Death marks the end of life.
Death is the one great certainty in life. Some of us will die in ways out of our control, and most of us will be unaware of the moment of death itself. Still, death and dying can be approached in a healthy way. Understanding that people differ in how they think about death and dying, and respecting those differences, can promote a peaceful death.
The primary course of action when death is near is to fulfill the dying person's wishes. If the person is dying from an illness, ideally, they will have participated in decisions about how to live and die. If the requests made do not seem practical to the caregiver, options should be raised with the dying individual to try to accommodate his or her request and still provide adequate care. If the dying individual has not been able to participate in formulating final plans, you should strive to do what you think this person would want.
If the individual is in a hospice, he or she may desire a natural death. In this situation, the aim will be for the final days and moments of life to be guided toward maintaining comfort and reaching a natural death.
Cardiopulmonary criteria have traditionally been used to declare death. When breathing ceases 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 or she is nearing death, each day the person may grow weaker and sleep more, especially if their 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. At this time, the pulse is absent.
The individual 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.
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
As a family member or friend of a dying individual, you may aim to do the following:
Guidelines are also suggested for the person who is dying. Foremost is taking care of himself or herself. Other suggestions are to think ahead about what could happen—and about how you will deal with problems if they do occur—and to create a better quality of life for yourself and for the people who love and care about you. Ideally, death and dying should be peaceful for you, the dying person and for the people who love and care about the dying individual. Helping friends and family deal with your death may help you find peace and comfort. If you are not at peace with death, you should seek advice from your health care provider.
More specific guidelines for the dying individuals include:
Bone, R. C. (1997). Benediction: A farewell to my medical colleagues. Consultant, 37(9), 2505-2507.
van der Kloot Meijburg, H. H. (2005). The significance of dying well. Illness, Crisis & Loss, 13(1), 49-62.
Kramer, K. (2005). You cannot die alone: Dr. Elisabeth Kübler-Ross (July 8, 1926–August 24, 2004). OMEGA-Journal of Death and Dying, 50(2), 83-101.
Kübler-Ross, E. (2009). On death and dying: What the dying have to teach doctors, nurses, clergy and their own families. Taylor & Francis.
Hospice Patients Alliance
Harvard Ad Hoc Committee on Brain Death
Last reviewed 04/19/2017