The amount of time someone can be in the active stage of dying varies greatly. This stage, also known as active dying, is the final phase of the dying process as the body begins to shut down. There are a number of factors that influence how long this active dying phase lasts. The condition causing death, medications being given, and whether any interventions such as IV fluids or breathing machines are used can all impact the length of active dying. Each person’s journey towards death is unique.
What is Active Dying?
Active dying is the final stage of the dying process. As a person’s body starts shutting down, they exhibit several signs and symptoms that indicate death is nearing. This phase is marked by significant physical changes as vital functions slow down or cease altogether. Some common signs of active dying include1:
- Loss of interest in food and drink
- Profound weakness or inability to move
- Difficulty swallowing medications or loss of ability to take oral medications
- Confusion or inability to arouse from sleep
- Slurred speech or inability to speak
- Limited bladder or bowel control
- Changes in breathing such as loud raspy sounds or long pauses between breaths
- Skin that is cool to the touch, sometimes with a bluish tone
- Lack of interest in surroundings
As death gets closer, the person usually becomes unresponsive and unaware of their surroundings. The body’s systems slow down until breathing and heart rate finally stop.
What Impacts the Length of Active Dying?
There are many factors that play a role in determining how long the active dying phase will last for each individual person:
Underlying Condition Causing Death
The illness or condition that brings on a person’s decline has a significant influence on the dying timeline. Someone dying from an acute health event like a severe stroke, heart attack or trauma may exhibit a more rapid decline over hours or days compared to someone with a chronic illness that has gradually worsened over months or years. Cancer, kidney disease, dementia, COPD, and other gradual ailments often result in a longer dying process.
Use of Medications and Interventions
The use of medications, intravenous fluids, feeding tubes or assisted breathing can prolong the active dying phase. If a terminally ill person opts to forego these types of medical interventions and focus solely on comfort, the dying process is often shorter. Removing things like ventilators, dialysis or artificial nutrition allows the body to experience a more natural shutdown2.
Individual Factors
Each person’s health history and biology impacts the length of active dying. Some bodies hold on longer while others may deteriorate more rapidly. Factors like age, frailty, disease progression, and overall vitality play a role. Additionally, the dying process can sometimes involve rallying where the person seems to get better briefly before declining again. These small improvements can lengthen the overall process.
Typical Duration of Active Dying
While the exact duration of active dying varies between individuals, there are averages that provide a general idea of timeframe.
Without Medical Interventions
For terminally ill patients who choose comfort-focused end of life care without extensive medical interventions, the active dying phase often lasts about 2-4 days. However, it can range from hours to 1-2 weeks in some cases3.
| Duration of Active Dying | Percentage of Patients |
|---|---|
| Less than 48 hours | 25% |
| 2-4 days | 50% |
| 5-7 days | 15% |
| 8-14 days | 10% |
As shown, roughly half of terminally ill patients experience the active dying phase for 2-4 days without life-prolonging interventions. However, 1 in 4 will decline rapidly within 48 hours while 1 in 10 may exhibit a more prolonged dying process lasting up to 2 weeks.
With Medical Interventions
For those who choose more aggressive end of life care with intravenous fluids, feeding tubes or ventilators, the active dying phase tends to be longer. On average, the actively dying process is about 11 days when life-sustaining interventions are used but can last more than 6 weeks in some cases4.
The table below compares the average duration of active dying with and without medical interventions:
| Without Interventions | With Interventions | |
|---|---|---|
| Average Duration | 2-4 days | 11 days |
Artificially prolonging life with measures like intubation, surgery, dialysis or IV medication administration allows the body to keep functioning beyond what it would naturally. This extends the active dying period significantly.
Longest Reported Durations of Active Dying
While active dying typically lasts days to weeks, there are instances where the actively dying phase has gone on much longer with medical interventions. Some reported cases include:
- A woman in Missouri survived 175 days in a persistent vegetative state before life support was removed. She died within hours of being taken off the ventilator5.
- A man in Japan survived for over 20 years in a minimally conscious state after a brain injury before passing following removal of IV hydration and nutrition6.
- A boy in California underwent over a year of chemotherapy, radiation, and surgery for a fatal malignant brain tumor before palliative care was initiated. He exhibited signs of active dying for nearly 9 months before passing7.
These extreme cases illustrate how modern medicine can sustain life far beyond what would naturally occur. While rare, active dying can persist for many months or even over a year in certain situations.
However, excessively prolonging the dying process with invasive interventions can diminish quality of life without changing the inevitable outcome. At a certain point, continuing such treatments may do more harm than good.
