http://www.nationalmssociety.org/about-multiple-sclerosis/living-with-advanced-ms/index.aspx   On this page, please find the document listed below the main article and video, called "Advanced MS: a guide for families" . Print it off and refer to it often as things change.    for those in the UK, there is a similar link: http://www.mssociety.org.uk/downloads/MS_Essentials_16_Support_for_people_severely_affected_by_MS_-_web.8df5f599.pdf   Read both, as each one has important info.   to read more about Palliative care:   http://www.mssociety.org.uk/about_ms/care_and_support/support_for_people_severely_affected_by_ms/palliative_care.html   signs: in addition to all the typical MS symptoms of stiffness and being bed or wheelchair bound, what makes it end stage is new or worsening problems with Breathing- shallow and ragged sounding, labored, pneumonia, Swallowing problesm that result in choking on food, fluids, saliva, talking, worsening bladder and bowel problems, having a permanent catheter, pain patches such as morphine or fentanyl patch, disoriented, lack of focus, crying out in the night, not sleeping through the night, needing more and more from you because they are uncomfortable, such a drink, repositioning, more pain medication. Changes in mental attitude, worsening depression, forgetful, worried, anxious, confused....   While most MS does not take this form, for the 10% who do, they need info. I think you will answers to all your questions at those links.