Preparing together for the last weeks and days of life

Begin with what matters to you

You do not need to work through every decision in one sitting. A useful first step is to ask for a conversation with your oncologist or palliative care team, with the people you would like involved. Ask for privacy, an interpreter or help with hearing and communication if you need it.

You might begin with: “I want to understand what is happening, but I need to take it a little at a time.” Tell the team whether you want detailed information, a broad outline, or a trusted person to hear it with you. You can pause and return to the conversation.

If you are a family member, ask what the patient wants to know rather than assuming what they can bear. If you are worried that information will upset them, explain that concern privately to the doctor, who can explore the patient’s own preferences.

• What matters most to me now, and what would make an ordinary day easier?
• What am I most worried about?
• Who would I like beside me, and who may receive information about my health?

Understand what is happening and what may come next

Before weighing treatments, ask the team to explain the overall situation. Is the cancer responding? Could a new problem be treated? Is the aim recovery from this episode, a period of stability, or comfort as life draws to a close? The expected course of an illness is called its prognosis.

If you want to discuss time, ask whether the team is thinking in terms of months, weeks or days, and how uncertain that estimate is. No clinician can give an exact date. Ask what changes would lead them to reassess; some people stabilise or improve for a time.

A sudden deterioration should not automatically be attributed to dying. Infection, a medicine effect or a blockage may need assessment and treatment. Ask who will review a new change and how the plan would change if you improve.

It is reasonable to say: “Given what you know about my illness and what matters to me, what do you recommend, and why?” You should not have to choose between unfamiliar treatments without an explanation.

Understand the care that will continue

Palliative care aims to improve comfort and quality of life. It helps with physical symptoms, emotional distress, family needs and spiritual concerns, and can be provided alongside cancer treatment. Ask for this support when it would help; it is not restricted to the final days.

The team may use the phrase goals of care to mean what treatment is trying to achieve. If further cancer treatment is unlikely to offer enough benefit, ask what will replace it in your care plan: who will manage symptoms, arrange medicines, support you at home and review changes. Comfort-focused care still involves active treatment and attentive nursing.

Decisions should address each treatment separately. A decision about one cancer treatment does not automatically decide whether antibiotics, fluids or hospital care are appropriate. Do not stop medicines, feeds, oxygen or medical devices yourself. Ask for a medication review and a named clinician responsible for the continuing plan.

Keep your voice central and choose who supports you

An adult who can make an informed decision remains the person whose consent or refusal matters. Decision-making capacity means being able to understand and retain the information long enough to weigh the choices and communicate a decision. Needing help to speak, being older, having a disability or disagreeing with relatives does not by itself mean someone cannot decide. Ask the team to assess uncertainty and provide communication support.

Record a trusted supporter, next of kin and an alternative contact, including who may receive updates. These people can help with conversations and practical tasks. Their contact role is different from formal authority to make medical decisions; being a spouse or caregiver does not automatically give unrestricted authority over every decision.

If the patient cannot decide, the team must identify the appropriate representative or surrogate and follow the applicable legal process. The discussion should consider the patient’s known wishes and best interests: the likely benefits and burdens for this person, not simply what others would choose for themselves. Tell the team about any existing document naming a representative.

Treatment choices, ICU care and CPR

Once the team understands your priorities, discuss what should happen if you become more unwell. Escalation of care means increasing treatment, such as admission to hospital or an intensive care unit (ICU), a ventilator to support breathing, or other organ support. These options have different purposes, benefits and burdens.

Ask what each treatment could realistically achieve for you, what receiving it would involve, and what care would be offered if it is unlikely to help. You can ask for a clinical recommendation and time to discuss it with the people you choose.

When benefit is uncertain, the team may suggest a time-limited trial. Agree what improvement it is looking for, when progress will be reviewed and who will explain the next decision. A review date does not authorise automatic withdrawal of treatment. Comfort and symptom relief need a plan throughout.

• What problem would this treatment address, and could that problem improve?
• What outcome are we hoping for, how likely is it, and what burdens would treatment involve?
• If it does not help, how will we review the options and keep me comfortable?

