End of Life

When The End Comes

Just as every life is unique, so is each death -- it can happen suddenly, or a person may become increasingly frail and slowly slip away. Listen closely to what a dying person’s health care provider says. He or she may not come right out and say your loved one is close to death. You may have to ask if the end is near, and the provider can only give you a best estimate of how much time is left.

Common Signs of Death

The following are some common experiences that may mean the end is very near.

Each of these signs, taken alone, does not mean someone is dying. But when many are experienced by someone with a serious illness or declining health, it suggests a person is nearing the end of life.

As Death Approaches

It is common for breathing and heart rate to slow near the end. In fact, there may be times when the person doesn’t breathe for many seconds, known as Cheyne-Strokes breathing. Some people hear a “death rattle” or noisy breathing that makes a gurgling or rattling sound. Finally, the chest stops moving, no air comes out of the nose, and there is no pulse. Eyes that are open can seem glassy.

After Death Occurs

After death, there may still be a few shudders or movements of the arms or legs. There could even be an uncontrolled cry because of muscle movements in the voice box. Sometimes there will be a release of urine or stool, but usually only a small amount since so little has probably been eaten in the last days of life.

If the person has an implantable cardioverter defibrillator (ICD) and it has not been deactivated, it may continue to deliver shocks that cause the body to jump slightly. If this occurs, you don’t need to do anything, the ICD will stop on its own.

Note: If you are caring for a dying person at home, you may wish to check with your state concerning the need for a “non-hospital DNR.” In many states, emergency medical technicians (EMTs) are legally required to perform CPR and similar techniques when called to a home where someone’s heart has stopped beating. A “non-hospital DNR,” signed by the dying person’s health care provider, may be needed to allow the EMTs to not do CPR.

What to Do After Someone Dies

Immediately following death, nothing has to be done. Take the time you need to grieve. Some people want to stay in the room with the body, while others prefer to leave.

How long you stay with the body depends on where death happens and if you wish to observe any special customs based on your religious, cultural, or ethnic background. If the death will take place in a facility (a hospital or nursing home), let the staff know about any customs or rituals early on, if possible. This will help ensure you have appropriate time with the body.

If you choose to leave the room, you may want to have someone make sure the body is lying flat before the joints become stiff and cannot be moved. Known as rigor mortis, this stiffness sets in during the first hours after death.

You may have several people you wish to notify, who might want to come see the body before it is moved. Some people ask a member of the community or a spiritual counselor to come as well.

The Death Certificate

As soon as possible, the death must be “pronounced” by someone in authority, like the health care provider in a hospital or nursing home or a hospice nurse. This person fills out the forms certifying the cause, time, and place of death.

If death happens at home without hospice, talk to the health care provider, local medical examiner (coroner), local health department, or funeral home representative to find out how to proceed.

The process of having an authority figure pronounce the death makes it possible for an official death certificate to be prepared. A death certificate is a legal form necessary for many reasons, such as filing a life insurance claim and settling financial and property issues. It is useful to obtain multiple copies of the death certificate so it can be provided to banks, insurance companies, credit card companies, and other institutions.

Arrangements for the Body

Arrangements will need to be made for the body to be picked up, usually by a funeral home, from wherever death takes place. Hospital or nursing home staff may call a funeral home for you. If at home, you will need to contact the funeral home directly, or ask a friend or family member to do that for you.

Autopsies

The health care provider may ask you if you want an autopsy. This is a medical procedure conducted by a specially trained doctor to learn more about what caused the death. For example, if the person who died was believed to have Alzheimer’s disease, a brain autopsy would help confirm the diagnosis.

If your religion or culture objects to autopsies, talk to the health care provider. Some people worry that asking for an autopsy means they will not be able to plan a funeral with a viewing, but in almost all cases, the physical signs of an autopsy will not show.

Organ Donation

At some point before death or right after it, a health care provider may ask if the dying person is an organ donor. This means he or she agreed, at death, to donate healthy organs, such as the heart, lungs, pancreas, kidneys, cornea, liver, and skin, to living people who need them.

Experts say that organs from one donor can save up to eight people. This is why it is often called “the gift of life.” More than 114,000 people of all ages are on the waiting list for an organ.

People of any age can be an organ donor. In some states, this choice is included on a person’s driver’s license. If not, the decision has to be made quickly. There is no cost to the donor’s family.

If the dying person has a Do Not Resuscitate (DNR) order but wants to donate organs, he or she might have to indicate that the desire to donate supersedes the DNR.

To learn more about organ donation, visit www.organdonor.gov