Death is a definite certainty in life. Some will pass away in ways beyond our control, and many will not know exactly the moment of death itself. However despite the taboo, the journey towards death and dying well can be managed in an appropriate manner. Knowing people could have different views about death and dying, and appreciating these differences, could promote a meaningful way of dying and ‘good’ death.

When death is near, the main course of action is to fulfil the dying person’s wishes. If the person is dying from an illness, ideally, they will have shared their preferences about how to live and die. Different suggestions could be provided to the dying individual in an attempt to accommodate his or her requests and still provide adequate care. If the dying individual is not able to involve in formulating final plans, you should strive to facilitate their desired preferences. Ideally, the aim will be for the final days to be guided toward maintaining comfort and reaching a natural death.

The Process of Dying & Death

If a person is dying from a chronic illness, he or she may grow weaker and sleep more as each day passes, especially if his pain has been eased.

Closer to the very end of life, his or her breathing becomes slower – sometimes with very long pauses in between breaths. The final outcome of dying is death itself. You will know death has arrived because the person’s chest will not rise and you will not detect any breath. His or her eyes may be glassy and you will not feel the pulse.

The dying process may go through two main stages prior to actual death. The first stage is called the pre-active phase of dying followed by the second stage called the active phase of dying. The duration of pre-active phase of dying may last weeks or even months, while the active phase will be shorter and last only a few days, or, sometimes, a couple of weeks.

Pre-active Phase

• Person speaks of “tying up loose ends” such as finances, wills
• Person spends more time alone and withdraws from social activities
• Person desires to make amends or catch up with family and friends
• Lesser activity, more lethargy or sleep
• Loss of interest in daily activities, eating or drinking
• Increased discomfort, anxiety, agitation, confusion
• Increased difficulty to heal from bruises, infections or wounds
• Person talks about dying or asks questions about death
• Person shows more interest in religious activities e.g. praying, or requests to speak with a religious leader

Active Phase

• Person says that he is going to die soon
• Has problems swallowing or resist consuming food and fluids
• Getting more unresponsive or difficulty speaking
• Personality change
• The hands, feet, arms and legs could be starting to feel very cold.
• However not all the above signs would be apparent and they are merely a guide to what may or often happens

How can you support?

As a family member or friend, you could do the following:

• Ask the person whom he/she would like to see and invite those people. Have a list of people to contact near the time of death.
• Help them to feel comfortable (massage, holdings hands, reading and background music can help decrease a person’s sense of isolation and enhance comfort)
• Standby for physical discomfort (e.g. lip balm to prevent chapped lips)
• Talk with someone you trust about your feelings of potential loss
• Feel free to say good-bye at the time of death

Below are guidelines are for the person who is dying. Ideally, death and dying should be peaceful and healthy for the dying person and the people who love and care about the dying individual.

Specific guidelines for the dying individuals include:

• Don’t be fearful to ask to be alone, time to be by yourself is important
• Be grateful and willing to seek help
• Some people may interact with you differently after knowing that you are dying. Be patient with them as they may slowly adjust to this fact.
• Slow down, and request your family and friends to slow down the pace. Sometimes there may not be a lot of time, but there is sufficient time, except in the most extreme cases, to reflect, plan and carry out the necessary.
• Get someone you trust to help you handle the matters related with your dying and death. Pre-planning will provide your loved ones both assurance that your wishes are being fulfilled and peace of mind from the knowledge that decisions have already been made.
• Ask your health care providers to explain what is being done to you so that you can understand why things are being done and what benefits you can expect.
• If necessary, utilize resources that are available from the community e.g. counselling services.