ABSTRACT
A range of emotional reactions is normal in terminal illness, and organic effects, subtle or severe, iatrogenic or due to disease, may also produce psychological changes. In terminal care the patient's state of health distorts the phenomenology of depression. Suicidal ideas are common, and suicide is an appreciable risk in terminal disease. Four per cent of suicides in Bristol were found to have disease likely to have been fatal and J. Hinton found that 16 per cent of referrals to him of terminal disorders arose after a suicide attempt. Acute and subacute confusional states commonly come and go in terminal disease, especially in the elderly. Children are essentially realists and in a long terminal illness their personal priorities readjust so that the hierarchy of important people may run: nurses, doctors, ancillary staff, parents, siblings and friends. Psychotherapy is probably beneficial to most patients in their final illness, and for some is essential to ameliorate distress.
