Definition

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
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.

Symptoms
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.

Dying

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.
Pre-active Phase

 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

Active Phase

 Person states that he or she 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

Causes
Treatments
As a family member or friend of a dying individual, you may aim to do the following:

 Comfort and rest (back rubs, holdings hands, reading and background music can be very
comforting and help decrease a person's sense of being alone)
 Prepare for physical problems (lip balm or salve prevent chapped lips, for example)
 Welcome visitors and children, or ask the person who he or she would like to see and
invite those people
 Prepare a list of people to call near the time of death
 Talk with a friend about your feelings
 Feel free to say good-bye at the place of death

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:

 Be grateful and accept help

 Don't be afraid to ask to be alone
 Be your own counsel no one, including your physician, religious counselor, spouse or
friends can understand 100 percent what you want and need
 Some people may treat you differently after learning that you are dying.
 Slow down, and ask your family and friends to slow down. There may not be a lot of
time, but there is sufficient time, except in the most extreme cases, to think, plan and
prepare
 Search for, and then trust in, a single individual. This does not mean you should not listen
to and follow reasonable directions and advice. But focus on one individual as the final
helper.
 Ask your health care provider to explain what is being done to you so that you can
understand why things are being done and call the health professional if you are
concerned or uncertain and need more explanation.
 You should be aware that nurses and other hospital staff may not know that you are
dying. This fact may not be written in your chart, and can lead to conflicts between
families and hospital staff.
 Pre-planning will give your loved ones both assurance that your wishes are being
followed and peace of mind from the knowledge that decisions have already been made.
 Consider getting a durable power of attorney in which you name one or two people to
make decisions or choices on your behalf if you should become incapable of making
decisions.

Use resources that are available from the health care community. These include social services
and psychological, financial and religious counseling, as well as hospital financial counseling.