Death is hours or minutes away…
The information on the following page may be confronting. Death is a process that profoundly affects the body and its functions. It can be unpredictable – it may be evident that death is near, as described below, or it may occur very quickly, with little or no warning.
If you think information may cause you distress, please consider reading the following information with a loved one, or when support is available.
Remember, Banksia staff will be able to answer any questions that you may have.
How long does dying take?
It is very difficult to know how long it will take for the bodily functions to fade completely and for death to occur. The process can take weeks, days or hours. In some cases, where there may be a very sudden and unexpected complication, death occurs very quickly. Even in people with the same disease, the rate that deterioration and death occurs will often vary.
Anecdotally, people appear to be waiting for an event to occur, such as a baby’s birth, or a person to arrive from overseas. Though it is difficult to understand how this occurs, it appears that people will wait for the moment which allows them to feel like they can let go … In other circumstances, they will wait until they are alone and someone has left the room to take their last breath.
We will not be able to tell “how long” – all we know is that they are getting closer to death.
Is death painful?
Dying itself is not painful, however the symptoms of the disease or condition such as cancer, recent fracture or pressure injury can continue to cause discomfort that they did prior to deterioration.
Many other changes occur because the person becomes unconscious therefore, are not distressing. Most notorious of these is the breathing changes including the build-up of saliva / secretions, sometimes called the “death rattle”. This is actually similar in mechanism to snoring – occurring because the person is in deep sleep.
The person is not able to move or care for themselves so repositioning, mouth care and personal hygiene need to be provided to preserve dignity and prevent pressure injuries and other uncomfortable skin and mucosal complications.
Sometimes, agitation and restlessness can occur even when there is no underlying physical pain. They occur in setting of delirium as the organs of the body stop functioning as normal.
It is important that Banksia is involved during the dying process. We have expertise in managing the above situations and we will discuss any symptoms you’re concerned about and make informed decisions about the best medications to use – using the wrong medication can sometimes make things worse.
Lastly, while some people may have expressed preference not to ‘linger’, there’s no evidence to suggest an unconscious person is aware of how long they’ve been unconscious – the process of death will take as long as it takes for each person. Any suggestions or treatments that we recommend will not hasten death, nor will they expressly prolong life – our goal will always be to gain the greatest level of comfort and provide support.
What to expect from Banksia at this time?
As the person may not be able to communicate, Banksia staff will use their expertise and experience to ensure people are as comfortable as they can be during this time.
Our staff will visit regularly and will always be available by phone. We will suggest and arrange all the use of medications for management of distressing symptoms. If our client is unable to swallow, these medications may be in oral drops that can be absorbed in the mouth or injectable under the skin.
On these visits, please raise any concerns you may have with the nurse. They are there to answer any questions and address your concerns.
A gradual decline to death is occurring
When death is very close, the person will usually be deeply unconscious – they will not be rousable at all. They are unaware of the changes to their bodies, and therefore not feeling distress, even though some of the changes to their body may appear to the family to be causing distress or discomfort.
It is very common for a person’s breathing to change again at this stage, sometimes slowing, other times speeding up – it may become noisy, soft, uneven or shallow. Some people will make a gurgle-like sound with each breath – this is sometimes unfortunately referred to as the “death rattle”. This sound is caused by secretions (fluids) sitting in the back of the throat which the person can no longer shift. There may also be an irregular breathing pattern where there are long gaps between breaths (so long, that you may think they are not going to breathe again), followed by a number of quick breaths – this is known as Cheyne-Stokes breathing.
This irregular breathing may happen for minutes or hours. These changes occur as blood flow slows, and the body starts to close down. As above, the changes in breathing can be very distressing for those in the room, however it does not cause the person any pain or discomfort as it is similar in mechanism to snoring – occurring because the person is in deep sleep.
Circulation changes also mean a person’s heartbeat may be very fast or very slow, and will become fainter. Skin can become flushed, mottled or pale grey-blue, particularly on the knees, feet and hands. They may feel very cold to touch in places, such as the cheekbones, nose, forehead, fingers and feet; there may be perspiration or clamminess present. The unconscious person is not aware of feeling hot or cold.
The eyes may begin to water, appear glazed over, or a slightly different colour. The eyelids may not stay fully closed, even though the person is not awake.
The mouth may stay open and the lips and tongue may appear to be either darker, or become very pale.
As discussed previously, repositioning, mouth care and personal hygiene needs to continue to preserve dignity and prevent pressure / other skin and mucosal complications.
Myth-busting: Injectable morphine & dying
There are common myths related to the use of injectable morphine in someone who is dying – one is that dying is always painful, and another is that morphine speeds-up the dying process.
These myths lead to two problems:
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- Inappropriate and unnecessary delay in use of morphine due of fear of causing death in someone who is suffering and would benefit from the actions of morphine, and
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- Use of morphine instead of other more appropriate actions and medications in a dying person. This can add to hallucinations, agitation, physical symptoms such as jerking/twitching, restlessness, and rarely, seizures, actually causing discomfort.
Banksia will always discuss the most appropriate opioid or other medication to use, as well as when the best time to commence those will be. It is extremely helpful to work positively with Banksia to gain the best comfort and symptom management in a dying person.
What is the moment of death?
The moment of death is when the body ceases to take a breath and a heartbeat (or pulse) is absent. This can occur in either order. It is usually extremely difficult to know exactly when this will occur – people may have taken very few breathes for several minutes, or may have been breathing regularly, then suddenly stop…
When they do stop breathing, and there is no longer a pulse, the person has died because of their disease or medical condition – their body has stopped functioning, and life for this person is no longer possible. At this point, there is nothing further that can be done to keep them alive.
The following signs typically indicate that death has occurred:
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- Breathing ceases and there is no heartbeat.
- No response to loud talking or movement.
- Eyes are fixed, pupils dilated, eyes may be open.
- The person may be incontinent.
Death may happen when the room is full of people, or it may happen when a carer leaves the room briefly. Most loved ones want to be present at the time of death, however sometimes this simply does not happen. It is very important not to feel guilty or sad about this – what is much more important to remember is the time leading up to the death…
After death has occurred
If your loved one dies at home, please remember it is an expected death and not an emergency so you do not need to contact an ambulance or the police.
There is no rush to move a person when they have died, so take the time you and your family need with them.
When you are ready, please call Banksia on the numbers provided and we will arrange for one of our nurses to come to you and give you support and help with the next steps.
Our nurse will examine your loved one and complete a “Verification of Death” document (this is a normal process). This verification allows the funeral director to collect your loved one from your home when you are ready.
Their body can remain at home for several hours to allow time for family and friends to say goodbye. Ideally, the person should be positioned so that they are lying on their back with their head and chest very slightly elevated on pillows with their hands on their chest. It is natural for their jaw to drop, and eyes to stay slightly open. The nurse who visits your home to verify the death can assist with positioning, some basic hygiene or tidying of bedclothes as required.
We will contact your GP to inform them of your loved ones passing so the “Medical Certification of Cause of Death” can be submitted to The Registry of Births, Deaths and Marriages – Victoria, which is required before the funeral can proceed.
This is technically not the ‘Death Certificate’, which is the document eventually issued by Births, Deaths and Marriages – Victoria after the funeral. If the proof of someone’s death is required (e.g. for banking) prior to this, contact your GP to write a separate letter of support.
NOTE: If your loved one dies in hospital, the staff there will support you and explain the processes.