Does a Person Know When They Are Dying?

As death approaches, it's thought that many people have an intuitive sense, or know, they are dying, even if nobody is talking about it. There may be some physical signs of approaching death, too, such as abnormal breathing, refusal to eat, and cool skin.

People who have near-death experiences commonly report feelings of peace, serenity, and even acceptance in what were almost their final moments. Flashbacks of their lives as well as euphoric, mystical experiences have also been described.

There are ways to recognize the signs that someone is close to dying and why it is ok to talk about it.

They Know They're Dying

Dying is a natural process. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.

In some cases, the person may come from a culture or a family in which death is simply not discussed. Furthermore, your loved one may sense that others feel uncomfortable recognizing the dying process so they don't want to bring it up.

Death can then become the "elephant in the room"—everyone knows it's there but no one will acknowledge it. Family discussions may be awkward and superficial and never reach an intimate level. In this case, the important work of mending and completing relationships may not happen.

Signs That Death Is Near

As someone nears the end of life, they usually experience certain specific physical and mental changes, including:

• Increased fatigue or sleepiness
• Refusing to eat or drink
• Bowel and bladder changes, such as constipation and/or urine incontinence
• Mental confusion, reduced alertness, or hallucinations
• Changes in vital signs, like fluctuating or irregular blood pressure and heart rate
• Agitation and restlessness
• Shortness of breath or slowed or abnormal breathing
• Hands, arms, feet, and legs that are cool to the touch
• Increased pain

At the very end, the eyes may look glassy and the person may breathe noisily, making a gurgling sound known as a "death rattle."

Awareness May Linger

It isn't clear how long a person who is dying retains awareness of what is going on around them, but research suggests that some degree of awareness may remain even after the person slips from consciousness.

A 2014 study looked at 2,060 patients from 15 hospitals in the United Kingdom, the United States, and Austria who had been given CPR after going into cardiac arrest (the heart stops completely). Of those who survived, 140 were surveyed about their near-death experiences. Thirty-nine percent reported feeling some kind of awareness before their heart was restarted but did not have an explicit recall of events.

Often, people will lapse into a coma before they die—a deep state of unconsciousness and unresponsiveness. People in a coma may still hear people talking even when they can no longer respond. Because of this, the Hospice Foundation of America suggests that caregivers, family, and physicians should behave as if the dying person is aware of what is going on and is able to hear and understand voices.

The Five Tasks of Dying

It is natural to want to shield the ones we love from pain and sorrow. Trying to protect a loved one from the truth about their condition may initially seem like a good idea, but in fact, withholding that information can lead to resentment and disappointment.

When a person knows they are dying, they have the opportunity to do five important things:

1. Apologize for past mistakes
2. Forgive others for their mistakes
3. Thank those people who matter most
4. Say "I love you" to those they love
5. Say goodbye

Without the opportunity to do these valuable things, your loved one could die in a way that is against their wishes.

Hope at the End of Life

It may seem like a dying person can't possibly feel hopeful, but dying people do retain an amazing capacity to hope. While they may have stopped hoping for a cure or for a long life, they may still hope to mend relationships with loved ones and die peacefully.

Talking About Dying

Talking about death is rarely easy. Many of us feel uncomfortable even saying the words "death" or "dying." Talking about it with a loved one who has been diagnosed with a terminal illness can be especially awkward.

First, remember that you are talking to someone who is still living, and that talking about memories and shared experiences honors the dying person's life. Experiencing sadness with the loved one is appropriate; that's part of life, too.

If necessary, a therapist or hospice social worker with experience in this area can make these conversations easier.

Summary

As uncomfortable as it can be to acknowledge openly that a person you love is dying, it's important to realize that the person is most likely aware that they are dying, so you don't have to struggle with "breaking the news." In fact, dying people often appreciate being able to use the time they have left to tell people they love them and mend certain relationships if necessary.