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Dying is the final stage of
life Life is a quality that distinguishes matter that has biological processes, such as Cell signaling, signaling and self-sustaining processes, from that which does not, and is defined by the capacity for Cell growth, growth, reaction to Stimu ...
which will eventually lead to
death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
. Diagnosing dying is a complex process of clinical decision-making, and most practice checklists facilitating this diagnosis are based on cancer diagnoses.


Signs of dying

The
National Cancer Institute The National Cancer Institute (NCI) coordinates the United States National Cancer Program and is part of the National Institutes of Health (NIH), which is one of eleven agencies that are part of the U.S. Department of Health and Human Services. ...
in the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
advises that the presence of some of the following signs may indicate that death is approaching: * Drowsiness, increased sleep, and/or unresponsiveness (caused by changes in the patient's metabolism). * Confusion about time, place, and/or identity of loved ones; restlessness; visions of people and places that are not present; pulling at bed linens or clothing (caused in part by changes in the patient's metabolism). * Decreased socialization and withdrawal (caused by decreased oxygen to the brain, decreased blood flow, and mental preparation for dying). * Decreased need for food and fluids, and loss of appetite (caused by the body's need to conserve energy and its decreasing ability to use food and fluids properly). * Loss of bladder or bowel control (caused by the relaxing of muscles in the pelvic area). * Darkened urine or decreased amount of urine (caused by slowing of kidney function and/or decreased fluid intake). * Skin becoming cool to the touch, particularly the hands and feet; skin may become bluish in color, especially on the underside of the body (caused by decreased circulation to the extremities). * Rattling or gurgling sounds while breathing, which may be loud (
death rattle Terminal respiratory secretions (or simply terminal secretions),, known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throa ...
); breathing that is irregular and shallow; decreased number of breaths per minute; breathing that alternates between rapid and slow (caused by congestion from decreased fluid consumption, a buildup of waste products in the body, and/or a decrease in circulation to the organs). * Turning of the head toward a light source (caused by decreasing vision). * Increased difficulty controlling pain (caused by progression of the disease). * Involuntary movements (called
myoclonus Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus (myo "muscle", clonic "jerk") describes a medical sign and, generally, is ...
), increased
heart rate Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excr ...
, hypertension followed by
hypotension Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the dia ...
, and loss of reflexes in the legs and arms are additional signs that the end of life is near.


Cultural perspectives on dying

How humans understand and approach the process dying differs across cultures. In some cultures, death is the complete termination of life. In other cultures, death can include altered states of being, like sleep or illness. In some traditions, death marks the transition into a different kind of existence, or involves a cyclic pattern of death and rebirth. These cultural differences affect people's lifestyles, behaviors, and approach to death and dying.


United States

In the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
, a pervasive "death-defying" culture leads to resistance against the process of dying. Death and illness are often conceived as things to "fight against", with conversations about death and dying considered morbid or taboo. Most people die in a hospital or nursing facility, with one around 30% dying at home. As the United States is a culturally diverse nation, attitudes towards death and dying vary according to cultural and spiritual factors.


China

In
Chinese Chinese can refer to: * Something related to China * Chinese people, people of Chinese nationality, citizenship, and/or ethnicity **''Zhonghua minzu'', the supra-ethnic concept of the Chinese nation ** List of ethnic groups in China, people of ...
culture, death is viewed as the end of life — there is no afterlife — resulting in negative perceptions of dying. These attitudes towards death and dying originate from the three dominant religions in China:
Taoism Taoism (, ) or Daoism () refers to either a school of philosophical thought (道家; ''daojia'') or to a religion (道教; ''daojiao''), both of which share ideas and concepts of Chinese origin and emphasize living in harmony with the '' Ta ...
,
Buddhism Buddhism ( , ), also known as Buddha Dharma and Dharmavinaya (), is an Indian religions, Indian religion or Indian philosophy#Buddhist philosophy, philosophical tradition based on Pre-sectarian Buddhism, teachings attributed to the Buddha. ...
, and
Confucianism Confucianism, also known as Ruism or Ru classicism, is a system of thought and behavior originating in ancient China. Variously described as tradition, a philosophy, a religion, a humanistic or rationalistic religion, a way of governing, or a ...
.


South Pacific

In some cultures of the South Pacific, life is believed to leave a person's body when they are sick or asleep, making for multiple "deaths" in the span of one lifetime.


