Laboured breathing end of life

Laboring To Leave ~ Difficult Breathing at End of Life

  1. Dear Barbara, I would like to know why the breathing pattern is different at end of life. My Mother had fast and labored respirations. She did have COPD, but my Dad had the same breathing pattern and he did not die fromCOPD. This was very disturbing to me. Are they suffering when breathinglike that? The irregular, difficult breathing that occurs at end of life frightens mostpeople. As we watch.
  2. Breathing Patterns Before Death As a patient nears death, it is common for their breathing patterns to change. These end-of-life breathing patterns can happen very quickly, or it can occur over many hours or even days. This is a normal part of the dying process as the body begins to slowly shut down
  3. Changes in breathing towards the end of life As someone approaches the end of their life, they may experience changes in their breathing. Everyone is different, so it's not possible to say exactly what will happen to the person. But there are common changes you might see
  4. Labored Breathing Towards end of life most people begin to experience changes in breathing. Shortness of breath is often described as air hunger. Air hunger is a fearful desire to breathe better
  5. Labored breathing Increased congestion, including possible fluid secretions Hours Before Death Symptoms In the final hours of life, your loved one's body will begin to shut down
Intensive End-Of-Life Care On The Rise For Cancer Patients

Towards the end, dying people will often breathe only periodically, with an intake of breath followed by no breath for several seconds, and then a further intake. This is known as Cheyne-Stokes breathing. This can be upsetting to witness as the person seems to have ceased breathing only to start again. When death happens, it happens very quickly When a person is just hours from death, you will notice changes in their breathing: The rate changes from a normal rate and rhythm to a new pattern of several rapid breaths followed by a period of no breathing (apnea). This is known as Cheyne-Stokes breathing—named for the person who first described it Terminal respiratory secretions occur as the body's breathing slows. This typically lasts no more than a few hours, but each patient is different and it can continue for as long as 24-48 hours. While the sound is difficult for family members to hear, it does not cause the patient pain or distress Breathing patterns change as someone nears death. Breaths may alternate from quiet to very loud. A dying person may draw a sharp breath, then not breathe for several moments. This labored breathing.. Labored Breathing At the very end of life, breathing often becomes ragged. Instead of a nice, even in-and-out, you might hear great breaths in, and then a long pause, and a little sigh out. There might be panting, or great pauses, or almost a rattling sound as your pup struggles to keep going

Breathing Patterns Before Death: End-of-Life Breathin

Labored breathing 2. Estimate his age. If you suspect your guinea pig may be sick or injured, or if you think he may be approaching the end of his life, seek medical attention for him. In addition to providing potentially life-saving treatment for your sick guinea pig, a vet can provide her professional opinion regarding your pet's. The deep, rapid breathing may be followed by a pause before breathing begins again. Your breathing may also become more noisy as a result of the build-up of mucus. The body naturally produces mucus in your breathing system, including the lungs and nasal passages. When you're healthy, this mucus is removed through coughing

Breathlessness (dyspnoea), is one of the most common symptoms experienced by people who are nearing the end of life. 1 It is reported as being the most debilitating symptom by 95% of people with Chronic Obstructive Pulmonary Disease (COPD), and is also common in patients with lung fibrosis, heart failure and terminal cancer. 2 Breathlessness is caused by a complex interaction of signals from. Death rattle is caused by saliva or mucus collecting in the throat or chest. Agonal breathing is instead an abnormal and often brief and inadequate pattern of breathing. Agonal breathing may sound.. Using accessory muscles to breathe is a sign of labored breathing. 4  Accessory muscles assist breathing but are not the primary breathing muscles. Muscles other than the diaphragm and intercostal muscles, such as the sternocleidomastoid, spinal, and neck muscles, are accessory muscles in breathing

