Death is an inevitable part of life that all living things must face. For humans, death is often feared and misunderstood. Most people are curious about what exactly happens to the body in the final moments before death occurs. Understanding the physiological processes and timeline of events leading up to death can help demystify the experience and provide comfort to both the dying and their loved ones.
What are the stages leading up to death?
There are several well-defined stages that occur as death approaches. These include:
- Withdrawal – The dying person begins to withdraw from loved ones and the outside world. They become less responsive and interested in things happening around them.
- Unresponsiveness – The person loses the ability to respond to external stimuli. They fall unconscious and can no longer be roused.
- Clinical death – Breathing and circulation stops. No heartbeat or pulse can be detected. The person is clinically dead but cells and organs may still be alive.
- Biological death – Cellular death begins as oxygen levels deplete. Organs begin shutting down. Within hours there is irreversible brain damage.
The withdrawal and unresponsiveness stages can last days or weeks as death slowly approaches. Clinical death marks the stopping of vital functions while biological death follows over several hours as the body systems fully shut down.
What happens in the “active dying” phase?
The active dying phase is the final 1-2 days of life when the body is actively shutting down. It involves dramatic changes that prepare the body for death. These include:
- Loss of appetite – The body loses interest in food and drink as digestion shuts down.
- Less frequent urination – Lower fluid intake leads to less urination.
- Swollen extremities – The hands, feet and legs swell as circulation slows.
- Skin discoloration – Skin takes on a bluish, purplish hue as blood oxygen levels drop.
- Difficulty breathing – Breathing becomes irregular and labored as lungs accumulate fluid.
- Cooling body temperature – Blood no longer circulates normally so the body becomes cool to the touch.
These changes occur rapidly over several hours as death nears. They indicate the body’s systems are failing and prepare it for the final shutdown.
What happens in the final hour before death?
The last 60 minutes of life are the most physically distressing and involve the final breakdown of bodily processes. Here is a general timeline of what a person may experience in their last moments:
| Time Before Death | Signs and Symptoms |
|---|---|
| 1 hour | Breathing becomes very irregular. Long pauses between breaths. Congestion can cause loud, rattling sounds. |
| 30 minutes | Breathing pauses become prolonged. Hands and feet become cool as circulation decreases. |
| 15 minutes | Lips and nail beds turn blue or purple from lack of oxygen. |
| 5 minutes | Breathing stops completely. No visible sign of life. |
| Clinical death | No breathing, no heartbeat. Death has occurred. |
As breathing slows, less oxygen circulates which causes the extremities to cool and skin to become discolored. Congestion in the airways can lead to loud, rattling sounds with each breath. Right before death, breathing will stop completely as the brain irreversibly shuts down.
What bodily changes indicate death has occurred?
Several physical changes occur after death that signal the end of the body’s ability to function.
- No response to stimuli – The person cannot be aroused by touch, sound or pain.
- No breathing – The chest is still with no rise and fall.
- No detectable pulse – No pulse can be felt anywhere on the body.
- Loss of bowel and bladder control – Incontinence occurs as the muscles relax.
- No reflexes – Reflexes like coughing and pupil response have ceased.
- Skin pallor – The skin loses color and appears pale or grey.
- Dropped jaw – The mouth falls open as the jaw relaxes.
- Dilated pupils – Pupils remain dilated even in bright light.
When a person exhibits these unresponsive reflexes and changes for an extended time, it signifies all brain function has permanently stopped. The heart has stopped beating and cannot be restarted.
What happens to the body immediately after death?
For a short time after the heart stops, cells and organs in the body remain alive even without oxygen. Changes continue to take place internally and externally.
- Emptying of the bladder and bowels – Loss of sphincter control leads to release of urine and stool.
- Algor mortis – Body temperature drops to that of the surrounding environment.
- Rigor mortis – Chemical changes cause the muscles to stiffen and contract.
- Livor mortis – Gravity causes the blood to settle and pool in the lowest points of the body, creating a purplish discoloration.
- Decomposition – Enzymatic breakdown of cells leads to decay of tissues.
These processes show the definitive end of life functions. The breakdown of cells leads to progressive decomposition and the eventual dissolution of the body.
How long does the dying process take?
The duration of active dying and final descent into death can vary from person to person. On average the process lasts about 2-3 days but can occur in less than a day in some cases or extend as long as 2 weeks.
