Dr. Regina McQuillan:

This is a really challenging area. Sometimes bad deaths are not necessarily painful deaths. A bad death might depend on the person experiencing it, but also the people who are looking on. There is a challenge around physical symptoms and physical pain, but not as much as people would believe. The most difficult symptom people have when they are dying is, as Dr. Doré noted, terminal agitation or terminal delirium.

The difficulty with the term "delirium" is that person is not thinking clearly. They are very frightened and agitated. That is a very difficult situation to be in. When we say that person is not thinking clearly, they literally do not understand what is going on. They are completely confused and do not understand what is going on. That is very difficult. In those situations, where people have that level of delirium, we need to give medication that reduces it, and try to reverse the delirium in the first instance. Very often towards the end of life, that is not possible but we give them medication to have them feeling calm and relaxed.

Some people may have very difficult to manage pain. I have been practising palliative medicine for more than 30 years and what I think has been good is that there have been developments in it but not as many as one would like. There is not as much scope and research going into how to manage and improve symptoms, whether those symptoms are pain. A lot of the difficult symptoms we deal with are pain, breathlessness and nausea. A big problem we also deal with is fatigue. Fatigue is a very common effect of advanced illness. The things people really are concerned about-----