The Dying Process at the End of Life
Published on January 16, 2022
Updated on June 7, 2025
Published on January 16, 2022
Updated on June 7, 2025
Table of Contents
Living is a continuum. Scientifically, we start life (as preborn human beings) from conception and actively live through the birthing process as we grow from child to adolescent to adult. We are actively living without regard to the quality of life we are living at the time. As we arrive closer to death, we often go through a transitioning phase before actively dying.
In this article, I would like to discuss the dying process at the end of life, answering frequent questions such as “What is transitioning?” “How do I know if my loved one is actively dying?” and “What are the phases of dying?” The phases of dying can be divided into two phases: transitioning towards actively dying and actively dying.
This is the start of the dying process that, for most people, is a mystery from the standpoint that their loved one may still be eating, talking, and, in some rare cases, even somewhat mobile. This phase can last seconds in the case of a sudden event like a myocardial infarction or one to a handful of weeks.
Clues that your loved one is starting to transition include the following:
The more time your loved one spends sleeping (out of consciousness), the more frequent the changes, especially respirations, complexion, and the more likely they are coming towards the end of the transitioning phase and heading into the actively dying stage.
The active dying phase starts when your loved one is unconscious, and sometimes it can be hard even for healthcare professionals who have worked with death and dying for years to know the exact end of transitioning and the exact start of the active dying portion. So much so that one of my former clinical managers who worked in hospice for approximately fifteen years would tell staff to tell families when we believe they are transitioning that their loved one is dying (therefore ignoring — which is not necessarily a terrible thing as it does reduce the complexity of it all — the two phases by combining them into one phase). The active dying phase involves the following:
Moments before death, as the active dying phase comes to completion, your loved one’s respirations (it cannot be stressed enough that changes to respirations — pattern/rhythm and rate are critical signs of changes in condition) will become more erratic. If your loved one didn’t have any death rattle until this point, secretions may start coming out of their mouth. Soon, they will take their last breath, which may sound like a gasp; fluid may come out of their mouth, and it’s now the end (for them, but not for you, as you are among the ones left standing).
In addition to the above, let me share some key highlights from the book Gone from my sight: The Dying Experience by well-known and expert Barbara Karnes, RN:
MENTAL CHANGES
PHYSICAL CHANGES
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
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Gone from My Sight: The Dying Experience
The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death
By Your Side, A Guide for Caring for the Dying at Home
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Finding Meaning: The Sixth Stage of Grief
It’s OK That You’re Not OK: Meeting Grief and Loss in a Culture That Doesn’t Understand
Need Help Dealing with Grief? GriefShare Grief & Loss Support Groups Are Here for You
CaringInfo – Caregiver support and much more!
Surviving Caregiving with Dignity, Love, and Kindness
Caregivers.com | Simplifying the Search for In-Home Care
As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.
Take Back Your Life: A Caregiver’s Guide to Finding Freedom in the Midst of Overwhelm
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Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying
Bridges to Eternity: The Compassionate Death Doula Path book series:
Find an End-of-Life Doula
Currently, there is no universal director of end-of-life doulas (EOLD). It’s essential to note that some EOLDs listed in directories may no longer be practicing. The author recommends starting with IDLM, as their training program is always current and thorough, followed by NEDA, which is the only independent organization not affiliated with any school.