CPR, DNR and DNAR: a specific decision

Cardiopulmonary resuscitation (CPR) is an emergency attempt to restart circulation and breathing after a cardiac or respiratory arrest. It may involve chest compressions, breathing support, medicines and, when appropriate, an electric shock. Ask about its realistic chance of helping this particular person recover to a condition they would find acceptable; the answer depends on the illness and the cause of the arrest.

DNR means do not resuscitate; DNAR means do not attempt resuscitation. Both refer to CPR after an arrest. A DNAR decision does not by itself mean no treatment, no admission, no antibiotics or no symptom relief. Hospital admission, ICU care and other treatments need their own discussion.

The Indian Council of Medical Research (ICMR) guidance places responsibility for the clinical DNAR decision with the treating physician, after an informed discussion with the patient or appropriate surrogate. Ask for the documented resuscitation plan, what it covers and when it will be reviewed. A family worksheet cannot issue this medical order.

When life support may no longer help: India and Karnataka

A conversation about life support can feel frightening. It should begin with what the treatment is trying to achieve, what recovery is realistically possible and what matters to the patient. Having advanced cancer, needing help at home or being older does not by itself mean that life support should be stopped.

Life-sustaining treatment supports an essential body function, for example a ventilator that supports breathing or dialysis that replaces some kidney functions. Withholding means not starting a particular treatment; withdrawing means stopping one already being given. These are decisions about a specified treatment, not withdrawal of all care. They are also separate from a decision about CPR after an arrest.

A patient who can understand the decision, weigh the information and communicate a choice should be supported to make an informed decision, including refusing a treatment. When the patient cannot decide, wishes previously expressed, any applicable advance medical directive and their best interests become important. Being next of kin does not give a relative unrestricted authority to stop treatment.

India’s framework comes from Supreme Court decisions, including Common Cause, modified in January 2023, and Harish Rana in March 2026. In the circumstances covered by the framework for patients unable to decide, safeguards include Primary and Secondary Medical Boards, appropriate consent, documentation and the prescribed review process. This is not a decision for the family to carry out on its own.

Karnataka’s order of 30 January 2025 helped put the Secondary Medical Board nomination arrangements into practice. It must now be read with the Supreme Court’s later 2026 directions on case-by-case nomination and other safeguards. Ask the hospital to explain the current pathway for this patient. The order is not blanket permission to withdraw treatment, and it does not mean that cancer alone meets the requirements.

Where recovery is uncertain, a time-limited trial of treatment may help: agree what improvement would look like and when the team will review it. Reaching that date calls for reassessment, not automatic withdrawal. If opinions differ, ask for a family meeting, a clear explanation of the medical reasoning and the hospital’s route for another opinion or review.

Whatever is decided about a particular treatment, relief of pain, breathlessness and distress, nursing care, communication and support must continue. Active euthanasia—an intervention intended to cause death—is different and remains unlawful in India. The care-preferences worksheet helps you prepare questions; it cannot authorise withholding or withdrawal.

• Which treatment are we deciding about, and is there a reversible problem it could help?
• What would continuing it, a trial of it, or not using it mean for comfort and possible recovery?
• How will the patient’s wishes be heard, and which safeguards and review steps apply here?
• What care will continue, who will coordinate it, and whom can we contact if we are unsure?

Record your wishes: advance care planning in India

Advance care planning is the process of talking about your values, worries and future care while you can participate. It can begin with a conversation and be revisited as your wishes or health change. An advance medical directive (AMD), also called a living will, is a separate formal document with legal requirements. It is different from a will about property.

A directive does not take effect simply because a family presents it. Its authenticity, the patient’s capacity, the clinical circumstances and the required institutional process must be assessed. A patient’s present informed wishes should not be overridden by an older document.

If you want a formal directive, ask the treating team and an appropriately qualified legal adviser about the current requirements in your state for making, witnessing or attesting, storing and implementing it. If one already exists, tell the team where the latest copy is held, whom it names and whether it has been amended or revoked.

Turn the conversation into a plan you can find

The care-preferences worksheet helps you record what matters, who should be involved, unanswered questions about CPR and escalation, and where existing medical or legal documents are held. You can leave questions blank. Ask the team to check the medical details and provide a copy of the clinical plan.

