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id="toc-Medications_for_terminal_patients-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Continued_treatment" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Continued_treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.5</span> <span>Continued treatment</span> </div> </a> <ul id="toc-Continued_treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transplant" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transplant"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.6</span> <span>Transplant</span> </div> </a> <ul id="toc-Transplant-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Physician-assisted_suicide" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Physician-assisted_suicide"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.7</span> <span>Physician-assisted suicide</span> </div> </a> <ul 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class="vector-toc-list"> </ul> </li> <li id="toc-Mortality_predictions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mortality_predictions"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Mortality predictions</span> </div> </a> <ul id="toc-Mortality_predictions-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Healthcare_spending" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Healthcare_spending"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Healthcare spending</span> </div> </a> <ul id="toc-Healthcare_spending-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Psychological_impact" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Psychological_impact"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Psychological impact</span> </div> </a> <button aria-controls="toc-Psychological_impact-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Psychological impact subsection</span> </button> <ul id="toc-Psychological_impact-sublist" class="vector-toc-list"> <li id="toc-Impact_on_patient" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Impact_on_patient"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Impact on patient</span> </div> </a> <ul id="toc-Impact_on_patient-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Coping_for_patients" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Coping_for_patients"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Coping for patients</span> </div> </a> <ul id="toc-Coping_for_patients-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Impact_on_family" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Impact_on_family"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Impact on family</span> </div> </a> <ul id="toc-Impact_on_family-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Coping_for_family" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Coping_for_family"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Coping for family</span> </div> </a> <ul id="toc-Coping_for_family-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Dying" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Dying"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Dying</span> </div> </a> <button aria-controls="toc-Dying-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Dying subsection</span> </button> <ul id="toc-Dying-sublist" class="vector-toc-list"> <li id="toc-Advance_directives" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Advance_directives"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Advance directives</span> </div> </a> <ul id="toc-Advance_directives-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Do-not-resuscitate" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Do-not-resuscitate"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Do-not-resuscitate</span> </div> </a> <ul id="toc-Do-not-resuscitate-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Symptoms_near_death" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Symptoms_near_death"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>Symptoms near death</span> </div> </a> <ul id="toc-Symptoms_near_death-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Good_death" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Good_death"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.4</span> <span>Good death</span> </div> </a> <ul id="toc-Good_death-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" 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Available in 23 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-23" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">23 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%85%D8%B1%D8%B6_%D8%B9%D8%B6%D8%A7%D9%84" title="مرض عضال – Arabic" lang="ar" hreflang="ar" data-title="مرض عضال" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%85%E0%A6%A8%E0%A7%8D%E0%A6%A4%E0%A6%BF%E0%A6%AE_%E0%A6%A6%E0%A6%B6%E0%A6%BE%E0%A6%B0_%E0%A6%85%E0%A6%B8%E0%A7%81%E0%A6%B8%E0%A7%8D%E0%A6%A5%E0%A6%A4%E0%A6%BE" title="অন্তিম দশার অসুস্থতা – Bangla" lang="bn" hreflang="bn" data-title="অন্তিম দশার অসুস্থতা" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-zh-min-nan mw-list-item"><a href="https://zh-min-nan.wikipedia.org/wiki/Boa%CC%8Dt-k%C3%AE_ch%C3%A8ng-ch%C5%8Dng" title="Boa̍t-kî chèng-chōng – Minnan" lang="nan" hreflang="nan" data-title="Boa̍t-kî chèng-chōng" data-language-autonym="閩南語 / Bân-lâm-gú" data-language-local-name="Minnan" class="interlanguage-link-target"><span>閩南語 / Bân-lâm-gú</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Malaltia_terminal" title="Malaltia terminal – Catalan" lang="ca" hreflang="ca" data-title="Malaltia terminal" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Pr%C3%A4finalit%C3%A4t" title="Präfinalität – German" lang="de" hreflang="de" data-title="Präfinalität" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Paciente_terminal" title="Paciente terminal – Spanish" lang="es" hreflang="es" data-title="Paciente terminal" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Gaixotasun_terminal" title="Gaixotasun terminal – Basque" lang="eu" hreflang="eu" data-title="Gaixotasun terminal" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A8%DB%8C%D9%85%D8%A7%D8%B1%DB%8C_%D9%84%D8%A7%D8%B9%D9%84%D8%A7%D8%AC" title="بیماری لاعلاج – Persian" lang="fa" hreflang="fa" data-title="بیماری لاعلاج" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%A7%90%EA%B8%B0_%EC%A6%9D%EC%83%81" title="말기 증상 – Korean" lang="ko" hreflang="ko" data-title="말기 증상" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Terminalne_bolesti" title="Terminalne bolesti – Croatian" lang="hr" hreflang="hr" data-title="Terminalne bolesti" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Penyakit_terminal" title="Penyakit terminal – Indonesian" lang="id" hreflang="id" data-title="Penyakit terminal" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Malattia_terminale" title="Malattia terminale – Italian" lang="it" hreflang="it" data-title="Malattia terminale" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9E%D7%97%D7%9C%D7%94_%D7%A1%D7%95%D7%A4%D7%A0%D7%99%D7%AA" title="מחלה סופנית – Hebrew" lang="he" hreflang="he" data-title="מחלה סופנית" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Terminaal" title="Terminaal – Dutch" lang="nl" hreflang="nl" data-title="Terminaal" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%9C%AB%E6%9C%9F%E7%97%87%E7%8A%B6" title="末期症状 – Japanese" lang="ja" hreflang="ja" data-title="末期症状" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Terminal_pasient" title="Terminal pasient – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Terminal pasient" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Choroba_terminalna" title="Choroba terminalna – Polish" lang="pl" hreflang="pl" data-title="Choroba terminalna" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Doen%C3%A7a_terminal" title="Doença terminal – Portuguese" lang="pt" hreflang="pt" data-title="Doença terminal" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Terminal_illness" title="Terminal illness – Simple English" lang="en-simple" hreflang="en-simple" data-title="Terminal illness" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sd mw-list-item"><a href="https://sd.wikipedia.org/wiki/%D9%84%D8%A7%D8%B9%D9%84%D8%A7%D8%AC_%D8%A8%D9%8A%D9%85%D8%A7%D8%B1%D9%8A" title="لاعلاج بيماري – Sindhi" lang="sd" hreflang="sd" data-title="لاعلاج بيماري" data-language-autonym="سنڌي" data-language-local-name="Sindhi" class="interlanguage-link-target"><span>سنڌي</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Terminalna_bolest" title="Terminalna bolest – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Terminalna bolest" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Terminaalivaihe" title="Terminaalivaihe – Finnish" lang="fi" hreflang="fi" data-title="Terminaalivaihe" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E7%B5%95%E7%97%87" title="絕症 – Chinese" lang="zh" hreflang="zh" data-title="絕症" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q1364787#sitelinks-wikipedia" 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.hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">This article is about fatal diseases. For the alternative definition of eyestrain, see <a href="/wiki/Computer_vision_syndrome" title="Computer vision syndrome">computer vision syndrome</a>. For other uses, see <a href="/wiki/Terminal_(disambiguation)" class="mw-redirect mw-disambig" title="Terminal (disambiguation)">Terminal</a>.</div> <p class="mw-empty-elt"> </p><p><b>Terminal illness</b> or <b>end-stage disease</b> is a <a href="/wiki/Disease" title="Disease">disease</a> that cannot be <a href="/wiki/Cure" title="Cure">cured</a> or adequately treated and is expected to result in the <a href="/wiki/Death" title="Death">death</a> of the patient. This term is more commonly used for progressive diseases such as <a href="/wiki/Cancer" title="Cancer">cancer</a>, rather than fatal injury. In popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. A patient who has such an illness may be referred to as a <b>terminal patient</b>, <b>terminally ill</b> or simply as being <b>terminal</b>. There is no standardized <a href="/wiki/Life_expectancy" title="Life expectancy">life expectancy</a> for a patient to be considered terminal, although it is generally months or less. An illness which is lifelong but not fatal is called a <i><a href="/wiki/Chronic_condition" title="Chronic condition">chronic condition</a></i>. </p><p>Terminal patients have options for disease management after diagnosis. Examples include <a href="/wiki/Caregiver" title="Caregiver">caregiving</a>, continued treatment, <a href="/wiki/Palliative_care" title="Palliative care">palliative</a> and <a href="/wiki/Hospice" title="Hospice">hospice</a> care, and <a href="/wiki/Assisted_suicide" title="Assisted suicide">physician-assisted suicide</a>. Decisions regarding management are made by the patient and their family, although medical professionals may offer recommendations of services available to terminal patients.