(Chris Palmer is an author, speaker, wildlife filmmaker, conservationist, educator, professor, and grandfather. He now devotes his life to end-of-life activism. Bloomsbury published his 10th book, Achieving a Good Death: A Practical Guide to the End of Life, in October 2024. He is a trained hospice volunteer and founded and runs an aging, death, and dying group for the Bethesda Metro Area Village. He serves on several nonprofit boards, including Final Exit Network. He frequently gives presentations and workshops to community groups on aging, death, and dying issues.)
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No one truly knows what it’s like to die. Anyone talking about it hasn’t experienced it and can only guess based on observing others. Moreover, how a person dies depends on many factors, including their diagnosis, the rate of disease progression, and which organs are failing most quickly.
Eighty to 90 percent of us will die slowly from disease or old age. Only 10 to 20 percent will die suddenly, from heart attacks, accidents, or suicide. Hospice nurse and author Barbara Karnes says that when people die slowly, they typically die in a way that reflects how they’ve lived. If you’re irritable and grumpy, that’s likely how you’ll be as you die. If you’re calm and relaxed, your death may mirror those qualities. “Dying doesn’t change us,” she writes. “It intensifies our personalities.”
Having a purpose can help as we approach the end. Without one, the will to live can atrophy. That purpose might be finishing an ethical will or legacy letter, working with grandchildren to identify people in old photos, organizing scrapbooks, calling friends to say goodbye, or recording family history. Anything meaningful can help.
Even up to the time we lose consciousness, we can set an example of how to die, with dignity, gratitude, and serenity. That modeling can be a beautiful parting gift to loved ones, imbuing our final days with lasting significance.
When dying loved ones are still alert and able to talk, it’s a good time to reflect on their life and help them make sense of it. You can do this by sharing stories, asking questions, looking at photos, and reminiscing.
If you’re caring for someone dying and haven’t yet thanked them for all they’ve done, do it before the chance slips away. Express your love. Share memories. Tell them how much they’ve meant to you and how they’ve shaped your life. Say that you’ll pass on their values and stories, and that they won’t be forgotten.
Dying people often fear losing their dignity (for example, by pooping in their diapers), becoming a burden, or worrying about how their loved ones will cope after they’re gone. Assure them that they are loved and that everything will be okay.
Speak gently and from the heart. Say things like, “I love you … Thank you … You’ve been the best parent a son could ask for … I’m proud to be your daughter … You’ll always live on in my life,” and “You’ve meant so much to me.” These heartfelt words offer peace to the dying and comfort to the living. They help to bring closure and peace to everyone involved.
Say you are sorry about old misunderstandings or regrets, if you need to. Recall fond memories and retell favorite jokes and stories. Let there be tears and laughter. Then, both parties (the dying and the surviving) can feel that everything that needed to be said has been said. Remember what Winnie the Pooh observed: “How lucky I am to have something that makes saying goodbye so hard.”
If the person welcomes it, gather friends and family around. Remember that some people may avoid visiting, not out of indifference, but because they’re afraid of not knowing what to say, or fearful of their own mortality.
Karnes notes three signs that indicate the dying process has begun: changes in eating habits, increased withdrawal from the world, and sleeping more and more.
During the final hours or minutes, even if patients can’t respond, doctors believe they may still hear. So speak to them gently and lovingly. Hold their hand. Stroke their face. Sit beside them.
Some physical signs of dying, like the “death rattle,” can be alarming. The more you understand about what happens as death nears, the better prepared you’ll be. Hospice nurses are invaluable for helping families understand and cope. Witnessing a frightening death without preparation can complicate grief.
As death nears, the person may become incontinent, lie still, and eventually make a gurgling sound (the death rattle) caused by saliva pooling in the throat. It’s often more distressing to loved ones than to the dying person, who is usually unaware of it.
In the last few days, dying patients may be restless or agitated. They may pick at their sheets, sleep much of the time, become uncommunicative or confused, or withdraw socially. As organs begin to fail, breathing becomes uneven and fingers or toes may darken.
The person stops speaking and becomes unresponsive. Breathing becomes sporadic. If pain or agitation persists, hospice teams may recommend terminal sedation, when patients usually drop into a coma before taking their final breath.
Dying is a profoundly moving process, and being present with someone you love at life’s end can be one of the most powerful, emotional, and sacred experiences imaginable.
Some people slip away peacefully; others experience confusion, discomfort, or distress. These signs can often be managed with medication, but may still be upsetting for loved ones. Even when a death doesn’t go as hoped, it’s important to accept what comes and remain compassionate.
It’s a mysterious and solemn time. Everyone present will reflect on mortality. Some may feel fear, not just for the dying person, but for themselves. Learning what to expect from hospice staff or experienced caregivers can reduce that fear.
As a caregiver, your presence plays a critical role in how peaceful the death is. Sitting quietly can be a source of comfort. Watch for signs of pain, and ensure medications are given as needed.
Death is natural. As a caregiver, you can help by keeping the person clean, comfortable, and turned to prevent bedsores. Soft music and gentle massages may help if the person enjoys them.
Sometimes death lingers. Days or weeks may pass. Even devoted caregivers may feel exhausted, frustrated, or even angry, even if they have spent years keeping the person alive. These feelings are normal and understandable.
When death comes, there is no breathing or pulse. The jaw relaxes. Pupils become fixed. The mouth falls open. Skin becomes pale and waxy. There will likely be a loss of sphincter control. These are all natural signs that life has ended.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
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