Much of our fear around dying is caused by our not knowing what to expect and/or being troubled by specific symptoms. Here we take a brief look at the biology of dying.

Signs of imminent death


Before looking at what you might expect to observe in someone whose death is imminent, it can be helpful to understand what is happening to the body at this time.

Dr David Goldhill (he is a Consultant in Intensive Care and Anaesthesia) describes just what happens to the body….

The Biology of Death

  • When the circulation stops – and the delivery of oxygen to the cells and the removal of waste products also ceases – some cells become damaged and organs fail
  • Without oxygen for more than a few minutes, the brain dies.
  • Endorphins, which serve to blot out any anxiety and pain, are released
  • In the visual cortex dying cells randomly start to fire off signals.
  • The brain cells detach from each other, severing the connections they made for a life of thinking and remembering and rendering the brain dead.
  • All other bodily functions stop and every tissue and organ shuts down at its own pace. Skin cells may be produced for some minutes after death and muscles will live on for hours. As each cell dies so the body starts to cool to room temperature. (How to Have a Good Death)

Common Signs and Symptoms

  • Withdrawal – physical and emotional.
  • Profound weakness and fatigue
  • Gaunt, pale physical appearance; coolness, discolouration
  • Nausea and vomiting
  • Decreased ability to swallow
  • Increasing lack of interest in food or fluid, leading to weight loss, dehydration and inability to swallow medications
  • Dry or sore mouth
  • Mental state: There may be drowsiness, a reduction in awareness, insight and perception; difficulty in concentrating – limited attention span. Also a disorientation in time and space; semi-comatose. Confusion-agitation e.g. trying to get out of bed; picking at covers, may be present.
  • Change in breathing patterns: Shortness of breath, laboured breathing and/or irregular breathing – very slow or very rapid or gaps of 10-30 seconds where there is no breathing at all. These changes indicate a decrease in circulation.
  • Muscle twitches, spasms, seizures, which may be caused by a build-up of waste products.
  • Oral secretions collect at the back of the throat causing noisy respiration, ‘the death rattle’ mostly heard after someone has become unconscious. Indicates that death is just hours away. The swallowing reflex may be absent.

Ref: How to Have a Good Death forward by Esther Ranzen (Dorling Kindersley Pub)


Additional Resources

Being with someone when they die

Some helpful suggestions of how to be with someone right at the end of their life; physical signs that death is near; the moment of death; death-related phenomena; immediately afterwards.



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