<sup id="cite_ref-Lima-2016a_1-0" class="reference"><a href="#cite_note-Lima-2016a-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hendry-2013_2-0" class="reference"><a href="#cite_note-Hendry-2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Lifestyle after diagnosis varies depending on management decisions and the nature of the disease, and there may be restrictions depending on the condition of the patient. Terminal patients may experience depression or <a href="/wiki/Death_anxiety" title="Death anxiety">anxiety associated with impending death</a>, and family and caregivers may struggle with psychological burdens. Psychotherapeutic interventions may alleviate some of these burdens, and is often incorporated into <a href="/wiki/Palliative_care" title="Palliative care">palliative care</a>.<sup id="cite_ref-Lima-2016a_1-1" class="reference"><a href="#cite_note-Lima-2016a-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Block-2006_3-0" class="reference"><a href="#cite_note-Block-2006-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>When terminal patients are aware of their impending deaths, they have time to prepare for care, such as <a href="/wiki/Advance_healthcare_directive" title="Advance healthcare directive">advance directives</a> and living wills, which have been shown to improve end-of-life care. While death cannot be avoided, patients can strive to die a death seen as good.<sup id="cite_ref-AHRQ-2017_4-0" class="reference"><a href="#cite_note-AHRQ-2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Qaseem-2008_5-0" class="reference"><a href="#cite_note-Qaseem-2008-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Steinhauser-2000_6-0" class="reference"><a href="#cite_note-Steinhauser-2000-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> However, many healthcare providers are uncomfortable telling people or their families that they are dying. To avoid uncomfortable conversations, they will withhold information and evade questions.<sup id="cite_ref-:0_7-0" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Definition">Definition</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=1" title="Edit section: Definition"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Accurately identifying the start of terminal status is important because it usually occasions a review of treatment goals.<sup id="cite_ref-:1_8-0" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Although there is no single official definition, there are four typical characteristics for determining whether a person has a terminal illness: </p> <ul><li>The person is expected to die from this illness (i.e., not from old age).<sup id="cite_ref-:0_7-1" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></li> <li>The illness cannot be cured (or it is medically unlikely)<sup id="cite_ref-:0_7-2" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> and is <a href="/wiki/Progressive_disease" title="Progressive disease">expected to get worse</a>.<sup id="cite_ref-:1_8-1" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></li> <li>The illness has reached an advanced stage.<sup id="cite_ref-:0_7-3" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></li> <li>The statistically likely remaining lifespan is measured in weeks or months, rather than years or decades.<sup id="cite_ref-:0_7-4" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> For example, four different <a href="/wiki/U.S._federal_laws" class="mw-redirect" title="U.S. federal laws">US federal laws</a> define the maximum expected lifespan in four different ways: no more than six months, nine months, 12 months, or 24 months.<sup id="cite_ref-:1_8-2" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></li></ul> <p>When the remaining lifespan is expected to be days and the physical process of dying has begun, the term <i>active dying</i> may be used instead.<sup id="cite_ref-:1_8-3" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Communicating_terminal_status">Communicating terminal status</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=2" title="Edit section: Communicating terminal status"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Most terminally ill people are not distressed by being told that they are likely to die sooner rather than later,<sup id="cite_ref-:0_7-5" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> and they usually value knowing whether their realistic lifespan is likely to be "weeks", "months", or "years", even if more specific estimates are unavailable.<sup id="cite_ref-:1_8-4" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> However, many healthcare providers avoid telling them this because the healthcare providers are uncomfortable with death or perceive it as a professional failure.<sup id="cite_ref-:0_7-6" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> To avoid admitting that the person will inevitably die from an incurable condition, they may withhold information or, if pressed, give overly optimistic answers.<sup id="cite_ref-:0_7-7" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> For example, if the typical person in that situation usually lives for two to six months, they may say only the larger number. They may rationalize the inflated claim by thinking of hopeful possibilities, such as an unproven treatment (which might shorten the person's life even further<sup id="cite_ref-:0_7-8" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup>) being attempted, or because they know that life expectancy is an imperfect estimate and could be both shorter or longer than expected.<sup id="cite_ref-:1_8-5" class="reference"><a href="#cite_note-:1-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>They may feel pressure from family members to give pleasant news or to preserve the false appearance of <a href="/wiki/Hope" title="Hope">hope</a>.<sup id="cite_ref-:0_7-9" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> They often want to avoid the emotional outbursts that are associated with people understanding the medical situation accurately.<sup id="cite_ref-:0_7-10" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> For example, they will use death-denying language such as "She has a life-limiting diagnosis" – a term that makes the inevitable death seem less inevitable<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> – rather than bluntly saying "No matter what we do, your daughter is almost certainly going to die from this cancer, probably within the next few months."<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=3" title="Edit section: Management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/End-of-life_care" title="End-of-life care">End-of-life care</a></div> <p>By definition, there is not a cure or adequate treatment for terminal illnesses. However, some kinds of medical treatments may be appropriate anyway, such as treatment to reduce pain or ease breathing.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Some terminally ill patients stop all debilitating treatments to reduce unwanted side effects. Others continue aggressive treatment in the hope of an unexpected success. Still others reject conventional medical treatment and pursue <a href="/wiki/Unproven_cancer_therapy" class="mw-redirect" title="Unproven cancer therapy">unproven treatments</a> such as radical dietary modifications. Patients' choices about different treatments may change over time.<sup id="cite_ref-pmid17608872_12-0" class="reference"><a href="#cite_note-pmid17608872-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> People who pursue aggressive treatment usually do not understand that their illness has reached a terminal stage, and they are pursuing treatment because they do not understand it to be <a href="/wiki/Futile_medical_care" title="Futile medical care">futile</a>.<sup id="cite_ref-:0_7-11" class="reference"><a href="#cite_note-:0-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a> is normally offered to terminally ill patients, regardless of their overall disease management style, if it seems likely to help manage symptoms such as pain and improve quality of life. <a href="/wiki/Hospice" title="Hospice">Hospice care</a>, which can be provided at home or in a long-term care facility, additionally provides emotional and spiritual support for the patient and loved ones. Some complementary approaches, such as <a href="/wiki/Relaxation_therapy" class="mw-redirect" title="Relaxation therapy">relaxation therapy</a>, <a href="/wiki/Massage" title="Massage">massage</a>, and <a href="/wiki/Acupuncture" title="Acupuncture">acupuncture</a> may relieve some symptoms and other causes of suffering.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Caregiving">Caregiving</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=4" title="Edit section: Caregiving"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Terminal patients often need a <a href="/wiki/Caregiver" title="Caregiver">caregiver</a>, who could be a <a href="/wiki/Nurse" class="mw-redirect" title="Nurse">nurse</a>, licensed practical nurse or a family member. Caregivers can help patients receive medications to reduce pain and control symptoms of <a href="/wiki/Nausea" title="Nausea">nausea</a> or <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>. They can also assist the individual with daily living activities and movement. Caregivers provide assistance with food and <a href="/wiki/Psychology" title="Psychology">psychological</a> support and ensure that the individual is comfortable.<sup id="cite_ref-Mitnick-2010a_17-0" class="reference"><a href="#cite_note-Mitnick-2010a-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p><p>The patient's family may have questions and most caregivers can provide information to help ease the mind. Doctors generally do not provide estimates for fear of instilling false hopes or obliterate an individual's hope.