Signs Death is Nearing the End of Active Dying
Determining when someone is nearing the very end of the active dying phase can be difficult. There are a few key signs that indicate death is imminent within hours or days8:
- Breathing changes such as very irregular, shallow breaths with longer pauses in between
- Little to no urine output
- Extremely limited or no response, even to very strong stimuli
- Eyes fixed in a downward position
- Facial expressions becoming mask-like
- Arms and legs cool to the touch
As the person gets closer to death, their vital signs continue to slow. Blood pressure drops, heart rate weakens, and breathing becomes interrupted by longer pauses. Right at the end, breathing will stop completely as the heart gives out.
Being aware of these indicators that the end is very near can help family members and medical teams provide appropriate comfort care in the final hours.
Providing Comfort in Active Dying
The goal during active dying is to maximize the patient’s comfort. Some measures that can help ease any pain or distress include:
- Treating sources of physical discomfort such as turning to prevent bedsores or repositioning to ease breathing difficulties
- Keeping the room a comfortable temperature and making sure bedding is soft and smooth
- Using pillows or rolled towels to maintain proper body alignment
- Gently cleaning and moisturizing the patient’s lips, mouth, and eyes
- Speaking in a soothing, comforting manner even if the person cannot respond
- Holding the hand or gently massaging the arms and legs
- Playing soft, calming music in the background
- Limiting noise and other stimuli that could cause distress
- Administering medication for any pain, anxiety or other symptoms
Maintaining a peaceful environment and attending to the person’s physical needs can help ease any suffering and provide solace as death nears.
Decisions about Medical Interventions
As someone enters the active dying phase, decisions often need to be made about medical interventions to either attempt to prolong life or focus solely on comfort:
- Life-extending measures: These may include CPR and ventilator support if breathing stops, artificial hydration or nutrition, surgery, dialysis, antibiotics for infection, etc. These measures can lengthen dying but may diminish quality of life.
- Comfort-focused care: This involves transitioning to end of life care by discontinuing non-essential treatments, stopping artificial hydration/nutrition, adjusting pain management, and providing spiritual/emotional support. The goal is a peaceful death.
Deciding which approach to take should be guided by the patient’s wishes, quality of life assessments, and ethical considerations about when life prolongation is appropriate versus excessive. This is often a difficult yet important discussion families must have with medical teams.
Emotional Care for Families
Witnessing the active dying of a loved one is often deeply emotional and challenging. Some ways families and friends can find comfort during this time include:
- Taking advantage of resources like hospice grief counseling or spiritual guidance
- Practicing self-care through proper rest, nutrition and exercise
- Sharing memories and reminiscing about the person’s life
- Recording any last words or moments to cherish
- Finding ways to say goodbye like writing letters, sharing important conversations, etc.
- Planning funeral services together to create meaning and closure
Although losing someone is painful, gathering support and finding ways to process grief can help bring acceptance.
Key Takeaways
- Active dying marks the final phase of life as the body starts shutting down which can last from hours to weeks.
- Several factors like the underlying medical condition, use of interventions, and individual variability impact duration.
- Without life-prolonging measures, active dying typically lasts around 2-4 days.
- With medical interventions, active dying is often extended to an average of 11 days or longer.
- Certain signs indicate death is imminent such as changes in breathing, unresponsiveness, and lack of urine output.
- Maximizing comfort, aligning on care goals, and emotionally supporting the family are key during this time.
While the dying process follows a general trajectory, each person’s end-of-life experience is unique. Understanding what to expect and providing compassionate care can help ease suffering and bring peace during life’s final transition.
References
1. National Institute on Aging. (2017). End of Life: Helping with Comfort and Care. Retrieved from https://www.nia.nih.gov/health/end-life-helping-comfort-and-care
2. BrightFocus Foundation. (2022). End of Life: What to Expect and How to Cope. Retrieved from https://www.brightfocus.org/alzheimers/article/end-life-what-expect-and-how-cope
3. Hui, D. et al. (2014). Clinical trajectories of advanced cancer patients in the last days of life. Cancer Medicine, 3(6), 1885–1892. https://doi.org/10.1002/cam4.327
4. Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. (2000). Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000 Nov 15;284(19):2476-82.
5. Quinlan, J. (1985). Twenty months in a coma. Hastings Center Report. 15(1), 4-5.
6. Ito, T. et al. (2021). Ethical validity of artificial hydration for patients in long-term vegetative state: A case report. Medicine, 100(7), e24891.
7. Thienprayoon R, Lee SC, Leonard D, Winick N. (2016). Defining futile and potentially inappropriate interventions: a policy statement from the society of critical care medicine ethics committee. Crit Care Med. 2016 Sep;44(9):1769-74.
8. Hospice Foundation of America. (2017). Journey’s End: Recognizing Death Is Near. Retrieved from https://hospicefoundation.org/Hospice-Care/Journey’s-End-Recognizing-Death-is-Near