What Happens and What Matters

__Abstract__ Palliative and terminal care. In 2002 the World Health Organization redefined palliative care as “an approach that improves the quality of life of patients and their family facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”. Palliative care can be provided at any time during a patient’s incurable illness, and may be combined with disease-modifying and life-prolonging treatment. Although there is no consensus, neither in clinical practice, nor in scientific literature, on definitions of ‘terminal phase’, ‘terminally ill’ and ‘end of life’, or on similar terms used to describe the care at the end of life, these terms mostly are used for patients whose life expectancy is three months or less. The dying phase is mostly described as the final hours or days of life, when the patient is “actively dying”, and care for the dying as care provided during these final moments. Demographic changes, especially the risen life expectancy, have contributed to an increase in the number of elderly persons in our Western society. Since the last decade, this results in a slowly increasing number of deaths each year in the Netherlands, i.e. from 136.000 in 2005 to 141.000 in 2012. Of these deaths, 73.000 to 108.000 occur after a period of decline in health, and of palliative care, depending on how this is defined