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The terminal phase 

The terminal phase
The terminal phase

Victor Pace

, Adrian Treloar

, Sharon Scott

, and Max Watson

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date: 11 July 2020

Introduction 254

Recognizing approaching death 256

Managing the last few days of life 261

The Liverpool Care Pathway for the dying patient 267

After death has occurred 269

Management of syringe drivers (SDs) 270

Entering the dying phase in a terminal illness is the culmination of a process which began, often years before, with diagnosis. It is usually impossible to know how aware the person with far advanced dementia is of their impending death. But the carers and family will have gone through massive change, adaptation, and emotional turmoil over the years in anticipation of this moment. For some, death will bring a sense of relief, or of the satisfaction of having lived out their promise to look after a loved one. But at the end of a long and terminal illness, the final parting is still often associated with emptiness and profound loneliness and loss for those left behind. Managing the death in a dignified, caring, and competent way is of the greatest importance in helping carers and family feel that the life they cherished has come to an end in a fitting manner. It is also of course crucial for patients themselves that they are kept comfortable in this most vulnerable time. But managing the terminal phase well is also important preventively. Deaths perceived as badly handled are common precipitants of mental illness, and in palliative care one frequently meets relatives who, years after a death, are still struggling to put their life together again and have numerous questions arising out of the last days of life. Again, families which have been divided but come together when a loved one is dying will often form new, lasting, strong emotional bonds, but families which remain split at this point may well never heal the rifts....

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