This study investigated the pattern and determinants of hyoscine (scopolamine) use for death rattle by a retrospective analysis of 100 consecutive deaths in a 22-bed hospice. Patient diagnoses, duration of stay, and doses and route of administration of hyoscine used in the final 48 hr before death were recorded. One-half of the patients received hyoscine in some form during the final 24 hr before death. Patients who were in the hospice for longer than 9 days and those with cerebral malignancy were given the highest doses of hyoscine in the final 24 hr (z = -2.558, P = 0.011, and z = -1.968, P = 0.048, respectively). Response to hyoscine appears to be variable, and a distinction is proposed between death while due to salivary secretions (type 1) and that due to bronchial secretions (type 2) to explain the observed patterns of use. It is likely that hyoscine is more efficacious in treating type 1 death rattle than it is in treating type 2 death rattle.