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>In most cases, the caregiver works along with physicians and follows professional instructions. Caregivers may call the physician or a nurse if the individual: </p> <ul><li>experiences excessive pain.</li> <li>is in distress or having difficulty <a href="/wiki/Breathing" title="Breathing">breathing</a>.</li> <li>has difficulty passing urine or is <a href="/wiki/Constipation" title="Constipation">constipated</a>.</li> <li>has fallen and appears hurt.</li> <li>is depressed and wants to harm themselves.</li> <li>refuses to take prescribed medications, raising <a href="/wiki/Medical_ethics" title="Medical ethics">ethical</a> concerns best addressed by a person with more extensive formal training.</li> <li>or if the caregiver does not know how to handle the situation.</li></ul> <p>Most caregivers become the patient's listeners and let the individual express fears and concerns without judgment. Caregivers reassure the patient and honor all advance directives. Caregivers respect the individual's need for privacy and usually hold all information confidential.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Mitnick-2010b_20-0" class="reference"><a href="#cite_note-Mitnick-2010b-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Palliative_care">Palliative care</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=5" title="Edit section: Palliative care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Palliative care focuses on addressing patients' needs after disease diagnosis. While palliative care is not disease treatment, it addresses patients' physical needs, such as pain management, offers emotional support, caring for the patient psychologically and spiritually, and helps patients build support systems that can help them get through difficult times. Palliative care can also help patients make decisions and come to understand what they want regarding their treatment goals and quality of life.<sup id="cite_ref-Buss-2017_21-0" class="reference"><a href="#cite_note-Buss-2017-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>Palliative care is an attempt to improve patients' <a href="/wiki/Quality_of_life_(healthcare)" title="Quality of life (healthcare)">quality-of-life</a> and comfort, and also provide support for family members and carers.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Additionally, it lowers hospital admissions costs. However, needs for palliative care are often unmet whether due to lack of government support and also possible <a href="/wiki/Palliative_care#Acceptance" title="Palliative care">stigma</a> associated with palliative care. For these reasons, the World Health Assembly recommends development of palliative care in health care systems.<sup id="cite_ref-Lima-2016a_1-2" class="reference"><a href="#cite_note-Lima-2016a-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a> and <a href="/wiki/Hospice" title="Hospice">hospice</a> care are often confused, and they have similar goals. However, hospice care is specifically for terminal patients while palliative care is more general and offered to patients who are not necessarily terminal.<sup id="cite_ref-Smith-2014_23-0" class="reference"><a href="#cite_note-Smith-2014-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Buss-2017_21-1" class="reference"><a href="#cite_note-Buss-2017-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Hospice_care">Hospice care</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=6" title="Edit section: Hospice care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>While hospitals focus on treating the disease, <a href="/wiki/Hospice" title="Hospice">hospices</a> focus on improving patient <a href="/wiki/Quality_of_life_(healthcare)" title="Quality of life (healthcare)">quality-of-life</a> until death. Hospice patients are able to live at peace away from a hospital setting; they may live at home with a hospice provider or at an inpatient hospice facility.<sup id="cite_ref-Buss-2017_21-2" class="reference"><a href="#cite_note-Buss-2017-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>A common misconception is that hospice care hastens death because patients "give up" fighting the disease. However, people in hospice care often live the same length of time as patients in the hospital, or longer. Additionally, people receiving hospice care have significantly lower healthcare expenditures.<sup id="cite_ref-Chiang-2015a_24-0" class="reference"><a href="#cite_note-Chiang-2015a-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Chiang-2015b_25-0" class="reference"><a href="#cite_note-Chiang-2015b-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>Hospice care allows patients to spend more time with family and friends. People in institutional (rather than home-care) hospice programs are also in the company of other hospice patients, which provides them with an additional support network.<sup id="cite_ref-Buss-2017_21-3" class="reference"><a href="#cite_note-Buss-2017-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medications_for_terminal_patients">Medications for terminal patients</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=7" title="Edit section: Medications for terminal patients"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Terminal patients experiencing pain, especially cancer-related pain, are often prescribed opioids to relieve suffering. The specific medication prescribed, however, will differ depending on severity of pain and disease status.<sup id="cite_ref-Caraceni-2012_26-0" class="reference"><a href="#cite_note-Caraceni-2012-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p><p>There exist inequities in availability of opioids to terminal patients, especially in countries where opioid access is limited.<sup id="cite_ref-Lima-2016a_1-3" class="reference"><a href="#cite_note-Lima-2016a-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>A common symptom that many terminal patients experience is <a href="/wiki/Shortness_of_breath" title="Shortness of breath">dyspnea</a>, or difficulty with breathing. To ease this symptom, doctors may also prescribe opioids to patients. Some studies suggest that oral opioids may help with breathlessness. However, due to lack of consistent reliable evidence, it is currently unclear whether they truly work for this purpose.<sup id="cite_ref-Barnes-2016_27-0" class="reference"><a href="#cite_note-Barnes-2016-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>Depending on the patient's condition, other medications will be prescribed accordingly. For example, if patients develop depression, antidepressants will be prescribed. Anti-inflammation and anti-nausea medications may also be prescribed.<sup id="cite_ref-Caresearch-2017_28-0" class="reference"><a href="#cite_note-Caresearch-2017-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Continued_treatment">Continued treatment</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=8" title="Edit section: Continued treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some terminal patients opt to continue extensive treatments in hope of a miracle cure, whether by participating in experimental treatments and <a href="/wiki/Clinical_trial" title="Clinical trial">clinical trials</a> or seeking more intense treatment for the disease. Rather than to "give up fighting," patients spend thousands more dollars to try to prolong life by a few more months. What these patients often do give up, however, is quality of life at the end of life by undergoing intense and often uncomfortable treatment. A meta-analysis of 34 studies including 11,326 patients from 11 countries found that less than half of all terminal patients correctly understood their disease <a href="/wiki/Prognosis" title="Prognosis">prognosis</a>, or the course of their disease and likeliness of survival. This could influence patients to pursue unnecessary treatment for the disease due to unrealistic expectations.<sup id="cite_ref-Buss-2017_21-4" class="reference"><a href="#cite_note-Buss-2017-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Chen-2017_29-0" class="reference"><a href="#cite_note-Chen-2017-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Transplant">Transplant</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=9" title="Edit section: Transplant"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>For patients with end stage <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a>, studies have shown that transplants increase the quality of life and decreases mortality in this population. In order to be placed on the organ transplant list, patients are referred and assessed based on criteria that ranges from current comorbidities to potential for organ rejection post transplant. Initial screening measures include: blood tests, pregnancy tests, serologic tests, urinalysis, drug screening, imaging, and physical exams.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p><p>For patients who are interested in liver transplantation, patients with acute liver failure have the highest priority over patients with only cirrhosis.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Acute liver failure patients will present with worsening symptoms of somnolence or confusion (hepatic encephalopathy) and thinner blood (increased INR) due to the liver's inability to make clotting factors.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Some patients could experience portal hypertension, hemorrhages, and abdominal swelling (ascites). Model for End Stage Liver Disease (MELD) is often used to help providers decide and prioritize candidates for transplant.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Physician-assisted_suicide">Physician-assisted suicide</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=10" title="Edit section: Physician-assisted suicide"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Assisted_suicide" title="Assisted suicide">Physician-assisted suicide</a> (PAS) is highly controversial, and legal in only a few countries. In PAS, physicians, with voluntary written and verbal consent from the patient, give patients the means to die, usually through lethal drugs. The patient then chooses to "<a href="/wiki/Die_with_dignity" class="mw-redirect" title="Die with dignity">die with dignity</a>," deciding on their own time and place to die. Reasons as to why patients choose PAS differ. Factors that may play into a patient's decision include future disability and suffering, lack of control over death, impact on family, healthcare costs, insurance coverage, personal beliefs, religious beliefs, and much more.