Cardiopulmonary criteria have traditionally been used to declare death. When breathing ceased and the heart no longer beats, the person is said to have died.
Brain death is another standard for declaring death that was adopted by most countries during the 1980s. The brain death standard was originally recommended in 1968 by a Harvard panel of experts that studied patients in irreversible coma. They concluded that once a patient's whole brain no longer functions and cannot function again, the brain is dead. Cardiorespiratory death invariably follows.
If an individual is dying from a chronic illness as he is nearing death, each day the person may grow weaker and sleep more, especially if his pain has been eased.
Near the very end of life, the person's breathing becomes slower—sometimes with very long pauses in between breaths. Some pauses may last longer than a minute or two. The final stage of dying is death itself. You will know death has happened because the individual's chest will not rise and you will feel no breath. You may observe that the eyes are glassy. When you feel for pulse, you will not feel it.
The individual dying and facing eventual death may go through two main phases prior to actual death. The first stage is called the pre-active phase of dying and the second phase is called the active phase of dying. The pre-active phase of dying may last weeks or months, while the active phase of dying is much shorter and lasts only a few days, or in some cases a couple of weeks.
- Person withdraws from social activities and spends more time alone
- Person speaks of "tying up loose ends" such as finances, wills, trusts
- Person desires to speak to family and friends and make amends or catch up
- Increased anxiety, discomfort, confusion, agitation, nervousness
- Increased inactivity, lethargy or sleep
- Loss of interest in daily activities
- Increased inability to heal from bruises, infections or wounds
- Less interest in eating or drinking
- Person talks about dying, says that they are going to die or asks questions about death
- Person requests to speak with a religious leader or shows increased interest in praying or repentance
- Person states that he is going to die soon
- Has difficulty swallowing liquids or resists food and drink
- Change in personality
- Increasingly unresponsive or cannot speak
- Does not move for longs periods of time
- The extremities—hands, feet, arms and legs—feel very cold to touch.
- Not all people show these signs. These signs of death are merely a guide to what may or often happens; some may go through few signs and die within minutes of a change being noticed
Death and Dying. Last reviewed 07/01/2008
- The Significance of Dying Well. Illness, Crisis & Loss
- British Medical Journal
- You Cannot Die Alone Elisabeth Kubler-Ross
- Death and Dying: Mount Sinai School of Medicine, New York. Encyclopedia of Life Sciences
- A Dying Person's Guide to Dying, Roger C. Bone, M.D. The American College of Physicians
- American College of Physicians; What to Do Before and After the Moment of Death.
- Hospice Patients Alliance
- Harvard Adhoc Committee on Brain Death