This worksheet records a conversation. It is not a DNAR order, an advance medical directive, a consent form, or permission to limit treatment. The treating team must assess and document the clinical plan and follow the applicable legal process.

Review the plan after a major change in health or wishes, or a move between care teams. Make sure those providing care can find the current, verified documents. If there is disagreement, ask for a family meeting, clarification of the patient’s wishes or an independent clinical opinion. Palliative care, hospital administration or an ethics service may help where available.

Tell the team about financial pressure or caregiver exhaustion so it can explore support. Neither should be taken as an assumption that the patient wants treatment limited.

A short checklist for your next conversation

Choose the questions you need answered now. Before the conversation ends, ask someone to summarise the agreed plan, what remains undecided and who will follow up.

• What is happening now, what remains treatable and what might change next?
• What care do you recommend in light of my wishes, and who will provide it?
• Have we discussed CPR separately from other treatment and recorded the clinical plan?
• Who may receive information, and who has a verified decision-making role if I cannot decide?
• Does an existing advance directive need formal review or verification?
• Who answers at night, what should we do if they cannot be reached, and what is the plan for an expected death at home?
• When will we review the plan, and who will receive the updated copy?

Choose where care can work for you and your family

With the care goals clearer, discuss where the necessary support can be provided: at home, in hospital or through a hospice where available. Hospice care focuses on comfort and support towards the end of life; the services and settings available vary locally.

Consider your preferences alongside symptoms, visiting arrangements, costs and the help available day and night. Choosing hospital care is not a family failure. A preference for home can change if your needs or the support available change.

Before going home, confirm who can visit, how medicines and equipment will arrive, who teaches their use and what happens if the main caregiver becomes ill. Check a usable bathroom, safe transfers and a resting place for the caregiver. A listed service does not guarantee a bed or round-the-clock response.

Before going home: check the practical plan

Use the home-comfort worksheet with the team before discharge or when needs increase. Keep it with the medicine list and verified clinical documents. Confirm the service hours and the response you can expect; a general clinic number may not be an emergency line.

Ask about anticipatory or “just in case” medicines for symptoms that may develop. The team should prescribe an individual plan, explain who can give each medicine and arrange help if swallowing becomes difficult. Having medicines ready does not mean giving them automatically.

• Who is responsible for care, and what are the daytime, out-of-hours and backup contact numbers?
• What are the written instructions for pain, breathlessness, confusion, vomiting or difficulty swallowing?
• Who supplies medicines and equipment, teaches their use and helps if supplies run out or equipment fails?
• Where is the nearest appropriate emergency facility, and how would transport be arranged?
• Who holds the verified resuscitation and escalation plan, and can another care team find it?
• If death is expected at home, whom should the family call and who can attend to confirm it?

Changes you may notice, and ways to offer comfort

Families often feel more confident when someone explains what they may see and what they can do. Ask the team which changes it expects in this person’s illness. Sleeping more, eating less or becoming weaker may occur near the end of life, but no single sign confirms that someone is dying or tells you how long remains.

The suggestions below support the individual care plan. Report a new or troubling change so the team can assess whether a reversible problem needs treatment. You can offer comfort while getting advice; you do not have to work out the cause yourself.

Food, drink and mouth care

Offering food is one way families show care, so it can be upsetting when a person wants less. Offer small amounts they want when they are awake and can swallow safely. Ask for advice about coughing, choking, food held in the mouth or increasing drowsiness. Do not force food, drinks or tablets into someone who cannot swallow.

Ask a nurse to demonstrate gentle mouth and lip care. Clinically assisted hydration means fluids given through a drip or another medical route; assisted nutrition may involve a feeding tube. These can have benefits and burdens that need an individual assessment. Discuss thirst, comfort, fluid overload and the person’s wishes with the team. Starting or stopping them requires the appropriate clinical, consent and legal process, rather than a decision based on this guide.

