The Actively Dying Phase of The Dying Process

Published on August 25, 2023

Updated on November 30, 2023

A non-healthcare professional who has never witnessed death before, it can be unsettling to be present with someone who is nearing the end of their life. However, there are certain signs and observations that you can make using your own senses that may indicate that the person you are with may pass away within seconds, minutes, or hours. Understanding these signs can help you provide support and comfort to both the individual and their loved ones during this grim time.

Changes in Breathing

One of the most noticeable signs that someone may be is a change in their breathing pattern. Pay attention to the following:

  • Cheyne-Stokes breathing: This is characterized by alternating periods of deep, rapid breaths followed by periods of no breathing. It may sound like the person is gasping for air.
  • Irregular breathing: The person's breathing may become erratic, with long pauses between breaths or shallow, rapid breaths.
  • Noisy breathing: You may hear gurgling or rattling sounds, often referred to as the “.” This occurs due to the accumulation of secretions in the throat and chest.

Decreased Responsiveness

As the person nears death, they may become less responsive to their surroundings. Look for these signs:

  • Lack of response: The person may not respond to your voice, touch, or other stimuli.
  • Decreased consciousness: They may appear drowsy or in a deep sleep-like state.
  • Loss of facial expressions: Their face may appear relaxed or devoid of normal expressions.

Changes in Skin Color and Temperature

Observing changes in the person's skin can provide important clues about their condition:

  • Pale or mottled skin: The person's skin may become pale or have patches of discoloration.
  • Ashen or dusky complexion: The person's complexion may look ashen or dusky.
  • Coolness of extremities: Their hands, feet, and limbs may feel cool to the touch as circulation decreases.
  • Cyanosis: The lips, fingertips, or other areas may turn bluish or purplish due to reduced oxygenation.

Decreased Urine Output

Monitoring urine output can be an indirect indicator of the body's declining function:

  • Reduced or no urine output: The person may produce very little urine or none at all.

Changes in Vital Signs

Although measuring accurately requires medical equipment, you can still look out for certain observable changes:

  • Weakening pulse: The pulse may become weaker or irregular.
  • Decreased blood pressure: The person's blood pressure may drop significantly.
  • Slowed heart rate: The heartbeat may become slower or irregular the closer one becomes to death, but there is often always a period of faster than normal heart rate (normal is 60 to 100 beats per minute).

Terminal Restlessness or Agitation

While not always present, some individuals may experience or in their final moments (these signs can occur as close to three days before death or as far as two to four weeks before death):

  • Inability to find comfort: The person may have difficulty getting comfortable in bed or may repeatedly change positions.
  • Agitated movements: They may exhibit restless behaviors, such as picking at bedding or pulling at their clothes.

Remember, these signs are not definitive indicators on their own, and each person's experience can vary. It is essential to consult with healthcare professionals for an accurate assessment and guidance in providing care.

As a supportive presence, your role is to offer comfort, reassurance, and a calming presence to the person who is dying and their loved ones. Be attentive, hold their hand, speak softly, and provide comfort measures such as adjusting pillows, moistening their lips, or playing soothing music.


The actively dying phase of the dying process can be a challenging and emotional time for both the individual and their loved ones. Understanding the signs and observations that may indicate that a person is nearing the end of their life can help provide support and comfort during this difficult time. Changes in breathing, decreased responsiveness, changes in skin color and temperature, decreased urine output, and changes in are some of the physical signs that may be observed. Additionally, terminal or may also be present in some individuals. It's important to note that these signs are not definitive indicators on their own, and each person's experience can vary. Therefore, consulting with your hospice provider for an accurate assessment and guidance in providing care is essential. As a supportive presence, offering comfort, reassurance, and a calming presence to the person who is dying and their loved ones is crucial. Being attentive, holding their hand, speaking softly, and providing comfort measures such as adjusting pillows, moistening their lips, or playing soothing music can help create a peaceful environment during this challenging time. Remember, the dying process is highly variable, and it's important to approach it with empathy, , and understanding.


Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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By Your Side , A Guide for Caring for the Dying at Home

Hospice Nurse Julie's video of an actively dying patient

Actively Dying Learn about Death and Lessen the Fear of Death (Video)

Signs of Approaching Death

End-of-Life Stages Timeline: What to expect as someone nears death

What Are 5 Physical Signs of Impending Death?

11 End-of-Life Symptoms in Older Adults

Comfort Measures: Practical Care of the Dying Cancer Patient

Clues to cancer death in days

The Dying Patient: Choices, Control, and Communication

Slide Player Presentation: The Stages of Death. SIGNS AND SYMPTOMS OF APPROACHING DEATH

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