These changes progress toward the end of life and these breathing changes often cause caregivers to feel anxious and alarmed. However, this type of breathing is normal at the end of life and does not mean the person is suffering Irregular Breathing: Slower, irregular breaths with pausing in between may be noted. As death nears, the dog may open and close his or her mouth. Heavy Breathing: While changes in breathing patterns are common when death is near, labored breathing may also take place when a dog is running a fever, is in pain, or has fluid in his chest If a person starts agonal breathing, they should get to the hospital or receive emergency medical intervention immediately, unless they are in a setting intended for the end of their life. Though.. This causes rapid breathing as the cat struggles for oxygen, followed by slow, labored breathing as the lungs fill with fluid and breathing becomes very difficult. Monitor your cat's breathing in the following way: Sit near your cat and quietly listen to his/her breathing. Watch his/her abdomen rise and fall with each breath

Changes in breathing towards end of life - Marie Curi

increasing prevalence at the end of life. Dyspneic patients experience difficult, labored, or uncomfortable breathing and often describe breathlessness, air hunger, or excessive effort to breathe. Patients with dyspnea may also experience anxiety, fear, and panic, all of which ma As the end of life approaches, there is a feeling of detachment from the physical world and a loss of interest in things formerly found pleasurable. There is a tendency to sleep more. Alert the doctor or nurse if breathing is especially labored or if you notice the death rattle and Cheyne-Stokes breathing Labored or congested breathing is common in the final days of life. You may hear the terms dyspnea or air hunger for labored breathing. Air hunger can be distressing for family members and scary for hospice patients. That breathing anxiety in patients can amplify air hunger and start a downward cycle of distress. Solutions Managing Shortness of Breath Near the End of Life Watching an aging family member struggle to catch their breath can be frightening. Imagine feeling like you're suffocating and you'll begin to understand how shortness of breath can trigger moments of crisis As a result, one can conclude that labored breathing is a normal feature of these severe diseases. When suffering various serious health problems (heart disease, diabetes, cancer, AIDS, etc.) the patient's life is very frequently threatened, not by the main health problem, but by complications and infections, such as in the case of bacteremic.

Five Physical Signs that Death is Nearing CRHC

Near the End of Life • Dyspnea • Cough • Changes in respiratory rate & rhythm • Increased Respiratory secretions E L N E C Geriatric Curriculum Dyspnea: Definition • Distressing shortness of breath, air hunger, or difficulty breathing • Associated with anxiety, depression, and decreased quality of life • Can be acute or chroni Hours before end of life. Signs that the body is actively shutting down are: abnormal breathing and longer space between breaths ( Cheyne-Stokes breathing) noisy breathing. glassy eyes. cold.

This breathing can continue for hours and often means that death will occur in hours or days. At the time of death, a few muscle contractions may occur, and the chest may heave as if to breathe. The heart may beat a few minutes after breathing stops, and a brief seizure may occur. Legal and Ethical Concerns at the End of Life. Acceptance of. Labored breathing is the only thing that one should immediately catch up on. Owners fail to notice this behavior, but this is the most dangerous symptom that spells Death sooner than later. Normal and healthy dogs have differed reaching patterns as compared to these dogs. Their breathing is usually labored and really heavy The pace of breathing changes Breathing may swing from very short and fast to very drawn out and irregular. While a healthy individual takes roughly 20 breaths a minute, someone near the very end of life may take only 1-3 breaths a minute. Breathing becomes more labored The act of breathing itself can take a lot of energy People can hover between life and death for a long time and it is easy to miss the moment. However, there are certain signs which indicate the person is approaching the end of life, such as: Congestion in the lungs: The person's breath becomes laboured and 'gurgling' which can sound alarming. However, this is quite normal and caused by.

End of Life Timeline: Signs & Symptoms Of The Dying Proces

Irregular Breathing Patterns and Sounds. Changes in breathing at the end of life are very common, especially for patients with lung disease. Your loved one's breathing may become shallow and alternate between rapid and slow. Changes in heart rate can accompany altered breathing patterns UNLESS breathing is an issue, not the normal puffing and start and stop breathing that occurs weeks and days before death, but severe labored breathing. Then a small, small, amount of morphine will often ease the difficulty in breathing. We must remember that taking in oxygen by breathing is one of the ways the body lives Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has. Respirations may slow with periods of apnoea. This is called Cheyne-Stokes breathing and is common in the last hours or days of life. This breathing pattern is distressing for parents and siblings to witness and they need reassurance that it is a normal part of the dying process and that it is not distressing to the dying child