Pain, nausea and other symptoms

Tell the team about pain, nausea, constipation, anxiety or difficulty passing urine, including symptoms the person feels reluctant to mention. If speech becomes difficult, describe grimacing, moaning, restlessness or discomfort during movement. These observations help assessment but do not identify the cause by themselves.

Ask which medicines are taken regularly and which are prescribed for breakthrough symptoms — symptoms that occur despite the regular treatment. Keep the written instructions and contact number together. Call if the plan is not helping; do not borrow medicines or change doses yourself.

If swallowing becomes difficult, contact the team promptly about a suitable alternative way to give medicines. Do not crush tablets unless a pharmacist confirms it is safe.

If oral morphine or another opioid is prescribed, ask which authorised service will supply it, how to obtain refills before it runs out, and whom to call if it is unavailable. Keep the prescription, dosing instructions and medicines secure. Your healthcare team can help you access these medicines. Availability and home support may vary between centres.

Breathlessness, breathing changes and confusion

Breathlessness, also called dyspnoea, needs assessment. Help the person into a comfortable supported position and follow their individual plan. Oxygen helps in particular situations rather than every case. After assessment, the team may prescribe an opioid for breathlessness in the last days of life; medicine choice and dose must be individualised. Do not use someone else’s prescription.

Irregular or noisy breathing can occur as swallowing and coughing become weaker near death. The sound can worry families, but noisy secretions are unlikely to cause discomfort to the dying person. Ask the team to assess distress and explain positioning or other measures that may help; new or sudden breathlessness should not simply be assumed to be part of dying.

A new disturbance in attention or awareness, often with confusion, is called delirium. It can have several causes, including infection or medicines. Sudden confusion, marked agitation or unusual sleepiness needs urgent clinical advice or assessment. If the change is unexpected, the plan is unavailable or help cannot be reached, seek urgent assessment.

While getting help, keep the surroundings calm and use a familiar voice and simple words. Glasses or hearing aids may help if the person uses them. Avoid arguing, restraining them or adding sedating medicines without clinical advice.

Positioning, skin care and being together

Ask a nurse to demonstrate comfortable positioning, skin care, safe transfers and prevention of pressure injuries, also called pressure sores. Move gently, explain what you are doing and respect a wish to rest. Do not lift alone if it is unsafe. Seek help for persistent wetness, sores or discomfort.

Someone who responds less may still find a familiar voice or gentle touch comforting. Ask before touching and avoid demanding a response. Music, silence, prayer or ordinary conversation may be welcome. You do not have to find perfect words or stay at the bedside every minute to show love.

When to get urgent help

Follow the team's personalised emergency plan. Seek immediate help for sudden severe breathlessness, major bleeding, collapse, a new seizure, chest pain or rapidly worsening distress. During chemotherapy, a temperature of 38°C (100.4°F) or above requires immediate contact or urgent assessment; follow a lower threshold if your unit has given one.

If the change is unexpected, the plan is unavailable or you cannot reach the team, seek urgent medical assessment rather than assuming it is part of dying. If someone is unresponsive or not breathing normally and there is no immediately available, verified clinical plan for that situation, contact local emergency services and follow their instructions. A CTI worksheet must not be used to delay emergency care.

Even when dying is expected and a documented comfort-focused plan exists, call the designated service if symptoms are not controlled or you feel unable to cope. A DNAR decision is never a reason to leave someone distressed without help.

Keep your healthcare team’s emergency number and the local ambulance service number handy, alongside the agreed day-and-night contact plan. Do not wait for a routine clinic reply during an emergency.

Make room for family life and support

Care is also about the people and moments that matter. With permission, arrange visits, calls, rituals or quiet time. Ask about privacy, modesty, preferred language and spiritual support without assuming a particular faith. Children benefit from honest, age-appropriate explanations and a reliable adult who can answer their questions. Our guide to talking with children offers words you can adapt and ways to prepare them for a possible loss.

Share practical tasks rather than expecting one person to do everything. Someone may coordinate updates, another collect medicines, and another cover meals or transport. Keep essential documents and contacts accessible to authorised people. Protect passwords and sensitive records rather than circulating them in a family group.

Legal, financial and inheritance arrangements need their own advice. A medical supporter or next-of-kin entry is not a financial power of attorney.