<sup id="cite_ref-Hendry-2013_2-1" class="reference"><a href="#cite_note-Hendry-2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>PAS may be referred to in many different ways, such as aid in dying, assisted dying, death with dignity, and many more. These often depend on the organization and the stance they take on the issue. In this section of the article, it will be referred to as PAS for the sake of consistency with the pre-existing Wikipedia page: <a href="/wiki/Assisted_suicide" title="Assisted suicide">Assisted Suicide</a>. </p><p>In the United States, PAS or <a href="/wiki/Medical_aid_in_dying_in_the_United_States" class="mw-redirect" title="Medical aid in dying in the United States">medical aid in dying</a> is legal in select states, including Oregon, Washington, Montana, Vermont, and New Mexico, and there are groups both in favor of and against legalization.<sup id="cite_ref-Compassion_and_Choices_36-0" class="reference"><a href="#cite_note-Compassion_and_Choices-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>Some groups favor PAS because they do not believe they will have control over their pain, because they believe they will be a burden on their family, and because they do not want to lose autonomy and control over their own lives among other reasons. They believe that allowing PAS is an act of compassion.<sup id="cite_ref-Sulmasy-2017_37-0" class="reference"><a href="#cite_note-Sulmasy-2017-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p><p>While some groups believe in personal choice over death, others raise concerns regarding insurance policies and potential for abuse. According to Sulmasy et al., the major non-religious arguments against physician-assisted suicide are quoted as follows: </p> <ul><li>(1) "it offends me", suicide devalues human life;</li> <li>(2) slippery slope, the limits on euthanasia gradually erode;</li> <li>(3) "pain can be alleviated", palliative care and modern therapeutics more and more adequately manage pain;</li> <li>(4) physician integrity and patient trust, participating in suicide violates the integrity of the physician and undermines the trust patients place in physicians to heal and not to harm"<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup></li></ul> <p>Again, there are also arguments that there are enough protections in the law that the slippery slope is avoided. For example, the <a href="/wiki/Oregon_Ballot_Measure_16_(1994)" class="mw-redirect" title="Oregon Ballot Measure 16 (1994)">Death with Dignity Act in Oregon</a> includes waiting periods, multiple requests for lethal drugs, a psychiatric evaluation in the case of possible depression influencing decisions, and the patient personally swallowing the pills to ensure voluntary decision.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p><p>Physicians and medical professionals also have disagreeing views on PAS. Some groups, such as the <a href="/wiki/American_College_of_Physicians" title="American College of Physicians">American College of Physicians</a> (ACP), the <a href="/wiki/American_Medical_Association" title="American Medical Association">American Medical Association</a> (AMA), the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a>, <a href="/wiki/American_Nurses_Association" title="American Nurses Association">American Nurses Association</a>, Hospice Nurses Association, <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a>, and more have issued position statements against its legalization.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Sulmasy-2017_37-1" class="reference"><a href="#cite_note-Sulmasy-2017-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p><p>The ACP's argument concerns the nature of the doctor-patient relationship and the tenets of the medical profession. They state that instead of using PAS to control death: "through high-quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live out life's last chapter."<sup id="cite_ref-Sulmasy-2017_37-2" class="reference"><a href="#cite_note-Sulmasy-2017-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p><p>Other groups such as the <a href="/wiki/American_Medical_Student_Association" title="American Medical Student Association">American Medical Students Association</a>, the <a href="/wiki/American_Public_Health_Association" title="American Public Health Association">American Public Health Association</a>, the <a href="/wiki/American_Medical_Women%27s_Association" title="American Medical Women's Association">American Medical Women's Association</a>, and more support PAS as an act of compassion for the suffering patient.<sup id="cite_ref-Compassion_and_Choices_36-1" class="reference"><a href="#cite_note-Compassion_and_Choices-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>In many cases, the argument on PAS is also tied to proper palliative care. The International Association for Hospice and Palliative Care issued a position statement arguing against considering legalizing PAS unless comprehensive palliative care systems in the country were in place. It could be argued that with proper palliative care, the patient would experience fewer intolerable symptoms, physical or emotional, and would not choose death over these symptoms. Palliative care would also ensure that patients receive proper information about their disease prognosis as not to make decisions about PAS without complete and careful consideration.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Medical_care">Medical care</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=11" title="Edit section: Medical care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Many aspects of medical care are different for terminal patients compared to patients in the hospital for other reasons. </p> <div class="mw-heading mw-heading3"><h3 id="Doctor–patient_relationships"><span id="Doctor.E2.80.93patient_relationships"></span>Doctor–patient relationships</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=12" title="Edit section: Doctor–patient relationships"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Doctor%E2%80%93patient_relationships" class="mw-redirect" title="Doctor–patient relationships">Doctor–patient relationships</a> are crucial in any medical setting, and especially so for terminal patients. There must be an inherent trust in the doctor to provide the best possible care for the patient. In the case of terminal illness, there is often ambiguity in communication with the patient about their condition. While terminal condition prognosis is often a grave matter, doctors do not wish to quash all hope, for it could unnecessarily harm the patient's mental state and have <a href="/wiki/Unintended_consequences" title="Unintended consequences">unintended consequences</a>. However, being overly optimistic about outcomes can leave patients and families devastated when negative results arise, as is often the case with terminal illness.<sup id="cite_ref-Chen-2017_29-1" class="reference"><a href="#cite_note-Chen-2017-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Mortality_predictions">Mortality predictions</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=13" title="Edit section: Mortality predictions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Often, a patient is considered terminally ill when his or her estimated life expectancy is six months or less, under the assumption that the disease will run its normal course based on previous data from other patients. The six-month standard is arbitrary, and best available estimates of longevity may be incorrect. Though a given patient may properly be considered terminal, this is not a guarantee that the patient will die within six months. Similarly, a patient with a slowly progressing disease, such as <a href="/wiki/AIDS" class="mw-redirect" title="AIDS">AIDS</a>, may not be considered terminally ill if the best estimate of longevity is greater than six months. However, this does not guarantee that the patient will not die unexpectedly early.<sup id="cite_ref-titleTerminal_Illness2_43-0" class="reference"><a href="#cite_note-titleTerminal_Illness2-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p><p>In general, physicians slightly overestimate the survival time of terminally ill cancer patients, so that, for example, a person who is expected to live for about six weeks would likely die around four weeks.<sup id="cite_ref-pmid12881260_44-0" class="reference"><a href="#cite_note-pmid12881260-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>A recent systematic review on palliative patients in general, rather than specifically cancer patients, states the following: "Accuracy of categorical estimates in this systematic review ranged from 23% up to 78% and continuous estimates over-predicted actual survival by, potentially, a factor of two." There was no evidence that any specific type of clinician was better at making these predictions.<sup id="cite_ref-White-2016_45-0" class="reference"><a href="#cite_note-White-2016-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Healthcare_spending">Healthcare spending</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=14" title="Edit section: Healthcare spending"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Healthcare during the last year of life is costly, especially for patients who used hospital services often during end-of-life.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p><p>In fact, according to Langton et al., there were "exponential increases in service use and costs as death approached."<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> </p><p>Many dying terminal patients are also brought to the <a href="/wiki/Emergency_department" title="Emergency department">emergency department</a> (ED) at the end of life when treatment is no longer beneficial, raising costs and using limited space in the ED.<sup id="cite_ref-Forero-2012_48-0" class="reference"><a href="#cite_note-Forero-2012-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p><p>While there are often claims about "disproportionate" spending of money and resources on end-of-life patients, data have not proven this type of correlation.