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Death doulas

— Helping people at the end of their life

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You may have heard of a birth doula – someone who provides non-medical support and advocacy throughout pregnancy, birth and after the baby has been born. More recently, so-called death doulas – people who assist at the other end of the lifespan – have been growing in popularity.

The role of death doulas is still relatively new, so the terminology and definitions of what they are based on what they do are in flux. They are sometimes referred to as an end-of-life doula, soul midwife, death coach, dying guide, death midwife and palliative care doula. The actual term used is often down to the preference of the practitioner and how they define their work, as well as cultural norms within the country they work in.

Death doulas are known to work in Brazil, Canada, the Czech Republic, Germany, Ireland, Italy, Japan, New Zealand, Russia, the UK and the US. They tend to provide support to people with life-limiting or terminal illnesses, focusing on improving both the quality of life and the quality of death someone experiences. This can include helping with funeral plans, talking about the processes involved around death, or helping someone with their care appointments.

Sometimes, the doula’s contribution is simply about being next to the person and providing company.

The work of a death doula can extend beyond the dying person. They can provide emotional and social support to family, friends and even neighbours – typically the informal carers and social network surrounding the dying person.

Doulas help those close to the dying person with the impending loss (so-called anticipatory grief). Some also carry out errands and chores to enable them to spend time with the dying person. They may also continue to visit those people after the death to support them as they grieve. Crucially, death doulas can enhance the links between professionals and the social support around a person by helping with communications and advocacy work.

Filling the gap

With healthcare systems and informal carers typically stretched beyond capacity, death doulas can provide a means to fill the gap and provide personalised attention. Someone can access doula support either privately or, depending on the doula, through voluntary means.

My colleagues and I recently examined how end-of-life doulas can be provided by the NHS. It noted that the flexibility of the services doulas can provide was not only helpful for the dying person but also for the wider healthcare system. It helped people who may otherwise not receive support due to service gaps, strict referral criteria, or lack of social support.

Beyond supporting individuals, some death doulas see community engagement as core to their role. They are keen to share information about the dying process and grief with others. They may host workshops or death cafes. Across this work, their contributions are to normalise talking about death, dying and loss in society.

Anyone can become a death doula, and it is not currently a regulated profession. There is a wide range of doula training available internationally, including online, provided either by individual doulas or by organisations such as Living Well Dying Well.

People at a death cafe
Death cafes give people the space to talk about the ultimate taboo.

Personal experience

In addition to their doula training, doulas bring their own professional and personal experience to the role. International research on death doulas has noted that many who have become death doulas have a background in professional healthcare, social care or education, and may already have some experience with death.

Those who have trained to be a death doula can be eligible to join a community of practice. Within the UK, End of Life Doula UK is a membership organisation for doulas, setting standards for doula practice and representing doulas. Similar organisations exist globally, including the International End of Life Doula Association.

Death doulas are not a replacement for specialist palliative care and cannot prescribe drugs. Their role is to support people in having a good death.

The growing demand for death doulas is one example of how society is questioning what a good death can be and how to make it happen. Other examples include discussions about assisted dying and improving death literacy. Rather than consider death a societal taboo, there is a growing recognition that people want to value the end of life and reshape how it is experienced.

Death doulas can play a pivotal role in supporting a dying person and those around them. Their support can be emotional and practical, often bridging the gaps in existing support or helping to signpost to relevant services. Not everyone may want a doula, but those who do may see it as someone who can guide them through a significant life process.

Complete Article ↪HERE↩!

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Planning for end-of-life expenses amid soaring costs

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In the realm of financial planning, agents and advisors diligently guide their clients through the complexities of retirement savings, investments, and insurance. Yet, there’s a critical aspect that often doesn’t receive the attention it warrants until it’s too late: the cost of dying. Recent data reveals a stark reality: The price tag attached to end-of-life care and funeral expenses is climbing, propelled by inflation and escalating health care costs. Let’s look at the implications of these rising costs and outline strategies financial professionals can employ to assist their clients in preparing for the future.

