness of breath. You might have heard that giving morphine leads to a quicker death. Is that true? Most experts think this is unlikely, especially if increasing the dose is done carefully. Successfully reducing pain and/or concerns about breathing can provide needed comfort to someone who is close to dying.
Pain. Watching someone you love die is hard enough, but thinking that person is also in pain makes it worse. Not everyone who is dying experiences pain, but there are things you can do to help someone who does. Experts believe that care for someone who is dying should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse. Don’t be afraid of giving as much pain medicine as is prescribed by the doctor. Pain is easier to prevent than to relieve, and overwhelming pain is hard to manage. Try to make sure that the level of pain does not “get ahead” of pain-relieving medicines. If the pain is not controlled, ask the doctor or nurse to arrange for consultation with a pain management specialist.
Struggling with severe pain can be draining. It can make it hard for families to be together in a meaningful way. Pain can affect mood—being in pain can make someone seem angry or short-tempered. Although understandable, irritability resulting from pain might make it hard to talk, hard to share thoughts and feelings.
Breathing problems. Shortness of breath or the feeling that breathing is difficult is a common experience at the end of life. The doctor might call this dyspnea (disp-NEE-uh). Worrying about the next breath can make it hard for important conversations or connections. Try raising the head of the bed, opening a window, using a vaporizer, or having a fan circulating air in the room. Sometimes, the doctor suggests extra oxygen, given directly through the nose, to help with this problem.