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p><p>The cost of healthcare for end-of-life patients is 13% of annual healthcare spending in the U.S. However, of the group of patients with the highest healthcare spending, end-of-life patients only made up 11% of these people, meaning the most expensive spending is not made up mostly of terminal patients.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p><p>Many recent studies have shown that <a href="/wiki/Palliative_care" title="Palliative care">palliative care</a> and <a href="/wiki/Hospice" title="Hospice">hospice</a> options as an alternative are much less expensive for end-of-life patients.<sup id="cite_ref-Chiang-2015a_24-1" class="reference"><a href="#cite_note-Chiang-2015a-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Chiang-2015b_25-1" class="reference"><a href="#cite_note-Chiang-2015b-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Smith-2014_23-1" class="reference"><a href="#cite_note-Smith-2014-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Psychological_impact">Psychological impact</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=15" title="Edit section: Psychological impact"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Coping with impending death is a hard topic to digest universally. Patients may experience <a href="/wiki/Grief" title="Grief">grief</a>, <a href="/wiki/Fear" title="Fear">fear</a>, <a href="/wiki/Loneliness" title="Loneliness">loneliness</a>, <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, and <a href="/wiki/Anxiety" title="Anxiety">anxiety</a> among many other possible responses. Terminal illness can also lend patients to become more prone to psychological illness such as <a href="/wiki/Depression_(differential_diagnoses)" class="mw-redirect" title="Depression (differential diagnoses)">depression</a> and <a href="/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorders</a>. <a href="/wiki/Insomnia" title="Insomnia">Insomnia</a> is a common symptom of these.<sup id="cite_ref-Block-2006_3-1" class="reference"><a href="#cite_note-Block-2006-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>It is important for loved ones to show their support for the patient during these times and to listen to his or her concerns.<sup id="cite_ref-Mayo-2017_51-0" class="reference"><a href="#cite_note-Mayo-2017-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>People who are terminally ill may not always come to accept their impending death. For example, a person who finds strength in <a href="/wiki/Denial" title="Denial">denial</a> may never reach a point of acceptance or accommodation and may react negatively to any statement that threatens this <a href="/wiki/Defense_mechanism" class="mw-redirect" title="Defense mechanism">defense mechanism</a>.<sup id="cite_ref-Mayo-2017_51-1" class="reference"><a href="#cite_note-Mayo-2017-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Impact_on_patient">Impact on patient</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=16" title="Edit section: Impact on patient"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Depression_(differential_diagnoses)" class="mw-redirect" title="Depression (differential diagnoses)">Depression</a> is relatively common among terminal patients, and the prevalence increases as patients become sicker. Depression causes quality of life to go down, and a sizable portion of patients who request <a href="/wiki/Assisted_suicide" title="Assisted suicide">assisted suicide</a> are depressed. These negative emotions may be heightened by lack of sleep and pain as well. Depression can be treated with <a href="/wiki/Antidepressant" title="Antidepressant">antidepressants</a> and/or therapy, but doctors often do not realize the extent of terminal patients' depression.<sup id="cite_ref-Block-2006_3-2" class="reference"><a href="#cite_note-Block-2006-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>Because depression is common among terminal patients, the American College of Physicians recommends regular assessments for depression for this population and appropriate prescription of antidepressants.<sup id="cite_ref-Qaseem-2008_5-1" class="reference"><a href="#cite_note-Qaseem-2008-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Anxiety_disorder" title="Anxiety disorder">Anxiety disorders</a> are also relatively common for terminal patients as they face their mortality. Patients may feel distressed when thinking about what the future may hold, especially when considering the future of their families as well. It is important to note, however, that some palliative medications may facilitate anxiety.<sup id="cite_ref-Block-2006_3-3" class="reference"><a href="#cite_note-Block-2006-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Coping_for_patients">Coping for patients</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=17" title="Edit section: Coping for patients"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Caregivers may listen to the concerns of terminal patients to help them reflect on their emotions. Different forms of <a href="/wiki/Psychotherapy" title="Psychotherapy">psychotherapy</a> and psychosocial intervention, which can be offered with palliative care, may also help patients think about and overcome their feelings. According to Block, "most terminally ill patients benefit from an approach that combines emotional support, flexibility, appreciation of the patient's strengths, a warm and genuine relationship with the therapist, elements of life-review, and exploration of fears and concerns."<sup id="cite_ref-Block-2006_3-4" class="reference"><a href="#cite_note-Block-2006-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Impact_on_family">Impact on family</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=18" title="Edit section: Impact on family"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Terminal patients' families often also suffer psychological consequences. If not well equipped to face the reality of their loved one's illness, family members may develop depressive symptoms and even have increased mortality. Taking care of sick family members may also cause stress, grief, and worry. Additionally, financial burden from medical treatment may be a source of stress.<sup id="cite_ref-Lima-2016b_52-0" class="reference"><a href="#cite_note-Lima-2016b-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> Parents of terminally ill children also face additional challenges in addition to mental health stressors including difficulty balancing caregiving and maintaining employment. Many report feeling as if they have to "do it all" by balancing caring for their chronically ill child, limiting absence from work, and supporting their family members.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> Children of terminally ill parents often experience a role reversal in which they become the caretakers of their adult parents. In taking on the burden of caring for their sick parent and assuming the responsibilities they can no longer accomplish, many children also experience significant declines in academic performance. <sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Coping_for_family">Coping for family</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=19" title="Edit section: Coping for family"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Discussing the anticipated loss and planning for the future may help family members accept and prepare for the patient's death. <a href="/wiki/Intervention_(counseling)" title="Intervention (counseling)">Interventions</a> may also be offered for <a href="/wiki/Anticipatory_grief" title="Anticipatory grief">anticipatory grief</a>. In the case of more serious consequences such as <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">depression</a>, a more serious <a href="/wiki/Intervention_(counseling)" title="Intervention (counseling)">intervention</a> or <a href="/wiki/Therapy" title="Therapy">therapy</a> is recommended. Upon the death of someone who is terminally ill, many family members that served as caregivers are likely to experience declines in their mental health.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> Grief counseling and grief therapy may also be recommended for family members after a loved one's death.<sup id="cite_ref-NCI-2007b_56-0" class="reference"><a href="#cite_note-NCI-2007b-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Dying">Dying</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=20" title="Edit section: Dying"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>When dying, patients often worry about their quality of life towards the end, including emotional and physical suffering.<sup id="cite_ref-Hendry-2013_2-2" class="reference"><a href="#cite_note-Hendry-2013-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>In order for families and doctors to understand clearly what the patient wants for themselves, it is recommended that patients, doctors, and families all convene and discuss the patient's decisions before the patient becomes unable to decide.<sup id="cite_ref-AHRQ-2017_4-1" class="reference"><a href="#cite_note-AHRQ-2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Qaseem-2008_5-2" class="reference"><a href="#cite_note-Qaseem-2008-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Brinkman-Stoppelenburg-2014_57-0" class="reference"><a href="#cite_note-Brinkman-Stoppelenburg-2014-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Advance_directives">Advance directives</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=21" title="Edit section: Advance directives"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>At the end of life, especially when patients are unable to make decisions on their own regarding treatment, it is often up to family members and doctors to decide what they believe the patients would have wanted regarding their deaths, which is often a heavy burden and hard for family members to predict. An estimated 25% of American adults have an advance directive, meaning the majority of Americans leave these decisions to be made by family, which can lead to conflict and guilt. Although it may be a difficult subject to broach, it is important to discuss the patient's plans for how far to continue treatment should they become unable to decide. This must be done while the patient is still able to make the decisions, and takes the form of an <a href="/wiki/Advance_healthcare_directive" title="Advance healthcare directive">advance directive</a>. The advance directive should be updated regularly as the patient's condition changes so as to reflect the patient's wishes.