For most patients with advanced illness there is a gentle ‘winding down’ of the body’s systems. Even in cardiac and respiratory failure, sudden, dramatic deaths are uncommon. As they approach the end, their circulation slows so that their fingers, nose and toes feel cool and are a little bluish or mottled. Their breathing pattern may change and become slower or irregular. At the end it is more a gentle absence of life, than a sudden presence of death. Peaceful silence is the most obvious feature.