Caregivers need rest and help too

Ask for a rota that includes rest, meals and someone who can take over. Say early if you cannot manage lifting, overnight care, costs or medication tasks. The team can help explore nursing, social-work or other local support; availability varies.

Fear, sadness, anger, guilt and relief can coexist. You are not expected to manage severe symptoms alone. If distress is overwhelming or you feel unsafe, seek urgent professional help and ask a trusted person to stay with you. Ask about counselling or bereavement support before and after the death.

After a death: take one step at a time

You can leave this section until you need it, or ask a trusted person to read it with you. Knowing whom to call in advance can ease some of the practical uncertainty. The first step is appropriate medical confirmation and guidance.

For an expected death at home, follow the agreed contact plan so that a qualified professional can attend and guide the required confirmation and documentation. If death is unexpected, uncertain or potentially related to an injury or other unnatural cause, contact emergency services; police or medicolegal procedures may be required. Do not assume that cancer removes those requirements.

In hospital, ask the ward who will explain the next steps and provide the relevant documents. Ask what time is available for family or religious practices within local requirements. Do not remove medical devices, arrange transport or move the body before the responsible team advises what is appropriate.

Know which documents are needed

Ask who confirms the death, who provides the medical certificate of cause of death where required, and who reports the death to the local registrar. The medical cause-of-death certificate and the civil death certificate issued through registration are different documents.

Death registration is generally reported within 21 days to the authority for the place where the death occurred. Ask the hospital or local registrar about the current procedure, required documents and any delayed-registration process. A death in another city is not necessarily registered in the person's hometown. Check spelling, dates and identifying details promptly, and keep secure copies of documents received.

A practical checklist for the family

Let one trusted person coordinate practical calls while others support the family. Some tasks can wait; ask which have a deadline. Use the after-death sheet to record the responsible person and what has been confirmed, without publishing private identifiers.

• Confirm the medical and registration contacts, documents and any medicolegal requirements.
• Ask about local cremation or burial requirements, transport and any permissions before travelling with the body.
• If donation was wished for, contact the treating team or authorised donation service promptly; eligibility and timing need specialist confirmation.
• Ask the pharmacy how to return or safely dispose of unused medicines, especially controlled medicines; do not give them to someone else.
• Arrange equipment return, a follow-up contact and help for dependants or a caregiver living alone.
• Seek separate advice for insurance, benefits, nominations and estate matters. Medical worksheets do not determine inheritance.

Grief and support in the time afterwards

Grief may involve numbness, yearning, anger, disrupted sleep or unexpected moments of ordinary life. People in the same family may grieve differently. There is no requirement to feel a particular way or move through fixed stages in order.

Ask someone to help with meals, appointments and essential paperwork. Offer children honest, age-appropriate explanations and opportunities to ask questions. A follow-up conversation with the care team can help clarify what happened. Seek professional support if distress is overwhelming, daily functioning remains very difficult or you feel unable to stay safe. You do not need to wait for a particular anniversary to ask for help.

Worksheets for this guide

Use only the pages that help. These are optional discussion aids; ask the team to check medical information and keep completed copies securely.

• Care preferences and medical decisions

  Discuss information wishes, supporters, representatives, CPR and other treatment separately, and record where verified medical or legal documents are kept.

  Fill in on this deviceDownload fillable PDF (4 pages)
• Home comfort and contact plan

  Agree realistic home support, out-of-hours help, prescribed symptom care and a backup plan with the treating team.

  Fill in on this deviceDownload fillable PDF (3 pages)
• Practical support after a death

  Prepare locally confirmed contacts and document questions, share practical tasks and identify support for the family.

  Fill in on this deviceDownload fillable PDF (2 pages)
• Comparing treatment choices

  Compare two clinically relevant options using the same questions, with the patient’s priorities alongside benefit, burdens and uncertainty.

  Fill in on this deviceDownload fillable PDF (4 pages)

Related reading

• Patient and family guides and printable tools
• Palliative care does not mean giving up
• Stage 4 cancer: what it means today
• Caregiver toolkit
• Costs and financial support