<sup id="cite_ref-Cancer.org-2017_58-0" class="reference"><a href="#cite_note-Cancer.org-2017-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Mitnick-2010b_20-1" class="reference"><a href="#cite_note-Mitnick-2010b-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>Some of the decisions that advance directives may address include receiving fluids and nutrition support, getting blood transfusions, receiving antibiotics, resuscitation (if the heart stops beating), and intubation (if the patient stops breathing).<sup id="cite_ref-NCI-2007_59-0" class="reference"><a href="#cite_note-NCI-2007-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> </p><p>Having an advance directive can improve end-of-life care.<sup id="cite_ref-Brinkman-Stoppelenburg-2014_57-1" class="reference"><a href="#cite_note-Brinkman-Stoppelenburg-2014-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p><p>It is highly recommended by many research studies and meta-analyses for patients to discuss and create an advance directive with their doctors and families.<sup id="cite_ref-AHRQ-2017_4-2" class="reference"><a href="#cite_note-AHRQ-2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Brinkman-Stoppelenburg-2014_57-2" class="reference"><a href="#cite_note-Brinkman-Stoppelenburg-2014-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Qaseem-2008_5-3" class="reference"><a href="#cite_note-Qaseem-2008-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Do-not-resuscitate">Do-not-resuscitate</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=22" title="Edit section: Do-not-resuscitate"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Do_not_resuscitate" title="Do not resuscitate">Do not resuscitate</a></div> <p>One of the options of care that patients may discuss with their families and medical providers is the <a href="/wiki/Do_not_resuscitate" title="Do not resuscitate">do-not-resuscitate</a> (DNR) order. This means that if the patient's heart stops, CPR and other methods to bring back heartbeat would not be performed. This is the patient's choice to make and can depend on a variety of reasons, whether based on personal beliefs or medical concerns. DNR orders can be medically and <a href="/wiki/Legally_binding" class="mw-redirect" title="Legally binding">legally binding</a> depending on the applicable <a href="/wiki/Jurisdiction" title="Jurisdiction">jurisdiction</a>.<sup id="cite_ref-Osinski-2017_60-0" class="reference"><a href="#cite_note-Osinski-2017-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> </p><p>Decisions like these should be indicated in the advance directive so that the patient's wishes can be carried out to improve end-of-life care.<sup id="cite_ref-Cancer.org-2017_58-1" class="reference"><a href="#cite_note-Cancer.org-2017-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Symptoms_near_death">Symptoms near death</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=23" title="Edit section: Symptoms near death"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A variety of symptoms become more apparent when a patient is nearing death. Recognizing these symptoms and knowing what will come may help family members prepare.<sup id="cite_ref-NCI-2007_59-1" class="reference"><a href="#cite_note-NCI-2007-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> </p><p>During the final few weeks, symptoms will vary largely depending on the patient's disease. During the final hours, patients usually will reject food and water and will also sleep more, choosing not to interact with those around them. Their bodies may behave more irregularly, with changes in breathing, sometimes with longer pauses between breaths, irregular heart rate, low blood pressure, and coldness in the extremities. It is important to note, however, that symptoms will vary per patient.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Good_death">Good death</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=24" title="Edit section: Good death"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Patients, healthcare workers, and recently bereaved family members often describe a "good death" in terms of effective choices made in a few areas:<sup id="cite_ref-pmid10819707_62-0" class="reference"><a href="#cite_note-pmid10819707-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Assurance of effective pain and symptom management.</li> <li>Education about death and its aftermath, especially as it relates to decision-making.</li> <li>Completion of any significant goals, such as resolving past conflicts.<sup id="cite_ref-Steinhauser-2000_6-1" class="reference"><a href="#cite_note-Steinhauser-2000-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></li></ul> <p>In the last hours of life, <a href="/wiki/Palliative_sedation" title="Palliative sedation">palliative sedation</a> may be recommended by a doctor or requested by the patient to ease the symptoms of death until they die. Palliative sedation is not intended to prolong life or hasten death; it is merely meant to relieve symptoms.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=25" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Advance_healthcare_directive" title="Advance healthcare directive">Advance healthcare directive</a></li> <li><a href="/wiki/Anticipatory_grief" title="Anticipatory grief">Anticipatory grief</a></li> <li><a href="/wiki/Do_not_resuscitate" title="Do not resuscitate">Do not resuscitate</a></li> <li><a href="/wiki/End-of-life_care" title="End-of-life care">End-of-life care</a></li> <li><a href="/wiki/Euthanasia" title="Euthanasia">Euthanasia</a></li> <li><a href="/wiki/Hospice_care_in_the_United_States" title="Hospice care in the United States">Hospice care in the United States</a></li> <li><a href="/wiki/Interventionism_(medicine)" title="Interventionism (medicine)">Interventionism (medicine)</a></li> <li><a href="/wiki/Liverpool_Care_Pathway_for_the_Dying_Patient" title="Liverpool Care Pathway for the Dying Patient">Liverpool Care Pathway for the Dying Patient</a></li> <li><a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a></li> <li><a href="/wiki/Assisted_suicide" title="Assisted suicide">Assisted suicide</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=26" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Lima-2016a-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Lima-2016a_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Lima-2016a_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Lima-2016a_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Lima-2016a_1-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFLimaPastrana2016" class="citation journal cs1">Lima, Liliana De; Pastrana, Tania (2016). <a rel="nofollow" class="external text" href="https://doi.org/10.1146%2Fannurev-publhealth-032315-021448">"Opportunities for Palliative Care in Public Health"</a>. <i>Annual Review of Public Health</i>. <b>37</b> (1): <span class="nowrap">357–</span>374. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1146%2Fannurev-publhealth-032315-021448">10.1146/annurev-publhealth-032315-021448</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26989831">26989831</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annual+Review+of+Public+Health&rft.atitle=Opportunities+for+Palliative+Care+in+Public+Health&rft.volume=37&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E357-%3C%2Fspan%3E374&rft.date=2016&rft_id=info%3Adoi%2F10.1146%2Fannurev-publhealth-032315-021448&rft_id=info%3Apmid%2F26989831&rft.aulast=Lima&rft.aufirst=Liliana+De&rft.au=Pastrana%2C+Tania&rft_id=https%3A%2F%2Fdoi.org%2F10.1146%252Fannurev-publhealth-032315-021448&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATerminal+illness" class="Z3988"></span></span> </li> <li id="cite_note-Hendry-2013-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-Hendry-2013_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Hendry-2013_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Hendry-2013_2-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFHendryPasterfieldLewisCarter2013" class="citation journal cs1">Hendry, Maggie; Pasterfield, Diana; Lewis, Ruth; Carter, Ben; Hodgson, Daniel; Wilkinson, Clare (1 January 2013). "Why do we want the right to die? 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id="CITEREFClaessensMentenSchotsmansBroeckaert2008" class="citation journal cs1">Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert (1 September 2008). <a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.jpainsymman.2007.10.004">"Palliative Sedation: A Review of the Research Literature"</a>. <i>Journal of Pain and Symptom Management</i>. <b>36</b> (3): <span class="nowrap">310–</span>333. