A person who is dying may be fearful of the unknown or anxious about the possibility of being alone at the very end. Some may also be worried about the welfare of loved ones who will be left behind. This is a time when it is crucial for family members, friends, and healthcare providers to step in and provide support. Unfortunately, even close family members and friends often stop visiting the dying person because they don’t know what to say and are uncomfortable dealing with their own feelings about the situation. It is important for loved ones to know that just their presence can be a vital source of strength and comfort for the patient, even if they feel helpless or powerless. Some patients may be in denial concerning their impending death or may not wish to discuss this inevitability. In such cases, loved ones can simply make it known that they are available to listen if the patient cares to share their thoughts.

One source of great comfort to patients is being touched, a practice that is often overlooked or avoided. Sadly, the amount of touching a dying person receives is apt to decrease more and more as loved ones realize that the person is getting closer to death. With a better awareness of the reassurance and solace conveyed by touching, friends and families may be motivated to overcome their own discomfort with this practice for the benefit of the patient.

Until just a few decades ago, most people died at home. However, that has changed with modern medical advances. Today, most Americans are in hospitals or nursing homes at the end of their lives. Some of the most important decisions to make concern the type and extent of medical care that a patient would like to receive.

Types of care include the following:

• Palliative care. This form of care entails treating symptoms, with or without continuing to treat the actual terminal illness. Although the primary emphasis is on keeping the patient comfortable, palliative care has evolved into a much more comprehensive approach. Measures are taken to improve the patient’s quality of life as much as possible, while also providing support for family members. Social and emotional needs are addressed along with medical concerns by involving professionals such as therapists, counselors, and social workers in addition to doctors and nurses. Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics, or the patient’s home.
• Hospice care. This form of care focuses on optimizing the dying person’s quality of life as much as possible after attempts to cure the illness or stop its progression have ceased. Hospice is not a place but rather a specific approach to care of the dying. Hospice care may be provided in the patient’s home or in a facility such as a hospital, nursing home, or separate hospice center. Professionals from diverse disciplines—medicine, social work, and spiritual guidance—may be involved in helping the patient through the process of dying.

Regardless of the setting in which the patient will receive final care, wishes concerning the level of treatment to be given at that time should be documented in advance. Such documents, often called “advance directives,” may include a durable power of attorney for healthcare and what is called a “living will.”

• Durable power of attorney. This document typically names a healthcare “proxy” to make decisions on behalf of the patient in case he or she becomes unable to do so. The proxy chosen should be someone who understands the patient’s wishes and is willing to carry them out.
• Living will. The living will is a document that states the limits a patient would like to place on the treatment received at the end of life. Some people choose not to receive certain kinds of treatment because they do not want to prolong the process of dying. Examples of such treatments include the following:
  • Cardiopulmonary resuscitation (CPR). The patient can specify that CPR should not be performed if the heart stops beating or breathing stops. This is called a “do-not-resuscitate,” or “DNR,” order. Without a specific directive, healthcare professionals will usually try to revive the patient. It should be noted that a DNR order can be requested of the healthcare facility even if the patient does not have an advance directive.
  • Use of a ventilator for breathing. Ventilators are used to breathe for patients whose lungs can no longer perform on their own. The ventilator pumps air into the lungs through a tube inserted into the mouth or nose and down the throat.
  • Artificial feeding. There are various ways to feed people who can no longer eat, such as inserting a tube into the stomach through the patient’s nose or abdominal wall or administering liquid nutrients though a catheter placed into a vein.