Changes in breathing (indicate neurologic compromise and impending death) and accumulation of upper airway secretions (resulting in crackling and gurgling breath sounds) 
Decreased need for food and fluids, and loss of appetite (caused by the bodys need to conserve energy and its decreasing ability to use food and fluids properly). Decreased oral intake and impaired swallowing (caused by general physical weakness and metabolic disturbances, including but not limited to hypercalcemia) 
Loss of bladder or bowel control (caused by the relaxing of muscles in the pelvic area). Darkened urine or decreased amount of urine (caused by slowing of kidney function and/or decreased fluid intake). Skin becoming cool to the touch, particularly the hands and feet; skin may become bluish in color, especially on the underside of the body (caused by decreased circulation to the extremities). Rattling or gurgling sounds while breathing, which may be loud (death rattle); breathing that is irregular and shallow; decreased number of breaths per minute; breathing that alternates between rapid and slow (caused by congestion from decreased fluid consumption, a buildup of waste products in the body, and/or a decrease in circulation to the organs). Turning of the head toward a light source (caused by decreasing vision). Increased difficulty controlling pain (caused by progression of the disease). Involuntary movements (called myoclonus), increased heart rate, hypertension followed by hypotension, and loss of reflexes in the legs and arms are additional signs that the end of life is near.
United States
As of 2019, physician-assisted dying is legal in eight states (California, Colorado, Hawaii, Maine, New Jersey, Oregon, Vermont, Washington) and Washington D.C.Spending on those in the last twelve months accounts for 8.5% of total aggregate medical spending in the United States.When considering only those aged 65 and older, estimates show that about 27% of Medicares annual $327 billion budget ($88 billion) in 2006 goes to care for patients in their final year of life. For the over-65s, between 1992 and 1996, spending on those in their last year of life represented 22% of all medical spending, 18% of all non-Medicare spending, and 25 percent of all Medicaid spending for the poor. These percentages appears to be falling over time, as in 2008, 16.8% of all medical spending on the over 65s went on those in their last year of life.Predicting death is difficult, which has affected estimates of spending in the last year of life; when controlling for spending on patients who were predicted as likely to die, Medicare spending was estimated at 5% of the total. See also
Advance health care directive
Death midwife
Hospice
Liverpool Care Pathway
Palliative care
Childrens palliative care
Physician assisted suicide
Robert Martensen

References
Further reading
External links
"End of Life Issues". MedlinePlus. "EndLink - Resource for End of Life Care Education". Robert H. Lurie Comprehensive Cancer Center. Northwestern University. Archived from the original on 2010-11-18. "End of life care". NHS Choices. 29 May 2018. "End of Life Care Strategy - promoting high quality care for all adults at the end of life". Publications policy and guidance. UK Department of Health.