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Dying process: when life comes to an end

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Written by Wiebke Posmyk • Medical editor

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Most people don't like to think about dying. No wonder - because what death feels like, whether it will continue afterwards and if so, how, no one can report about it. How the dying process takes place in the body, on the other hand, can to a large extent be explained medically.

Even if dying means death for many, the process of dying is, strictly speaking, also part of life: It begins in the last phase of life and marks that Transition from life to death.

The process of dying is a process of parting, detachment, and change. Contact with fellow human beings is lost more and more. Consciousness and mental activity dwindle. The vital functions such as pulse, heartbeat and breathing do not occur. The cells of the body gradually die, which changes the remains. There are different opinions about exactly when the process of dying begins.

Death can occur very suddenly, for example after an accident or as a result of an acute heart attack. Then the process of dying may be much faster than when someone dies due to a long illness.

Phases until death

People who have a serious, terminal illness often go throughdifferent phasesbefore they go out of life: Initially, many are self-employed despite the progression of the disease and continue to lead a self-determined life. At some point, however, the physical restrictions increase so much, despite care and treatments, that they restrict the person concerned more and more in his everyday life. Ultimately, the bodily functions decrease so much that the sick person becomes weaker and weaker and finally death occurs.

The German Society for Palliative Medicine divides the last phases before death in life-shortening diseases as follows:

  • Rehabilitation phase: Although the disease progresses and the patient is in need of care, he can continue to live independently and self-determined. The forecast lifespan is then usually a few months, rarely years.
  • Pre-terminal phase: In this phase, the patient usually has a few weeks or months to live. Due to his illness, his symptoms are getting worse and he is increasingly restricted in his everyday life. Therapy and care cannot stop the restrictions caused by the disease, the symptoms increase, the patient becomes weaker and his or her activity decreases.
  • Terminal phase: The sick person is permanently or mostly bedridden. It usually only takes a few days before death.
  • Final phase or dying phase: The body functions continue to decline until death finally occurs. This phase describes the actual dying process. It occurs in the last days to hours before death.

Strictly speaking, the body is in the process of dying all of its life: As we get older, cells constantly die. This is a completely normal process, but only certain cells are affected, such as skin cells, nerve cells or blood cells. It is true that these cells are constantly renewing themselves through cell division, so that new body cells are constantly being created. With increasing age, however, this process runs more and more slowly and at some point it comes to an end completely.

Dying phase: The last hours until death

The final phase of the dying process begins in the last hours or days of life: the Dying phase. They are also known asagony. The mental and physical performance decreases more and more in this phase. The sick person "is dying".

The dying phase is a little different for everyone. Many dying people experience certain physical changes and signs shortly before death that herald approaching death - others lack these signs.

Breathing changes

TheBreaths can become faster and flatter in the dying process, or also much slower. Sometimes the breath becomes very irregular.

If the patient is too weak to cough up the naturally existing layer of mucus in the airways, a rattling or rattling sound. The sound of breathing is unlikely to hinder the person's breathing, but relatives are often concerned about it. In this case, it can help to elevate the upper body or to position the patient in the lateral position. In most cases it is not recommended to aspirate the mucus in the airways: this procedure would be a great burden for the dying person. In addition, the mucus forms again within a very short time. It is also possible that the mucus production is even stimulated by the suction.

Hunger and thirst decrease

Many dying people have not wanted to eat or drink in the last few days, which often causes relatives to fear that the person affected might starve or die of thirst. However, the lack of hunger and thirst in the last few days is normal: the intake of calories and fluids is a burden on the body and makes the dying process more difficult. It is believed that pain is less severe and the body is less sensitive to various stimuli if no nutrients are supplied. Nevertheless, if possible, you can always offer small amounts to drink to those affected.

Many patients have dry mouths due to inadequate fluid intake. Above all, it is important to keep the affected person's oral mucosa moist and on agood and regular oral care to be careful to prevent dry mouth and to protect the natural oral flora.

Consciousness and emotional state change

Many dying people appear restless shortly before death and feel increasingly fearful. Others withdraw "inward" in the dying phase and no longer perceive the outside world properly. This often becomes cloudy in the last days of lifeawareness. Often people who are dying appear as if they are asleep or as if they are half asleep. The view appears cloudy and absent. For some, the perception no longer coincides with reality, they seem more and more confused. For example, they no longer recognize their relatives or they perceive people who have already died in the room.

The metabolism changes

The metabolism also changes in the dying phase, for example kidney function. The amount of urine will decrease, making it appear darker and smell stronger. It can happen that these changes in metabolism develop a special body odor that some find unpleasant.

The blood flow decreases

Eventually that changesBlood circulation: The pulse becomes weak and faster, the body temperature drops, so that the arms and legs cool down. The skin looks pale and marbled in some places.

Shortly before death occurs, the heart beats weakly and the breath becomes shallow. Brain activity decreases, so that perception only functions to a limited extent - vision and hearing decline until the heart stops. A few minutes after the circulation has ceased to function, thebrain death a.

Medicines: as much as necessary, as little as possible

In the dying phase, it is important to put as little unnecessary strain on the patient as possible. Now it is only a matter of alleviating symptoms and making the last phase of life as positive as possible.

Medicines are therefore only used to treat acute symptoms - such as nausea, pain, panic or shortness of breath. All other medications that the patient has taken so far can in many cases be discontinued or tapered off, as they would place additional stress on the body.

Dying process: clinical death, brain death, biological death

Doctors differentiate between clinical death, brain death, and biological death.

