What is the process of dying?

Dying can be a gradual process when someone has a terminal illness. If someone is receiving good palliative care, it can be quite a peaceful time — a time during which the body lets go of life.

Palliative care aims to keep those with a terminal illness comfortable and includes treatments to relieve pain.

In most people who are dying, the body's normal systems start to operate more slowly. What happens varies between people, but this article describes how people's bodies generally change as they die.

The heart beats a little more slowly, or with a little less force. So, blood is moved around the body more slowly. This means the brain and the other organs receive less oxygen than they need, and do not function as well.

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What happens in the weeks before death?

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.

Someone who is dying may also lose weight and their skin might become thinner. The body now finds it hard to regenerate skin cells in the way it used to.

What happens in the days before death?

In the days before their death, a person's control over their breathing starts to fail. They may breathe more slowly for a while, then more quickly, and so their breathing becomes quite unpredictable.

Fluid can start to gather in their lungs, and their breathing can begin to sound quite ‘rattly'. They might cough, but not very deeply.

Often, people's skin colour changes in the days before death as the blood circulation declines. They can become paler or greyer or their skin can become mottled or blotchy.

They may also have less control of their body temperature. Their hands, feet, fingers and toes may become cool to touch. At other times, they may be hot and sweaty.

With the loss of oxygen to their brain, they might become vague and sleepy. Some people hallucinate and talk to people who aren't there. They may be confused or disoriented.

Some become unconscious a few days before they die.

What happens in the 24 hours before death?

Someone who is close to death will spend most of the time asleep. They may not be able to communicate when they are awake because their senses are failing. However, they may still be able to hear, so speak to them normally.

Some people have a burst of energy in the 24 hours before they die. They may sit up and talk normally for a short period.

Physical signs that death is near include:

• mottled and blotchy skin, especially on the hands, feet and knees
• blood pressure decreases
• they can't swallow
• less urine (wee) and loss of bladder control
• restlessness
• difficult breathing
• congested lungs

What happens in the hours before death?

In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch.

Those who do not lose consciousness in the days before death usually do so in the hours before they die.

Most people are very calm at this time, although some may be restless or agitated.

Some symptoms a person may experience during this time include:

• glassy, teary eyes that may be half-open
• cold hands
• weak pulse
• hallucinations
• being fast asleep
• gasping, or periods where breathing completely stops

What happens when someone dies?

When someone dies, their heart stops and they stop breathing. Within a few minutes, their brain stops functioning and their skin starts to cool. At this point, they have died.

The signs that someone has died are:

• there is no breathing or heartbeat
• they cannot be woken up
• their skin is pale and waxy
• their eyelids might be half open
• their pupils are fixed
• their mouth may fall open

The moment of death is usually peaceful.

What happens after someone has died?

If the death occurs in a hospital, nursing home or hospice, the facility will take care of all the initial next steps for you.

If you are caring for someone who has died at home, when you are ready you can contact:

• your palliative care service (if one has been involved)
• your doctor
• a friend or relative to be with you for support
• the funeral director of your choice

A nurse from your palliative care service can visit to support you after the person you were caring for has died.

A Medical Certificate Cause of Death must be filled out by a doctor within 48 hours of death. The doctor or funeral director can notify the Registry of Births, Deaths and Marriages.

Preparing for a death at home has more information on what to do when someone dies at home.

How should I feel when someone dies?

You might feel all sorts of emotions. From grief that they are gone to relief that their pain is over, and any number of emotions in between. Take your time — it's fine to just sit with the person who has died for as long as you need to.

Resources and support

• You can learn about how to cope before and after someone dies, as well as advance care planning.
• Griefline offers grief support and resources — call 1300 845 745.
• Carer Help has resources if you care for someone with a life-limiting illness, including for:
  • Aboriginal and/or Torres Strait Islander carers
  • people caring in the country
  • specific communities with information in languages other than English
• Visit the CareSearch website for links to palliative care and end-of-life information in different community languages.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.