When someone may be entering the last days of life, a healthcare professional should tell the patient that they're dying (unless they don't want to know).
“Thinking of the good life you've lived, the great times we've shared, and feeling so grateful for you.” “You've been such an important part of my life, and for that, I'll always be grateful.” “I so admire the warm, funny, genuine person you are. My life will forever be better because you've been part of it.”
Not to tell the truth jeopardizes staff-patient trust, undermines the patient's capacity for autonomy, and deprives the terminally-ill of a 'good death'.
Active dying is the final phase of the dying process. While the pre-active stage lasts for about three weeks, the active stage of dying lasts roughly three days. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death.
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”
It's important to tell someone that they're dying so they can prepare and do what's most important to them. If the person consents, you should tell the people who are close to them as well, such as partners, friends and family members. This can allow them to make the most of the time they have left.
Fear of death is a natural human response. Faced with a terminal diagnosis, many patients struggle with how to overcome fear of death to find peace and acceptance.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
It says “Please forgive me,” “I forgive you,” “Thank you,” and “I love you” It's the four things you're supposed to express at the end of your life to find peace of mind before you die.
Terminal lucidity, also known as paradoxical lucidity, rallying or the rally, is an unexpected return of mental clarity and memory, or suddenly regained consciousness that occurs in the time shortly before death in patients with severe psychiatric or neurological disorders.
If a person says to you, I want to go home now, you may think to reassure them by saying, You are already home. But that may not be the home they mean. Perhaps they are thinking of their childhood home. They may mean the afterlife.
The Alzheimer's Society advises that if the person is in the early stages of dementia, it is usually best to start talking about the death and see how they react. If they are in the later stages they are less likely to understand, so it may not be appropriate to tell them.
"When we imagine our emotions as we approach death, we think mostly of sadness and terror," says psychological scientist Kurt Gray of the University of North Carolina at Chapel Hill. "But it turns out, dying is less sad and terrifying – and happier – than you think."
Fear is a common symptom at the end of life, and appropriate emotional and psychological support should be provided to mitigate the fears.
Metabolic failure: The kidneys, the liver, and other organs begin to fail near the end of life, and the physiological issues these events cause can interfere with brain function and result in delirium, restlessness, and agitation.
"I wish I'd had the courage to live a life true to myself, not the life others expected of me." "I wish I hadn't worked so hard." "I wish I'd had the courage to express my feelings." "I wish I had stayed in touch with my friends."
Most people who are dying feel tired. They may want to sleep more often, or for longer periods. They may want to talk less, although some may want to talk more. They may want to eat less or eat different foods since their stomach and digestive system are slowing down.
Research suggests that even as your body transitions into unconsciousness, it's possible that you'll still be able to feel comforting touches from your loved ones and hear them speaking. Touch and hearing are the last senses to go when we die.
As the blood pools, patches appear on the skin within 30 minutes of death. About two to four hours postmortem, these patches join up, creating large dark purplish areas towards the bottom of the body and lightening the skin elsewhere. This may be less apparent on darker skin. This process is called livor mortis.
After someone dies, it's normal to see or hear them. Some people also reporting sensing the smell or warmth of someone close to them, or just feel a very strong sense of their presence. Sometimes these feelings can be very powerful. They may be comforting but also feel disturbing.
When an individual is approaching death, the systolic blood pressure will typically drop below 95mm Hg. However, this number can vary greatly as some individuals will always run low.