Clinical death: rescue possible under certain circumstances

In the event of clinical death, the vital functions fail. This means: vital processes such as breathing and cardiovascular functions end.

In clinical death, in contrast to brain death, persists for a few minutes the ability to reactivate vital functions. With timely cardiac massage, artificial respiration or electrodefibrillation, the patient can be saved under certain circumstances.

Signs of clinical death are:

  • unconsciousness
  • Cardiac arrest (no pulse available)
  • Apnea
  • missing eyelid closing reflex when touched
  • lack of pupillary reflex when exposed to light

Brain death: brain functions have ceased

If all brain functions due to the lack of oxygen completely failed have and this state not undone doctors speak of brain death.

When the cardiovascular system stops working, the organs are no longer supplied with blood - and thus also not with oxygen that is in the blood. Without oxygen, the brain, heart, liver, kidneys and all other organs can no longer function and die. However, this does not happen at the same time.

The brain is the first organ to lose its function due to the lack of blood supply. After a few seconds without oxygen, the senses fail and consciousness disappears. The metabolism stops working. After about 10 to 15 minutes, the cells of the brain die. The patient is then considered to be brain dead.

When someone is brain dead

  • he falls into a deep coma with no stimulus response,
  • relaxes the muscles,
  • lack of central reflexes,
  • the pupils expand,
  • suspends breathing and
  • Brain waves can no longer be measured in the electroencephalogram (EEG) (so-called zero-line EEG).

However, brain death is not to be equated with the complete death of a person - various cells and cell complexes can survive for a while after brain death, so that further organ functions only gradually fail. However, brain death cannot be reversed.

In the brain dead, the cardiovascular function can be artificially maintained in the intensive care unit. This is relevant, for example, when organs are to be transplanted.

Survival time of various organs and cells after stopping the cardiovascular system:

  • brain: 8 to 10 minutes
  • heart: 15 to 30 minutes
  • liver: 30 to 35 minutes
  • Musculature: 2 to 8 hours
  • Sperm: 10 to 83 hours

Biological death: no more metabolism

It takes another 24 hours for the body to decompose - then the body has it Metabolism completely stopped. In this case one speaks in the technical language ofbiological death. When exactly this stage is reached cannot be determined in practice.

The process of dying: what does one understand by apparent death?

In very rare cases it happens that a person is thought to be dead even though he is alive. He is then in a state of deep unconsciousness. Clear signs of life such as breathing or heartbeat are then so weak that they are not perceived. At the same time, however, certain signs of death such as rigor mortis or death marks are missing. This condition is known asApparent death.

In order to guarantee the minimum metabolic rate of the cells, very weak breathing and blood circulation are sufficient. Under certain circumstances, the person appears as if dead - however, electrical activity can be detected in the electrocardiogram (EKG) or electroencephalogram (EEG).

Occurrence can cause an apparent death among other things

  • Overdose of sleeping pills,
  • carbon monoxide poisoning,
  • severe hypothermia,
  • the consequences of a lightning strike or
  • an accident with high voltage.

If breathing starts again in good time, the affected person may be able to regenerate after the apparent death.

Dying process: death sign

After death, the body changes - pathologists then speak of Death sign. A distinction can be made between certain and unsafe signs of death.

Unsure signs of death

Unsure signs of death While they occur in anyone who has recently died, they can also occur in people who are still alive. They are therefore not proof that death has already occurred.

Uncertain signs of death include:

  • a pale skin
  • a body that is getting cooler, especially on the extremities
  • lack of reflexes
  • no noticeable breathing
  • no palpable pulse, no heartbeat when listening
  • unconsciousness
  • Muscle relaxation
  • dilated pupils that do not respond to light

Safe death signs

Death can only be determined by thesure sign of death clearly establish.

To thesure sign of death belong:

  • Dead spots (livores)
  • Rigor mortis
  • late corpse manifestations such as putrefaction and putrefaction
  • severe injuries that are incompatible with life

Dead spots

The mostly red-bluish to purple onesDead spots usually become visible around 30 to 60 minutes after death. They arise because the blood is no longer in motion and therefore collects in certain places in the body according to the force of gravity.

Rigor mortis

In rigor mortis, the muscles stiffen. This happens because electrical impulses no longer reach the muscles. The muscles initially relax until they solidify one to three hours later, starting with the lower jaw and in the area of ​​the neck and neck. After a few days, the rigidity disappears again.

Online information from the Palliativ-Netzwerk Mainz: www.palliativnetzwerk-mainz.de (access date: October 24, 2019)

Online information from the Pschyrembel: www.pschyrembel.de (access date: 23.10.2019)

German Society for Palliative Medicine e. V .: Extended S3 guideline on palliative medicine for patients with incurable cancer. AWMF registration number: 128/001-OL (August 2019)

Brandt, S., Angstwurm, H .: The relevance of irreversible loss of brain function as a reliable sign of death. Deutsches Ärzteblatt International 2018, Vol. 115, pp. 675–81 (October 2018)

Thöns, M., Sitte, T .: Repetitorium Palliativmedizin: To prepare for the exam in palliative medicine. Springer, Berlin 2016

Adams, H., et al .: Pocket Atlas of Emergency Medicine. Thieme, Stuttgart 2011

Köther, I .: Care for the elderly. Thieme, Stuttgart 2011

Rosentreter, M., Groß, D., Kaiser, S .: Dying processes - approaches to death. University press, Kassel 2010

additional Information

Onmeda reading tips:

Link tips:

Guide to hospice and palliative care in Germany

Last content check:24.10.2019
Last change: 03.02.2020