Introduction This is the second of a three-part series. Fast Fact #33 reviewed a protocol for removing the ventilator, and Fast Fact #35 will review information for families. The most common symptoms related to ventilator withdrawal are breathlessness and anxiety. Opioids and benzodiazepines are the primary medications used; concerns about unintended hastened death are exaggerated. Breathing usually becomes increasingly shallow and/or laboured as death nears. There may be brief periods in which the person stops breathing, and then starts again. Respirations may slow. Some people, especially those who are well-hydrated, have increased fluid in their lungs and difficulty managing the fluids, i.e., they may have difficulty. Her breathing may speed up, sound shallow, or become irregular. There may even be short periods of time when your loved one stops breathing for a few moments. As death approaches, the time between breaths may get longer. Towards the very end of life, your loved one will be extremely drowsy and perhaps become unresponsive 5. Labored Breath. This can be one of the eeriest signs of dying and has been called a death rattle when the person is by this afflicted particularly heavily. Breathing patterns can change to a long, loud, deep breath followed by several seconds of not breathing

in the last days of life; consider using an end of life care pathway. Prescribe PRN drugs as described below in anticipation of anxiety or distress caused by breathlessness. Many patients will become unable to take drugs by the oral route so prescribe medication to be given parenterally e.g. subcutaneously The end of a pet's life is very emotional, making clear decisions difficult. Making the decision in advance will help you to not doubt yourself, which can lead to guilt and regret. Making an early decision will also give you more options such as planning for your cat's euthanasia in the comfort of your own home Due to a decrease in level of consciousness and cognitive impairment, assessment of clinical signs and symptoms such as headache at the end of life is difficult. Based on the signs and symptoms in the last days before death in patients with glioblastoma, supportive drug treatment remains challenging End Of Life Kidney Failure Symptoms - 10 Signs Death is Near. Labored breathing Breath intakes and exhales become raggedy, irregular, and labored. A distinctive pattern called Cheyne-Stokes respiration might be heard: a loud, deep inhalation is followed by a pause of not breathing (apnea) for between five seconds to as long as a full minute. Labored Breathing; As a loving pet owner, you know your dog better than anyone and will notice when they are not acting like themselves. While each dog's experience is different, there are similar patterns of behavior that may mean the end is close

As a person approaches the very end of life, two types of changes occur. There are physical changes that take place as the body begins to shut down its regular functions. And there are changes on the emotional and spiritual level as well, in which the dying person lets go of the body and the material world Often the change in cognition at the end of life is seen with terminal restlessness. I would encourage you, anytime you are seeing signs of impending end of life (such as breathing changes, circulation changes, or intermittent unresponsiveness), that you consider whether your pt is actually in discomfort End of Life Pet Hospice Program. If your pet has significant health issues such as cancer, kidney failure, another terminal illness, or a debilitating medical problem, the veterinarian may talk to you about an end-of-life pet hospice program.End of life pet hospice is a term for a personalized care plan to keep a dying pet comfortable A person nearing the end of life may be distressed or experience conflicting emotions. You can provide emotional support by listening and being present. Your physical presence — sitting quietly or holding hands — can be soothing and reassuring. Labored breathing: Gently turn the person's head, adjust pillows or raise the head of the bed.

Being with someone when they die Dying Matter

Life begins at the end of your comfort zone

Cough at the end of life can be treated in several ways. Cough at the end of life may add to a patient's discomfort. Repeated coughing can cause pain and loss of sleep, increase tiredness, and make shortness of breath worse. At the end of life, the decision may be to treat the symptoms of the cough rather than to find and treat the cause Most dogs with laryngeal paralysis exhibit loud, labored breathing and throat clearing, as Will did. The disease can cause life-threatening breathing obstruction if left untreated. Laryngeal paralysis is a well-known upper respiratory problem first diagnosed in the 1970s. It affects older, large-breed dogs, most commonly Labrador Retrievers and. Confusion, trouble concentrating and forgetfulness are early symptoms. Slurred speech, dramatic personality changes and agitation are examples of more severe symptoms. Eventually, encephalopathy can lead to coma and death. As the liver loses its ability to detoxify the body, harmful chemicals such as ammonia build up in the blood and brain. Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration.. In metabolic acidosis, breathing is first rapid and shallow but as.