The timeframe depends on factors like:
- The illness or condition leading to death
- How rapidly organs are shutting down
- Withdrawal of medical treatment and interventions
- Medications and sedation given for comfort
- The person’s overall endurance and health
Younger people with fatal injuries can pass quickly. Those with chronic illness may linger for a longer period. But in most cases, the last 1-3 days involve the most significant and obvious changes as the body prepares to stop functioning.
Do people know they are dying?
As people decline into unresponsiveness during the dying process, they are unlikely to be aware of their surroundings or bodily shutdown in the final hours before death. However, some limited evidence suggests hearing may persist even in dying patients who appear unconscious. So words of comfort spoken to the dying person are recommended.
In the active dying phase, the combination of organ failure and medication can produce withdrawal from consciousness. But prior to this, the person may experience some awareness of impending death. Some signs a dying person knows death is near include:
- Saying goodbyes to loved ones
- Requesting religious rites or sacraments
- Making amends or resolving conflicts
- Speaking about dying itself or afterlife beliefs
- Giving away possessions
- Saying they “feel like they are dying” or won’t make it
Even without clear communication, actions like holding hands or focusing on a loved one’s voice can signal awareness of what is happening.
What are the signs death has occurred?
It is not always immediately obvious that someone has died. A doctor or nurse may be called to confirm death has unequivocally happened using these indicators:
- No breathing for at least 1-2 minutes
- No audible heartbeat heard through stethoscope
- Fixed, dilated pupils unreactive to light
- Eyelids remain partially open with no blink reflex
- No pulse or rise in blood pressure
- Skin is pale and feels cold to the touch
- Jaw has dropped with mouth remaining open
- No response to painful stimulus like rubbing knuckles on breastbone
When all signs of brainstem reflexes and autonomic functions are gone for an extended time, the person can be declared biologically and legally dead.
What happens to the person after being pronounced dead?
Steps after a patient is declared dead depend on whether arrangements have been made beforehand:
- An autopsy may be performed to determine or confirm cause of death.
- Organs may be recovered for donation if the person is an organ donor.
- The body is transferred to a mortuary or funeral home.
- If requested, hospice staff can perform postmortem care like bathing and dressing the body.
- The remains are buried, cremated or entombed according to the wishes of the deceased and family.
Legal paperwork like a certificate of death must be completed. Belongings are collected and given to designated beneficiaries. The body is treated with respect throughout the process between death and final disposition.
Does the moment of death hurt?
People commonly wonder if death itself is painful. Based on evidence from terminal patients, the process of dying is usually not described as painful. Instead, the decline into unconsciousness brings increasing fatigue and drowsiness. The most discomfort often occurs in the days or weeks before death rather than the final moments.
At the time of passing, endorphins are released by the brain to blunt pain and create euphoric feelings. Levels of endogenous opioids surge as the body prepares to die. This chemical response appears protective to mask distress and make the act of dying less traumatic.
Do people choose when to die?
Some believe people can voluntarily choose when to die once the process has begun. Anecdotal reports describe patients seeming to hang on until a loved one arrives or significant date passes. They may fight to stay alive to meet a new grandchild or reform family bonds.
Yet the extent to which dying patients can prolong death is unclear. A very strong desire to survive for an important event may motivate someone to temporarily rally despite poor health. But the ultimate shutdown of organs limits the ability to prevent death indefinitely.
Letting go emotionally by resolving conflicts and saying goodbyes may provide a sense of control over the process. But the physical timing of death depends largely on the body’s decline.
Can the time of death be predicted?
Pinpoint predictions are difficult, but death can generally be anticipated within days or hours as signs appear. The most common end-of-life timeline comprises:
- Days/weeks before death: Long periods of sleeping and minimal responsiveness.
- 2-3 days before death: Little interest in food, extensive sleeping and difficult arousing.
- 1-2 days before death: No interest in food, notable breathing changes and incontinence.
- 12-24 hours before death: Irregular breathing, congestion, cool extremities.
- Final hours: No response to touch; cessation of breathing and heartbeat.
Knowing these general phases allows loved ones and health professionals to prepare for approaching death. But the exact moment cannot be predicted conclusively.
Conclusion
Dying is a process that the body purposefully undertakes at the end of life. Understanding how organs systematically shut down helps demystify what happens in the last hours before death occurs. Withdrawal from life, changes in breathing and heart function, and physical signs of stopping bring the body’s final moments to a peaceful close.
While the thought of death stirs fear and sadness, the physiology of dying itself often minimizes pain and distress for the terminally ill. Knowledge of this transition can provide some solace to grieving family members as they say goodbye.