Does Dying Hurt? What We Know About Pain at the End of Life

This is one of the most common questions people have about death, and many are afraid to ask it. The honest answer has two parts. Dying itself is often calm. But pain can happen in the weeks and days before death, and care teams have good ways to treat it.

Does dying hurt?

Often it does not, though it can. A booklet from two U.K. hospices says that most of the time the person is not in any pain, and that the changes are a normal part of dying. The same booklet notes that some people do have pain, and that there are medicines that can manage pain or discomfort. When pain does occur, it usually comes from the illness, not from the act of dying. Not everyone nearing the end of life has pain.

What is the goal of pain treatment?

The goal is the least pain with the fewest side effects. The Cigna health library describes this as the aim of good pain management. If pain is mild, over-the-counter medicines may help. For stronger pain, doctors may use opioids, sometimes along with other medicines. The National Institute on Aging says that successfully reducing pain and breathing problems can bring needed comfort to someone who is close to dying.

Do the medicines speed up death?

No. Farleigh Hospice states that these medicines do not slow down or hasten death. They are given to relieve symptoms, not to change how long a person lives. If a medicine makes the person sleepier, that is a known side effect, and the care team will talk with the family about it.

What about changes in breathing?

Breathing often changes, and it can look frightening. It may become slower, uneven, or noisy as secretions collect in the throat. The National Institute on Aging says this noisy breathing is usually not upsetting to the person who is dying. Hospice leaflets add that in most cases breathing actually becomes easier, and that doctors can prescribe medicines so that breathing changes are not uncomfortable. For more on the sound families often hear, see What to Expect in the Final Hours.

Why might someone seem restless or confused?

Some people become restless, confused, or agitated in the last days. This can have many causes, including changes in the body, medicines, or the illness itself. Tell the care team if you see this, because they may be able to help. Hospice leaflets suggest keeping the room calm, with few changes.

Will they still know we are there?

Possibly. Farleigh Hospice says that at the very end a person may be unresponsive, but may still be able to hear you and sense that you are there. Many hospice teams encourage families to keep talking and sit close. People also need less food and fluid near the end, because their metabolism changes. This is a normal part of dying.

What should I do if someone seems to be in pain?

Tell the care team right away. Do not wait for a scheduled visit. Hospice teams ask about pain often and watch for signs of it, such as grimacing, moaning, or restlessness. Many hospices have a 24-hour phone line. For an overview, see Comfort Care Explained and What Is Hospice?.