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.jpainsymman.2007.10.004">10.1016/j.jpainsymman.2007.10.004</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/18657380">18657380</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pain+and+Symptom+Management&rft.atitle=Palliative+Sedation%3A+A+Review+of+the+Research+Literature&rft.volume=36&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E310-%3C%2Fspan%3E333&rft.date=2008-09-01&rft_id=info%3Adoi%2F10.1016%2Fj.jpainsymman.2007.10.004&rft_id=info%3Apmid%2F18657380&rft.aulast=Claessens&rft.aufirst=Patricia&rft.au=Menten%2C+Johan&rft.au=Schotsmans%2C+Paul&rft.au=Broeckaert%2C+Bert&rft_id=https%3A%2F%2Fdoi.org%2F10.1016%252Fj.jpainsymman.2007.10.004&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATerminal+illness" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Terminal_illness&action=edit&section=27" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>"Letting Go" by Atul Gawande (<a rel="nofollow" class="external text" href="https://www.newyorker.com/magazine/2010/08/02/letting-go-2">link</a>)</li> <li>"Last Days of Life" for cancer patients provided by the National Cancer Institute (<a rel="nofollow" class="external text" href="https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/last-days-pdq#section/all">link</a>)</li> <li>"Living with a terminal illness" by Marie Curie (<a rel="nofollow" class="external text" href="https://www.mariecurie.org.uk/help/support/terminal-illness">link</a>)</li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline 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.navbar{display:block;font-size:100%}.mw-parser-output .navbox-title .navbar{float:left;text-align:left;margin-right:0.5em}body.skin--responsive .mw-parser-output .navbox-image img{max-width:none!important}@media print{body.ns-0 .mw-parser-output .navbox{display:none!important}}</style></div><div role="navigation" class="navbox" aria-labelledby="Death315" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar 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style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Necrosis" title="Necrosis">Necrosis</a> <ul><li><a href="/wiki/Avascular_necrosis" title="Avascular necrosis">Avascular necrosis</a></li> <li><a href="/wiki/Coagulative_necrosis" title="Coagulative necrosis">Coagulative necrosis</a></li> <li><a href="/wiki/Liquefactive_necrosis" title="Liquefactive necrosis">Liquefactive necrosis</a></li> <li><a href="/wiki/Gangrene" title="Gangrene">Gangrenous necrosis</a></li> <li><a href="/wiki/Caseous_necrosis" title="Caseous necrosis">Caseous necrosis</a></li> <li><a href="/wiki/Fat_necrosis" title="Fat necrosis">Fat necrosis</a></li> <li><a href="/wiki/Fibrinoid_necrosis" title="Fibrinoid necrosis">Fibrinoid necrosis</a></li> <li><a href="/wiki/Temporal_lobe_necrosis" title="Temporal lobe necrosis">Temporal lobe necrosis</a></li></ul></li> <li><a href="/wiki/Programmed_cell_death" title="Programmed cell death">Programmed cell death</a> <ul><li><a href="/wiki/Activation-induced_cell_death" title="Activation-induced cell death">AICD</a></li> <li><a href="/wiki/Anoikis" title="Anoikis">Anoikis</a></li> <li><a href="/wiki/Apoptosis" title="Apoptosis">Apoptosis</a></li> <li><a href="/wiki/Autophagy" title="Autophagy">Autophagy</a></li> <li><a href="/wiki/Intrinsic_apoptosis" class="mw-redirect" title="Intrinsic apoptosis">Intrinsic apoptosis</a></li> <li><a href="/wiki/Necroptosis" title="Necroptosis">Necroptosis</a></li> <li><a href="/wiki/Paraptosis" title="Paraptosis">Paraptosis</a></li> <li><a href="/wiki/Parthanatos" title="Parthanatos">Parthanatos</a></li> <li><a href="/wiki/Phenoptosis" title="Phenoptosis">Phenoptosis</a></li> <li><a href="/wiki/Pseudoapoptosis" title="Pseudoapoptosis">Pseudoapoptosis</a></li> <li><a href="/wiki/Pyroptosis" title="Pyroptosis">Pyroptosis</a></li></ul></li> <li><a href="/wiki/Autolysis_(biology)" title="Autolysis (biology)">Autolysis</a></li> <li><a href="/wiki/Autoschizis" title="Autoschizis">Autoschizis</a></li> <li><a href="/wiki/Eschar" title="Eschar">Eschar</a></li> <li><a href="/wiki/Immunogenic_cell_death" title="Immunogenic cell death">Immunogenic cell death</a></li> <li><a href="/wiki/Ischemic_cell_death" title="Ischemic cell death">Ischemic cell death</a></li> <li><a href="/wiki/Pyknosis" title="Pyknosis">Pyknosis</a></li> <li><a href="/wiki/Karyorrhexis" title="Karyorrhexis">Karyorrhexis</a></li> <li><a href="/wiki/Karyolysis" title="Karyolysis">Karyolysis</a></li> <li><a href="/wiki/Mitotic_catastrophe" title="Mitotic catastrophe">Mitotic catastrophe</a></li> <li><a href="/wiki/Suicide_gene" title="Suicide gene">Suicide gene</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Abortion" title="Abortion">Abortion</a></li> <li><a href="/wiki/Accidental_death" title="Accidental death">Accidental death</a></li> <li><a href="/wiki/Autopsy" title="Autopsy">Autopsy</a></li> <li><a href="/wiki/Brain_death" title="Brain death">Brain death</a> <ul><li><a href="/wiki/Brainstem_death" title="Brainstem death">Brainstem death</a></li></ul></li> <li><a href="/wiki/Clinical_death" title="Clinical death">Clinical death</a> <ul><li><a href="/wiki/Dead_on_arrival" title="Dead on arrival">DOA</a></li></ul></li> <li><a href="/wiki/Manner_of_death" title="Manner of death">Death by natural causes</a></li> <li><a href="/wiki/Death_rattle" title="Death rattle">Death rattle</a></li> <li><a href="/wiki/Dysthanasia" title="Dysthanasia">Dysthanasia</a></li> <li><a href="/wiki/End-of-life_care" title="End-of-life care">End-of-life care</a></li> <li><a href="/wiki/Euthanasia" title="Euthanasia">Euthanasia</a></li> <li><a href="/wiki/Lazarus_sign" title="Lazarus sign">Lazarus sign</a></li> <li><a href="/wiki/Lazarus_syndrome" title="Lazarus syndrome">Lazarus syndrome</a></li> <li><a href="/wiki/Legal_death#Medical_declaration" title="Legal death">Medical declaration of death</a></li> <li><a href="/wiki/Organ_donation" title="Organ donation">Organ donation</a></li> <li><a class="mw-selflink selflink">Terminal illness</a></li> <li><a href="/wiki/Manner_of_death" title="Manner of death">Unnatural death</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Category:Death-related_lists" title="Category:Death-related lists">Lists</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/List_of_causes_of_death_by_rate" title="List of causes of death by rate">Causes of death by rate</a></li> <li><a href="/wiki/Lists_of_deaths_by_year" title="Lists of deaths by year">Notable deaths by year</a></li> <li><a href="/wiki/List_of_expressions_related_to_death" class="mw-redirect" title="List of expressions related to death">Expressions related to death</a></li> <li><a href="/wiki/List_of_natural_disasters_by_death_toll" title="List of natural disasters by death toll">Natural disasters</a></li> <li><a href="/wiki/Lists_of_people_by_cause_of_death" title="Lists of people by cause of death">People by cause of death</a></li> <li><a href="/wiki/List_of_premature_obituaries" class="mw-redirect" title="List of premature obituaries">Premature obituaries</a></li> <li><a href="/wiki/Preventable_causes_of_death" title="Preventable causes of death">Preventable causes of death</a></li> <li><a href="/wiki/List_of_unusual_deaths" class="mw-redirect" title="List of unusual deaths">Unusual deaths</a></li> <li><a href="/wiki/List_of_ways_people_dishonor_the_dead" title="List of ways people dishonor the dead">List of ways people dishonor the dead</a></li> <li><a href="/wiki/List_of_ways_people_honor_the_dead" class="mw-redirect" title="List of ways people honor the dead">List of ways people honor the dead</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Mortality</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Birthday_effect" title="Birthday effect">Birthday effect</a></li> <li><a href="/wiki/Child_mortality" title="Child mortality">Child mortality</a></li> <li><a href="/wiki/Excess_mortality" title="Excess mortality">Excess mortality</a></li> <li><a href="/wiki/Gompertz%E2%80%93Makeham_law_of_mortality" title="Gompertz–Makeham law of mortality">Gompertz–Makeham law of mortality</a></li> <li><a href="/wiki/Infant_mortality" title="Infant mortality">Infant mortality</a></li> <li><a href="/wiki/Karoshi" title="Karoshi">Karoshi</a></li> <li><a href="/wiki/Maternal_death" title="Maternal death">Maternal death</a></li> <li><a href="/wiki/Maternal_mortality_in_fiction" title="Maternal mortality in fiction">Maternal mortality in fiction</a></li> <li><i><a href="/wiki/Memento_mori" title="Memento mori">Memento mori</a></i></li> <li><a href="/wiki/Micromort" title="Micromort">Micromort</a></li> <li><a href="/wiki/Mortality_rate" title="Mortality rate">Mortality rate</a> <ul><li><a href="/wiki/Risk_adjusted_mortality_rate" title="Risk adjusted mortality rate">RAMR</a></li></ul></li> <li><a href="/wiki/Mortality_salience" title="Mortality salience">Mortality salience</a></li> <li><a href="/wiki/Perinatal_mortality" title="Perinatal mortality">Perinatal mortality</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">After death</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;font-weight:normal;"><b><a href="/wiki/Cadaver" title="Cadaver">Body</a></b></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Stages</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pallor_mortis" title="Pallor mortis">Pallor mortis</a></li> <li><a href="/wiki/Livor_mortis" title="Livor mortis">Livor mortis</a></li> <li><a href="/wiki/Algor_mortis" title="Algor mortis">Algor mortis</a></li> <li><a href="/wiki/Rigor_mortis" title="Rigor mortis">Rigor mortis</a></li> <li><a href="/wiki/Putrefaction" title="Putrefaction">Putrefaction</a></li> <li><a href="/wiki/Decomposition" title="Decomposition">Decomposition</a></li> <li><a href="/wiki/Skeletonization" title="Skeletonization">Skeletonization</a></li> <li><a href="/wiki/Fossil" title="Fossil">Fossilization</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Preservation</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cryopreservation" title="Cryopreservation">Cryopreservation</a> <ul><li><a href="/wiki/Cryonics" title="Cryonics">Cryonics</a></li> <li><a href="/wiki/Neuropreservation" class="mw-redirect" title="Neuropreservation">Neuropreservation</a></li></ul></li> <li><a href="/wiki/Embalming" title="Embalming">Embalming</a></li> <li><a href="/wiki/Maceration_(bone)" title="Maceration (bone)">Maceration</a></li> <li><a href="/wiki/Mummy" title="Mummy">Mummification</a></li> <li><a href="/wiki/Plastination" title="Plastination">Plastination</a></li> <li><a href="/wiki/Prosection" title="Prosection">Prosection</a></li> <li><a href="/wiki/Taxidermy" title="Taxidermy">Taxidermy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Disposal_of_human_corpses" title="Disposal of human corpses">Disposal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Burial" title="Burial">Burial</a> <ul><li><a href="/wiki/Natural_burial" title="Natural burial">Natural burial</a></li> <li><a href="/wiki/Sky_burial" title="Sky burial">Sky burial</a></li></ul></li> <li><a href="/wiki/Cremation" title="Cremation">Cremation</a></li> <li><a href="/wiki/Dismemberment" title="Dismemberment">Dismemberment</a></li> <li><a href="/wiki/Excarnation" title="Excarnation">Excarnation</a></li> <li><a href="/wiki/Promession" title="Promession">Promession</a></li> <li><a href="/wiki/Alkaline_hydrolysis_(body_disposal)" class="mw-redirect" title="Alkaline hydrolysis (body disposal)">Resomation</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Beating_heart_cadaver" title="Beating heart cadaver">Beating heart cadaver</a></li> <li><a href="/wiki/Body_donation" title="Body donation">Body donation</a></li> <li><a href="/wiki/Cadaveric_spasm" title="Cadaveric spasm">Cadaveric spasm</a></li> <li><a href="/wiki/Coffin_birth" title="Coffin birth">Coffin birth</a></li> <li><a