The final moments before death can be different for each person. However, there are some common experiences that many people report as death draws near. In this article, we’ll explore what the research and first-hand accounts reveal about the end-of-life experience.
Physical Changes
In the weeks and days leading up to death, the body starts to shut down. Appetite lessens, and people often lose a significant amount of weight. Energy levels drop dramatically, and it becomes harder to move around. Sleep patterns change, with people sleeping more during the day and becoming restless at night. Senses like taste, smell, hearing, and vision may diminish.
Breathing often becomes irregular, sometimes slowing or speeding up. Noisy, wet breathing known as a “death rattle” is common as fluids build up in the throat and airways. Skin color changes as circulation drops, becoming pale, grey, or blotchy. Hands and feet may feel cool to the touch. Some people experience swelling in their limbs as fluids shift downward.
Control of bodily functions is lost at this stage. Incontinence is common, and some people lose control of their bladder and bowels. Eyes may remain open, and the pupils dilate. Right before death, breathing becomes extremely labored, then stops altogether as the heart finally ceases pumping.
Mental and Emotional Changes
In addition to physical changes, people often experience mental and emotional shifts as death approaches. Confusion and disorientation are common. Memory loss increases, and people may not recognize loved ones. Restlessness, anxiety, fear, and paranoia can occur. Visual and auditory hallucinations are also reported, where people see or hear things that aren’t really there.
Energy levels plummet, and people tend to sleep more. Some even slip into a semi-conscious sleep state. Appetite for food decreases, but thirst remains. People tend to withdraw from the living world as death nears.
Strong emotions often arise during this time. People may oscillate between acceptance and denial about their impending death. Fear, anger, and sadness are common, as is anxiety about leaving loved ones behind. Some find peace and feel ready to die, while others struggle to let go.
Near-Death Experiences
Some people report experiencing a phenomenon known as a “near-death experience” (NDE) as death approaches. These experiences often happen during states of clinical death, though sometimes they occur before vitals have stopped.
Common characteristics of NDEs include:
- Feeling profound peace, calm, and lack of pain
- Having an out-of-body experience, where they feel detached from their physical self
- Rising up through darkness into a light
- Encountering spiritual beings, guides, deceased loved ones, or religious figures
- Having a life review where they see their entire life flash before them
- Reaching a border, point of no return, barrier, or entrance to another realm
NDEs feel intensely real and vivid. Many people report losing their fear of death after experiencing one. Research shows these experiences cause long-lasting changes in outlook, beliefs, and values.
Possible Explanations for NDEs
The cause of NDEs is still unknown and debated. Here are some possible scientific explanations that have been proposed:
- Anoxia – Lack of oxygen to the brain
- Excess carbon dioxide – Increased CO2 levels have effects similar to oxygen deprivation
- Endorphins – The body releases endorphins to ease pain and induce euphoria
- REM intrusion – Elements of rapid eye movement (REM) sleep intrude into the waking state
- DMT release – The pineal gland releases DMT, a potent psychedelic drug
- Temporal lobe seizures – Electrical disturbances in the temporal lobe cause hallucinations
However, none of these explanations have been proven. Each only accounts for some elements of NDEs, but not the full experience. The spiritual hypothesis, that consciousness can detach from the body, offers another perspective.
Coma
Some dying people become unresponsive and slip into a coma in their final hours or days. This is due to the brain progressively shutting down. Comas resemble deep sleep, except the person can’t be awakened. They may still respond to pain or loud noises with reflexive movements. Breathing becomes irregular, eyes remain closed, and muscles relax.
Comas are unpredictable—some people recover while others remain in a vegetative state until death. For terminal patients, a coma typically precedes death by 1-4 weeks. Loved ones keeping vigil are recommended to continue talking to the dying person, even if no response is apparent. Hearing is believed to be the last sense to fade.
Social Withdrawal
Social withdrawal often happens in the final weeks of life. This serves several purposes. As the body weakens, interacting with others becomes exhausting. Reflection often turns inward during this time, focused on life review and letting go. Withdrawing from the world aids this process. Simplifying external stimuli also helps manage limited energy reserves.
People may offer little response when spoken to and stop communicating altogether in the final days. But don’t assume they can’t hear you—continue talking in a comforting voice. Silence may signal transition rather than isolation. Dying people are preparing to depart this life, which requires retreating inward.
When Death Is Near
Certain signs and symptoms indicate death is imminent, though the exact sequence varies by person. Here are common indications death will occur in hours or days:
- Breathing changes – Slows, pauses, speeds up, becomes irregular or congested
- Heart rate changes – Slows down or speeds up, irregularities
- Blood pressure drops – Often resulting in cool extremities
- Mottling – Skin takes on a blotchy, purplish marbling appearance
- Loss of reflexes – Swallowing, coughing, gag
- Speech difficulties – Slurred speech or inability to speak
- Decreased urination
- Loss of consciousness – Semi-coma or coma state
- Restlessness – Attempts to sit up, pull at bed linens, move limbs
As death nears, breathing often slows or pauses entirely for longer stretches. Congestion clears in the airways, creating better oxygen exchange in the final breaths. Right before death, many people demonstrate a surge of energy called “terminal restlessness.” Breathing regulates briefly, sometimes accompanied by improved color and alertness. Hands may reach out and try to grasp something invisible. After this final rally, breathing slows and stops completely.
Signs Death Has Occurred
Pronouncing death involves looking for these definitive signs:
- No breathing
- No heartbeat
- No pulse
- Loss of reflexes
- Skin color changes – Paleness or blueness
- Loss of muscle tone – Jaw and limbs relax
- Cooling of the body
- Fixed, dilated pupils
- Bowel or bladder release
Eyes that remain open are a myth—they typically close once the facial and ocular muscles relax after death. A common misconception is that hair and nails continue growing after death. Instead, skin dehydration makes them appear longer.
Transition From Dying to Death
Dying follows a gradual decline toward death. There are two broad stages, and the exact point between them is indistinct:
Active dying
- Irregular breathing patterns
- Little to no intake of food or water
- Loss of ability to close eyes
- Difficulty turning in bed
- Increasing periods of unresponsiveness
Clinical death
- No breath or pulse
- Skin turns pale and waxy looking
- Body starts to cool from lack of circulation
- Bowel and bladder contents released
Active dying merges into clinical death once the organs cease functioning. The duration of active dying varies, lasting hours to days or weeks in rare cases. Once clinical death occurs, resuscitation is impossible. The person has permanently departed the body.
Spiritual Perspectives on Death
Most world religions hold a spiritual perspective on death. While views differ, common themes exist about the nature of the soul and afterlife:
- The soul continues existing after physical death.
- Death represents a transition or transformation, not an end.
- Connection with deceased loved ones is still possible.
- How we live brings consequences in the afterlife.
- Heaven, hell, reincarnation, or another plane awaits after death.
Spiritual beliefs provide comfort to many people nearing the end of life. Faith in an afterlife gives death meaning and diminishes its sting. Religious rituals ease the threshold crossing for both the dying and bereaved. Welcome or unwelcome, the mystery beyond death awaits us all eventually.
Conclusion
The final moments before death are highly individual and shaped by one’s medical condition. But common themes emerge in the transition between life and death. The body declines in predictable ways as organs begin shutting down. Energy needs turn inward, bringing diminished interaction with the world. For some people, near-death experiences provide a glimpse across the border separating life and death. The mysteries of what lies beyond remain unfolding.
