I visited with a new hospice patient and her daughter last week. The patient was nearing death and was aware enough to know that her time was short. We had a wonderful conversation and they were very open to talking about everything that they may expect as she journeyed toward death. One of the daughters main concerns was what to do if her mother developed the "death rattle". She had been told by a co-worker that it was a horrible symptom to be dreaded and she wanted to be sure that we could treat it if it occurred. I reassured her that we could absolutely treat it if it developed but I also reassured her that the death rattle wasn't something to be dreaded.
Interestingly, I visited with another family over the weekend and we were discussing the hospice comfort kit. The kit our hospice sends out to patients includes a medication to dry up the excess secretions in the airway that cause the death rattle. As I was explaining this medication, the patient's daughter interrupted me and said, "But that's not really an uncomfortable symptom is it? I imagine it's probably worse for the people who have to listen to it than it is for the person experiencing it." How very astute! I affirmed her assumption, explaining that the death rattle doesn't likely cause serious discomfort. She then refused the medication saying, "If it's a natural part of death, I'd just assume let it happen and not fight it."
Two very different feelings about an often misunderstood symptom. Neither one is right or wrong. Whether the death rattle is a cause for concern and how aggressively to treat it, if at all, will vary from family to family. The role of hospice is to support the family in whatever is most important to them.
So, what causes the death rattle and how is it treated? Here is some information to help you understand one part of the natural process of dying.