Dr. Miriam Colleran:

When people get closer to dying, and Senator Seery Kearney mentioned the wonderful work of Dr. Kathryn Mannix, even though they may be dying of different illnesses, there is much similarity at the very end of life of what people experience, assuming they are not having sudden death. There are signs that we notice such as someone over time being less active, being less able to do things, needing to rest and sit more and being less mobile. There are certainly changes, depending on the different condition or illness a person has but there are many similarities and overlaps. When getting very close to dying, people can be much more tired and sleepy. My dad actually was awake as he died. He died in ICU but he was awake, although he could not speak. Regarding the Senator's question about consciousness, he was post-extubation but he was still awake as he died. Therefore, these things are not universal.

What happens frequently when people are dying and when we see people dying at home or with us in the hospice or hospitals is that they can often be much sleepier, go in and out of unconsciousness and then become fully unconscious. Sometimes people get a bit anxious as they get closer to dying. Sometimes people tell me they are worried about dying. I say this anecdotally. I will say, “I know this sounds like a strange question but what is it about dying that has you worried?” For the vast majority of people, it is the idea of leaving their families and the people they love. That makes so much sense. We all grieve the loss of someone we love. I am sure all of us have been bereaved. We all grieve the loss of someone we love. Sadly, grief is part of loving someone. We do not grieve as much what we did not love and what was not as important. Sometimes people get understandably anxious as they get closer to dying and need some relaxation medication. Our aim in giving that medication is just for their comfort and to ease the anxiety. However, very rarely, people are very anxious and need medication to help them sleep through the process as they get close to dying. That is very different from deliberately hastening a person’s death. By and large, we can achieve very good symptom control for people who are close to dying.