href="/wiki/Death_erection" title="Death erection">Death erection</a></li> <li><a href="/wiki/Dissection" title="Dissection">Dissection</a></li> <li><a href="/wiki/Gibbeting" title="Gibbeting">Gibbeting</a></li> <li><a href="/wiki/Postmortem_caloricity" title="Postmortem caloricity">Postmortem caloricity</a></li> <li><a href="/wiki/Post-mortem_interval" title="Post-mortem interval">Post-mortem interval</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;font-weight:normal;"><b>Other aspects</b></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Carrion" title="Carrion">Carrion</a></li> <li><a href="/wiki/Cemetery" title="Cemetery">Cemetery</a></li> <li><a href="/wiki/Consciousness_after_death" class="mw-redirect" title="Consciousness after death">Consciousness after death</a> <ul><li><a href="/wiki/Afterlife" title="Afterlife">Afterlife</a></li> <li><a href="/wiki/Tukdam" title="Tukdam">Tukdam</a></li></ul></li> <li><a href="/wiki/Category:Death_customs" title="Category:Death customs">Customs</a></li> <li><a href="/wiki/Crematorium" title="Crematorium">Crematorium</a></li> <li><a href="/wiki/Desecration_of_graves" class="mw-redirect" title="Desecration of graves">Desecration of graves</a></li> <li><a href="/wiki/Eternal_oblivion" title="Eternal oblivion">Eternal oblivion</a></li> <li><a href="/wiki/Medical_examiner" title="Medical examiner">Examination</a></li> <li><a href="/wiki/Funeral" title="Funeral">Funeral</a></li> <li><a href="/wiki/Grief" title="Grief">Grief</a></li> <li><a href="/wiki/Death_and_the_Internet" title="Death and the Internet">Internet</a></li> <li><a href="/wiki/Death_midwife" title="Death midwife">Midwife</a></li> <li><a href="/wiki/Mourning" title="Mourning">Mourning</a> <ul><li><a href="/wiki/Online_mourning" title="Online mourning">Online mourning</a></li></ul></li> <li><a href="/wiki/Obituary" title="Obituary">Obituary</a></li> <li><a href="/wiki/Reincarnation" title="Reincarnation">Reincarnation</a> <ul><li><a href="/wiki/Palingenesis" title="Palingenesis">Palingenesis</a></li> <li><a href="/wiki/Sa%E1%B9%83s%C4%81ra" title="Saṃsāra">Saṃsāra</a></li></ul></li> <li><a href="/wiki/Resurrection" title="Resurrection">Resurrection</a></li> <li><a href="/wiki/Underworld" title="Underworld">Underworld</a></li> <li><a href="/wiki/Vigil" title="Vigil">Vigil</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Paranormal</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ghost" title="Ghost">Ghosts</a></li> <li><a href="/wiki/Near-death_experience" title="Near-death experience">Near-death experience</a></li> <li><a href="/wiki/Near-death_studies" title="Near-death studies">Near-death studies</a></li> <li><a href="/wiki/Necromancy" title="Necromancy">Necromancy</a></li> <li><a href="/wiki/Out-of-body_experience" title="Out-of-body experience">Out-of-body experience</a></li> <li><a href="/wiki/Template:Reincarnation_research" title="Template:Reincarnation research">Reincarnation research</a></li> <li><a href="/wiki/S%C3%A9ance" title="Séance">Séance</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Legal</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Abortion_law" title="Abortion law">Abortion law</a></li> <li><a href="/wiki/Administration_(probate_law)" title="Administration (probate law)">Administration</a></li> <li><a href="/wiki/Capital_punishment" title="Capital punishment">Capital punishment</a></li> <li><a href="/wiki/Cause_of_death" title="Cause of death">Cause of death</a></li> <li><a href="/wiki/Civil_death" title="Civil death">Civil death</a></li> <li><a href="/wiki/Coroner" title="Coroner">Coroner</a></li> <li><a href="/wiki/Death-qualified_jury" title="Death-qualified jury">Death-qualified jury</a></li> <li><a href="/wiki/Death_certificate" title="Death certificate">Death certificate</a></li> <li><a href="/wiki/Presumption_of_death" title="Presumption of death">Declared death <i>in absentia</i></a></li> <li><a href="/wiki/Death_row" title="Death row">Death row</a></li> <li><a href="/wiki/Dying_declaration" title="Dying declaration">Dying declaration</a></li> <li><a href="/wiki/Inquest" title="Inquest">Inquest</a></li> <li><a href="/wiki/Legal_death" title="Legal death">Legal death</a></li> <li><a href="/wiki/Murder" title="Murder">Murder</a></li> <li><a href="/wiki/Necropolitics" title="Necropolitics">Necropolitics</a></li> <li><a href="/wiki/Prohibition_of_dying" title="Prohibition of dying">Prohibition of dying</a></li> <li><a href="/wiki/Right_to_die" title="Right to die">Right to die</a></li> <li><a href="/wiki/Suspicious_death" title="Suspicious death">Suspicious death</a></li> <li><a href="/wiki/Trust_(law)" title="Trust (law)">Trust law</a></li> <li><a href="/wiki/Will_and_testament" title="Will and testament">Will</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Fields</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/w/index.php?title=Death_tech&action=edit&redlink=1" class="new" title="Death tech (page does not exist)">Death tech</a><span class="noprint" style="font-size:85%; font-style: normal;"> [<a href="https://pt.wikipedia.org/wiki/Death_Tech" class="extiw" title="pt:Death Tech">pt</a>]</span></li> <li><a href="/wiki/Forensic_pathology" title="Forensic pathology">Forensic pathology</a></li> <li><a href="/wiki/Funeral_director" title="Funeral director">Funeral director</a></li> <li><a href="/wiki/Mortuary_science" title="Mortuary science">Mortuary science</a></li> <li><a href="/wiki/Cell_death" title="Cell death">Necrobiology</a></li> <li><a href="/wiki/Post-mortem_chemistry" title="Post-mortem chemistry">Post-mortem chemistry</a></li> <li><a href="/wiki/Post-mortem_photography" title="Post-mortem photography">Post-mortem photography</a></li> <li><a href="/wiki/Taphonomy" title="Taphonomy">Taphonomy</a> <ul><li><a href="/wiki/Biostratinomy" title="Biostratinomy">Biostratinomy</a></li></ul></li> <li><a href="/wiki/Thanatology" title="Thanatology">Thanatology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Apparent_death" title="Apparent death">Apparent death</a></li> <li><a href="/wiki/Chinese_burial_money" title="Chinese burial money">Chinese burial money</a></li> <li><a href="/wiki/Coins_for_the_dead" title="Coins for the dead">Coins for the dead</a></li> <li><a href="/wiki/Dark_tourism" title="Dark tourism">Dark tourism</a></li> <li><a href="/wiki/Darwin_Awards" title="Darwin Awards">Darwin Awards</a></li> <li><a href="/wiki/Death_and_culture" title="Death and culture">Death and culture</a></li> <li><a href="/wiki/Death_anniversary" title="Death anniversary">Death anniversary</a></li> <li><a href="/wiki/Death_anxiety" title="Death anxiety">Death anxiety</a></li> <li><a href="/wiki/List_of_death_deities" title="List of death deities">Death deity</a> <ul><li><a href="/wiki/Personifications_of_death" title="Personifications of death">Personification of death</a></li> <li><a href="/wiki/Dying-and-rising_deity" class="mw-redirect" title="Dying-and-rising deity">Dying-and-rising god</a></li> <li><a href="/wiki/Psychopomp" title="Psychopomp">Psychopomp</a></li></ul></li> <li><a href="/wiki/Extermination_camp" title="Extermination camp">Death camp</a></li> <li><a href="/wiki/Death_drive" title="Death drive">Death drive</a></li> <li><a href="/wiki/Death_education" title="Death education">Death education</a></li> <li><a href="/wiki/Death_from_laughter" title="Death from laughter">Death from laughter</a></li> <li><a href="/wiki/Death_hoax" title="Death hoax">Death hoax</a></li> <li><a href="/wiki/Death_knell" title="Death knell">Death knell</a></li> <li><a href="/wiki/Death_march" title="Death march">Death march</a></li> <li><a href="/wiki/Death_messenger" title="Death messenger">Death messenger</a></li> <li><a href="/wiki/Death_notification" title="Death notification">Death notification</a></li> <li><a href="/wiki/Death_panel" title="Death panel">Death panel</a></li> <li><a href="/wiki/Death_poem" title="Death poem">Death poem</a></li> <li><a href="/wiki/Opisthotonic_death_pose" title="Opisthotonic death pose">Death pose</a></li> <li><a href="/wiki/Death-positive_movement" class="mw-redirect" title="Death-positive movement">Death-positive movement</a></li> <li><a href="/wiki/Death_squad" title="Death squad">Death squad</a></li> <li><a href="/wiki/Death_threat" title="Death threat">Death threat</a></li> <li><a href="/wiki/Death_trajectory" title="Death trajectory">Death trajectory</a></li> <li><a href="/wiki/Dignified_death" title="Dignified death">Dignified death</a></li> <li><a href="/wiki/Extinction" title="Extinction">Extinction</a></li> <li><a href="/wiki/Festival_of_the_Dead" title="Festival of the Dead">Festival of the Dead</a></li> <li><a href="/wiki/Fascination_with_death" title="Fascination with death">Fascination with death</a></li> <li><a href="/wiki/Hierarchy_of_death" title="Hierarchy of death">Hierarchy of death</a></li> <li><a href="/wiki/Homicide" title="Homicide">Homicide</a></li> <li><a href="/wiki/Immortality" title="Immortality">Immortality</a></li> <li><a href="/wiki/Last_rites" title="Last rites">Last rites</a></li> <li><a href="/wiki/Longevity" title="Longevity">Longevity</a></li> <li><a href="/wiki/Martyr" title="Martyr">Martyr</a></li> <li><a href="/wiki/Museum_of_Death" title="Museum of Death">Museum of Death</a></li> <li><a href="/wiki/Necronym" title="Necronym">Necronym</a></li> <li><a href="/wiki/Necrophilia" title="Necrophilia">Necrophilia</a></li> <li><a href="/wiki/Necrophobia" title="Necrophobia">Necrophobia</a></li> <li><a href="/wiki/Philosophy_of_death" title="Philosophy of death">Philosophy of death</a></li> <li><a href="/wiki/Predation" title="Predation">Predation</a></li> <li><a href="/wiki/Sacrifice" title="Sacrifice">Sacrifice</a> <ul><li><a href="/wiki/Human_sacrifice" title="Human sacrifice">human</a></li></ul></li> <li><a href="/wiki/Suicide" title="Suicide">Suicide</a> <ul><li><a href="/wiki/Assisted_suicide" title="Assisted suicide">Assisted suicide</a></li></ul></li> <li><a href="/w/index.php?title=Thanabot&action=edit&redlink=1" class="new" title="Thanabot (page does not exist)">Thanabot</a><span class="noprint" style="font-size:85%; font-style: normal;"> [<a href="https://ca.wikipedia.org/wiki/Grief_bot" class="extiw" title="ca:Grief bot">ca</a>]</span></li> <li><a href="/wiki/Thanatosensitivity" title="Thanatosensitivity">Thanatosensitivity</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, 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