Hospice Foundation Of America - Signs of Approaching Deat

Bad Breath - Sometimes it can be hard to tell the difference between senior dog breath and sick dog breath, but breath that has an unusually chemical smell is a warning sign for a number of diseases, and bad breath that seems excessively smelly is a sure sign of periodontal disease The patient can have eating problems, pneumonia, fever, pain, and difficulty breathing, which are all caused by the failure of the brain. In the end, dementia involves so many other parts of the body. It is important to appreciate that the brain is the engine of our bodies Difficulty breathing, often characterised as laboured panting; Inability to reach the bathroom or incontinence; Allowing your beloved companion dignity in the end. Time is a factor though. Most dog lymphoma end of life symptoms share the fact that they will lead to final days which be ones of suffering for your pet

What is a Death Rattle? How Long After the Death Rattle

By: Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care, Hospice of Southern Illinois. October is American Pharmacists Month and we are proud to present to you an educational blog series throughout the month by, Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care.Our series will help expand your understanding of the use of medications at the end-of-life Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is this latter type of breathing pattern that is referred to as Kussmaul breathing Symptoms of End-Stage Kidney Failure in Dogs. The most common signs a dog is dying from kidney failure include:. Uremia: The buildup of waste products in the body that produces a distinctive ammonia smell that is especially apparent on the breath. Pale, dry gums: The gums are duller and dry to the touch.; Mouth ulcers: Uremia causes raw mouth ulcers that are painful

Physical and Emotional Behaviors. When cats are dying, they tend to seek out hiding places, sleep a great deal and even isolate themselves to some degree. It's no reflection of your cat's love for you, it's just a natural tendency as she nears the end. Make sure the place she's chosen is warm, quiet, easy to access and free of drafts Shortness of breath, also called dyspnea, occurs when the body cannot get enough oxygen. Either the lungs cannot take in enough air, or they cannot deliver enough oxygen to the blood stream. Shortness of breath has many causes, including illness, anxiety or pollution (including tobacco smoke) Breathing Problems in Daily Life Sometimes doing things like bathing, using the bathroom, or getting dressed can make breathing problems worse. If your loved one is having trouble with daily. Labored breathing in dogs (dyspnea), rapid breathing (tachypnea), and abnormal panting are common types of breathing abnormalities that affect dogs. Labored Breathing in Dogs (Dyspnea) When dogs are working harder to breathe than circumstances warrant, they are said to be dyspneic , or suffering from dyspnea

Dollars and Pets: The cost of end-of-life services for your pet No one wants to think about saying goodbye, but it's a reality when you have pets. Chronic labored breathing or coughing Breathing difficulties can affect cats of any breed or age, and the problem can quickly become life threatening. If your cat is having problems with breathing, it should be seen by a veterinarian as soon as possible. Learn more about the causes, symptoms and treatment options of these conditions on PetMD.com Mottling, commonly though not always, occurs when someone is near the end of their life. Gurgling, also known as the death rattle, is the gurgling or rattling sometimes made in the throat of a dying person. It is due to the loss of the coughing reflex and passage of breath through a collection of mucous. Mottling and Gurgling in the Dying Stage

at the End of Life HUNTER GRONINGER, MD, Breathing Independent of vocalization Normal Occasional labored breathing Short period of hyperventilation Noisy labored breathing Difficult or laboured breathing.. End of Life. A term sometimes used for the last year of someone's life although it can mean the last few weeks or days. End of Life Care. End of life care has been defined by the National Council for Palliative Care, as 'care that helps all those with advanced, progressive, incurable illness to live as well.