Religious perspectives on dying


Christianity

In Christian belief, death occurs only once, but the person leaves their bodily form to continue to in spirit, either to heaven or hell.


Islam

In Islamic belief, the time of death is predetermined, with dying therefore perceived as the will of Allah. Dying is therefore considered as something to be accepted, with Muslims regularly encouraged to reflect upon death and dying. The majority of Muslims prefer to die at home, surrounded by their loved ones, with large numbers expected at the bedside of those who are dying.


Hinduism

In
Hinduism Hinduism () is an Indian religion or '' dharma'', a religious and universal order or way of life by which followers abide. As a religion, it is the world's third-largest, with over 1.2–1.35 billion followers, or 15–16% of the global p ...
, people are believed to die and be reborn with a new identity.


Buddhism

In
Chinese Buddhism Chinese Buddhism or Han Buddhism ( zh, s=汉传佛教, t=漢傳佛教, p=Hànchuán Fójiào) is a Chinese form of Mahayana Buddhism which has shaped Chinese culture in a wide variety of areas including art, politics, literature, philosophy, ...
, it is said that dying patients will experience phases between the state of torment and the state of exultation, and that caretaker must help the dying patient remain in the state of exultation through
Nianfo Nianfo (, Japanese: , , vi, niệm Phật) is a term commonly seen in Pure Land Buddhism. In the context of Pure Land practice, it generally refers to the repetition of the name of Amitābha. It is a translation of Sanskrit '' '' (or, "recoll ...
prayers. In some parts of Buddhism, the dead and living exist together, with the former having power and influence over the lives of the latter.


Medicalization


Resuscitation

Resuscitation is the act of reviving of someone and is performed when someone is unconscious or dying. Resuscitation is performed using a variety of techniques, of those the most common is Cardio Pulmonary Resuscitation (CPR). CPR is a procedure consisting of cycles of chest compressions and ventilation support with the goal of maintaining blood flow and oxygen to the vital organs of the body. Defibrillation, or shock, is also provided following CPR in an attempt to jump start the heart.
Emergency Medical Services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
(EMS) are often the first to administer CPR to patients outside of the hospital. Although EMS is not able to pronounce death, they are asked to determine the presence of clear signs of death and gauge whether CPR should be attempted or not. CPR is not indicated if the provider is at risk of harm or injury while attempting CPR, if clear signs of death are present (rigor mortis, dependent lividity, decapitation, transection, decomposition, etc.), or if the patient is exempt from resuscitation. Exemption is typically the case when the patient has an
advanced directive An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no ...
, a
Physician Orders for Life-Sustaining Treatment POLST (Physician Orders for Life-Sustaining Treatment) is an approach to improving end-of-life care in the United States, encouraging providers to speak with the severely ill and create specific medical orders to be honored by health care workers d ...
(POLST) form indicating that resuscitation is not desired, or a valid Do Not Attempt Resuscitation (DNAR) order.


End-of-life care

End-of-life care is oriented towards a natural stage in the process of living, unlike other conditions. The National Hospice and Palliative Care Organization (NHPCO) states that hospice care or end-of-life care begins when curative treatments are no longer possible, and a person is diagnosed with a terminal illness with less than six months to live. Hospice care involves palliative care aimed at providing at comfort for patients and support for loved ones. This process integrates medical care, pain management, as well as social and emotional support provided by social workers and other members of the healthcare team including family physicians, nurses, counselors, trained volunteers, and home health aides. Hospice care is associated with enhanced symptom relief, facilitates achievement of end-of-life wishes, and results in higher quality of end-of-life care compared with standard care involving extensive hospitalization.


See also

* Assisted dying (disambiguation) * Assisted suicide * End-of-life care * Euthanasia *
Last rites The last rites, also known as the Commendation of the Dying, are the last prayers and ministrations given to an individual of Christian faith, when possible, shortly before death. They may be administered to those awaiting execution, mortall ...
*
Near-death experience A near-death experience (NDE) is a profound personal experience associated with death or impending death which researchers claim share similar characteristics. When positive, such experiences may encompass a variety of sensations including detac ...
*
Right to die The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of this right is often understood that a person with a terminal illness, incurable pain, or without ...
*
Terminal illness Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia or advanced h ...
*
Voluntary euthanasia Voluntary euthanasia (VE) is the ending of a person's life at their request in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in recent years. Some forms of ...


References

{{Authority control Human life stages Death Biology Signs of death Medical aspects of death