Dear Barbara,
Can you explain the stages of dying?
I was surprised to discover how often people search for information about the “stages of dying.” Surprised because dead is dead. Well, you can get into brain death and clinical death, but I don't think that is what people are searching for. I think they want answers about the dying process, the signs of approaching death. They just don’t know the words to use to find the answers they are looking for. Elisabeth Kübler-Ross introduced the five stages of grief, and over time I think that idea has become confused with “stages of death.”
What are the “stages of dying,” or what I think are better described as the signs of approaching death? First, there are only two ways to die: fast or gradual. Fast dying can happen from an accident, a heart attack, or another sudden event. A person is alive one minute and dead the next.
We can die gradually in two ways. We grow old and our body gradually wears out, or we develop a life-threatening illness or disease and die gradually from that.
Gradual death has a process to it, with signs that indicate death is approaching. Some of these changes can begin two to four months before death.
It doesn’t really matter what the disease is or how long a person has had it. When the disease reaches a place where it is stronger than the physical body and the illness is interfering with the normal functioning of the body, the body begins shutting down, preparing itself to die.
There are three key areas to watch for signs that death is approaching: eating, sleeping, and withdrawing. These changes can begin months before death from disease and even years before death in someone who is simply growing old. Gradually, a person eats less and less, begins sleeping more and more, and slowly withdraws physically and emotionally from the activities that make up their life.
As death continues to approach, a person reaches a place where they are eating almost nothing, sleeping most of the time, and withdrawing further into themselves. They may become confused as they sleep more, sometimes confusing dreams with reality.
In the weeks to days before death, a person’s breathing may change, blood pressure may lower, and skin color may become blueish. They may sleep with their eyes partially open and may become restless, picking at their clothes or bed linens.
Most people are what we call non-responsive in the hours to minutes before death. We generally sleep through our final experience.
Remember, humans and animals have died naturally forever. Dying is something our bodies know how to do. There has always been a normal, natural process as death approaches. How we understand and attend to the dying is what has changed over time.
Something more... on the stages of dying
This has been a very brief description of the signs of approaching death and what we generally see as a person gradually dies. To support caregivers and families I suggest giving them the End of Life Guideline Series and have them watch my short film, New Rules for End of Life Care, offer more detailed information about what to expect.