In this article we will explore these difficult thoughts, signs your dog may be nearing the end of their life, decisions you will need to being making, and the process of death in dogs. These are the signs to watch for when your dog is close to dying: Restlessness. Labored breathing. Decreased appetite (stops eating Support for carers, family and close friends at end of life As a carer, friend or family member, it can be challenging when a person with dementia is approaching the end of their life. It is important to know when a person with dementia is nearing the end of their life because it can help in giving them the right care When To Euthanise A Dog With Hemangiosarcoma at Home and Gently. When dog euthanasia at home is your final option end of life care home visit vets will give you all the help and support you need. The process involves two injections - the initial one will gently send your dog to sleep - and the anaesthetic agent will slowly stop the heart

Periods of Apnea (no breathing) The person may stop breathing for 15-45 seconds. There may be periods of rapid respiration alternating with periods of apnea. This is called Cheynes-Stokes respiration. It is very common and indicates a decrease in circulation to the internal organs and build-up in the body waste products Although the symptoms of a dog's impending death vary depending on the cause, some common signs that a dog may be dying include loss of appetite, dulling eyes, weakness and extreme lethargy. Incontinence is another common symptom, especially if the dog does not move out of the soiled area. Many signs that a dog may be near death are also.

Orthopnea is associated with breathing difficulty. Utilize pulse oximetry to check oxygen saturation and pulse rate. Pulse oximetry is a helpful tool to detect alterations in oxygenation initially; but, for CO2 levels, end tidal CO2 monitoring or arterial blood gases (ABGs) would require being obtained Consulting your vet for proper end-of-life care. Towards the end of their life, give them more understanding and provide them with love and affection to show that you are with them until you finally say goodbye. Give them a beautiful send-off that they truly deserve. Contact us to find out more about our services

Mechanical ventilation is clearly an artificial method of life support. Ventilation can be life-saving in an acute illness and patients are usually put on a ventilator as a temporary measure. Difficulty breathing is part of the terminal stages of several illnesses such as large strokes or severe long-standing lung disease Breathing rate. An increase in the number of breaths per minute may mean that a person is having trouble breathing or not getting enough oxygen. Color changes. A bluish color seen around the mouth, on the inside of the lips, or on the fingernails may happen when a person is not getting as much oxygen as needed. The color of the skin may also. Blue was still eating and drinking but lost a ton of weight, was in a lot of pain and could no longer control his hind legs. at the end I had to help him walk by lifting up his hind end. He loved to run and romp around our property with his sister. Once their quality of life has worsened, it's time. They don't enjoy life like they once did Pharmacologic Pearls for End-of-Life Care PATRICK L. CLARY, MD, Exeter Hospital, Normal Occasional labored breathing; short period of hyperventilation Noisy, labored breathing; long period.

Death rattle: Signs, meaning, and duratio

Chris Longenecker, a Certified Veterinary Technician in Reading, PA, contributed to this article.Laryngeal paralysis is a condition that severely affects a pet's breathing. In the veterinary world, we tend to call it Lar Par.The larynx is the medical name for the voice box. Please note, it is larynx and not lar-nynx as many people call it ALS varies greatly from person to person and symptoms related to your breathing can start early or much later. Weakness in the muscles of respiration (breathing) can lead to a variety of symptoms. Symptoms associated with weak respiratory muscles: Air hunger (gasping, labored breathing) with an without activity. Fatigue However, many people have the following symptoms during end-stage COPD as well as in earlier stages of the illness: coughing, wheezing, large amounts of phlegm/mucus, chest tightness, pain, fatigue, insomnia, and/or constipation. As a person approaches the end of life, they may experience the following: Shortness of breath while resting

Your Dog Is Breathing Fast? See Probable Reasons AndJewish Perspectives on End-of-Life Care | My Jewish Learning

Is My Dog Dying? Here Are Some Warning Signs and Symptoms

These may include pain, fatigue, nausea, depression, anxiety, drowsiness, lack of appetite, dyspnea (labored or difficult breathing) and difficulty sleeping. Once these symptoms are under control, team members speak with patients about their end-of-life goals Lung cancer is the most common cancer in the United States, and while often treatable, it frequently progresses and causes death. Knowing the signs of impending death in someone suffering from lung cancer can be helpful for family members, caretakers and health care professionals who encounter these patients 1. If your senior's dog breath is just too smelly. Most dogs, especially the dumpster-divers, have bad breath, but excessively smelly breath is a symptom of the most common ailment in older dogs: periodontal disease. Luckily, this disease is easier to spot than many other age-related diseases, so be on the lookout for pain while chewing, loss. end of life as focus turns inward. Some animals may remain responsive and somewhat interactive until late stages. Restlessness may occur as the animal experiences changes occurring in his/her body. In case of increasing agitation give low dosed medicine already supplied by your hospice-trained veterinarian. As life energy dwindles, mos Breathing Problems in Daily Life. Sometimes doing things like bathing, using the bathroom, or getting dressed can make breathing problems worse

How to Care for a Dying Guinea Pig: 13 Steps (with Pictures

Symptoms of Labored Breathing in Dogs. Your dog will show several signs and symptoms when experiencing labored breathing. If it's dyspnea, you will see the chest and belly move while breathing. Your dog's nostrils may also flare while breathing. Sometimes, your dog will breathe with an open mouth with elbows stuck out from the body Signs a Dog is Dying 1. Balance Issues. If you notice that your dog, who normally is light on his feet and able to walk around without issues, is beginning to stumble more or is having a more difficult time moving about, there is a possibility that they are losing their sense of coordination

Difficulty in Breathing. Changing the breathing pattern should be a warning sign. Heart problems can cause shortness of breath, rapid breathing, and shortness of breath in dogs. 3. Behavior Change. Fatigue easily, unwillingness to play, reluctance to exercise, or a depressed appearance may be signed compatible with dogs with heart disease. 4 Congestive heart failure in dogs occurs when the heart is unable to pump an adequate amount of blood to the body, thus causing an increase in pressure and fluid that eventually leaks into the lungs and, less frequently, other major organs. When fluid accumulates in or around a dog's lungs, it prohibits the lungs from expanding normally and. When a patient nears the end, a feared therapy can also comfort. By Bob Tedeschi. June 21, 2016. Reprints. Armella Leung for STAT. I t was mid-October 2008 when the medics rolled the elderly man.

Changes in the last hours and days - End of life care - NH

3Labored breathing. Respiratory symptoms including labored breathing could indicate that you're in it for the long-haul. The researchers found that this symptom disproportionately affects long-COVID patients, and could also indicate a more serious case. And for more on serious signs of coronavirus, find out why 80 Percent of COVID Patients Have. Below is a list of 10 things you should do to manage symptoms of congestive heart failure in dogs to ensure your pet lives a quality life. 1. Coughing. If coughing becomes severe, contact your.

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Obesity hypoventilation syndrome is a breathing disorder that affects some people who have been diagnosed with obesity. The syndrome causes you to have too much carbon dioxide and too little oxygen in your blood. Without treatment it can lead to serious and even life-threatening health problems If she seems relatively stable over the course of the evening then she should be fine to wait. However if her breathing seems more labored, if she is breathing with her mouth open or coughing more, I would be keen to have her checked over sooner as she may need medication and/or oxygen therapy if she is struggling

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End-stage multiple myeloma is a devastating situation for the patient and the family. It is important to recognize the end-stage multiple myeloma so, that the healthcare professionals and family members can focus on palliative treatment and improve quality of life rather than treating multiple myeloma dying of cancer suffer from a number of symptoms including pain, labored breathing, distress, nausea, confusion and other physical or psychological conditions that go untreated or undertreated and vastly diminish the quality of their remaining days.iii vi Financing end of life care in the USA. A heart murmur can be detected by your veterinarian when listening to your dog's heart with their stethoscope. Murmurs can eventually lead to an accumulation of fluid in the lungs, known as heart failure. Symptoms of heart disease include coughing, difficulty breathing, weakness, or lethargy. If your dog has a murmur or any of these signs. may make a lot of noise when breathing, even at rest, which may sound like snoring, snorting or wheezing. may show signs of struggling to breathe, including excessive panting, laboured or heavy breathing - the chest and stomach may heave when breathing. may not be able to exercise normally and might have to rest on walks Free Powerpoint Templates Page 29 Breathing Changes Rate will slow drastically with breaths becoming farther apart As death does approaches, breathing may become laboured with the person gasping for air A death rattle may be present and sounds like a low throat Breaths will slow and come further and further apart until the final breath is taken. End-of-life questions inevitably lead to the question of what constitutes a good death. Does the quality of time spent with family matter more than its quantity? It is often a hard conversation to have with patients or loved ones, but David and his physician had discussed his wishes many times in the years I'd taken care of him