The unavoidable cost of dying

The Consumer Price Index indicates a notable 4.8% increase in funeral costs over the past year, signifying the upward trajectory of end-of-life expenses. An average American now faces more than $24,000 in medical and funeral costs at life’s end. Specifically, end-of-life medical expenses average more than $16,000, while the median funeral cost nears $8,000. These figures highlight an uncomfortable truth: even in death, one cannot escape the financial implications of inflation.

Deepening funeral costs

The average funeral in the U.S. costs between $7,000 and $12,000, encompassing expenses from caskets and embalming to transportation, plots, flowers, services, headstones and funeral home fees. Opting for more elaborate services or higher-end options can significantly inflate these costs. This financial burden is not one most individuals wish to impose on their relatives posthumously.

The true ‘killer:’ Medical care costs

Although funeral expenses are steep, the cost of medical care in the final stages of life is even more daunting. Medicare provides some relief but hospital, palliative care and hospice care costs continue to surge. Hospital stays can exceed $10,000 per day before insurance. Despite a preference for dying at home, only about 25% of individuals do so, with the majority ending their lives in some form of medical care facility.

Planning for estate and legal considerations

Beyond medical and funeral costs, there are estate and legal fees to consider. The process of settling an estate and distributing inheritances involves a complex web of legalities, adding another layer of expense that can easily propel total end-of-life costs beyond $50,000.\

Strategic planning for end-of-life expenses

  • Savings and investments. One approach is for clients to allocate a portion of their savings or investments specifically for end-of-life expenses. This proactive measure can mitigate the financial impact on loved ones.
    • Insurance solutions. Life insurance or specialized end-of-life insurance products can offer a safety net for funeral and other final expenses. However, seniors may face high premiums, and those with existing life insurance policies may be overinsured if they plan to use these funds solely for funeral costs.
    • Life insurance settlements. For seniors facing steep life insurance premiums or those with more insurance coverage than necessary, a life insurance settlement presents a viable option. Selling their policy in the secondary market can provide them with a lump sum to cover end-of-life expenses, freeing them from the burden of escalating premiums.

    The role of agents and advisors

    Financial professionals play a pivotal role in navigating these complex waters. By conducting policy appraisals, advisors can determine whether a life insurance settlement is appropriate, potentially reallocating those funds toward long-term care insurance or directly covering end-of-life expenses. This strategic planning can alleviate the financial strain on clients and their families, ensuring a more manageable and dignified end-of-life experience.

    As the costs associated with end-of-life care continue to rise, agents and advisors are tasked with a crucial responsibility: to help their clients plan comprehensively, considering not only the joys of retirement but also the inevitable costs of dying. By exploring all available options, from savings and investments to insurance products and life insurance settlements, financial professionals can guide their clients toward peace of mind for themselves and their loved ones. Inflation may be an unyielding force, but with thoughtful planning and strategic advice, navigating the financial aspects of end-of-life can be less burdensome, allowing individuals to focus on living their final days with dignity and grace.

    Complete Article ↪HERE↩!

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Senior suicide

— The silent generation speaking up on a quiet killer

Graham and Bruce from the Ettalong men’s shed in NSW.

Over-85s have become the Australians most susceptible to suicide and a general lack of support is threatening to make the problem worse

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The age group most at risk of suicide may not be the one you expect.

The highest rate of suicide in Australia, for both men and women, is among people over 85, at 32.7 deaths per 100,000 for men and 10.6 deaths for women, respectively.

The global picture is similar. People over the age of 70 kill themselves at nearly three times the rate of the general population. Suicide attempts are also more lethal among older people, with US data showing that about one in four suicide attempts of older people result in death, compared with one in 25 among the general population.

But even these numbers are likely to be underestimates, says Prof Diego De Leo, emeritus professor of psychiatry at Griffith University.

Unless the death of an older person is very clearly a suicide, it is not likely to be investigated, he says, and deaths relating to misuse of medication or even falls that may have been deliberate are often assumed to be the result of senility or frailty.

“It’s widely reported in literature that there’s much more interest in scrutinising the causes of death of a young body than of an old man,” he says.

Helen Bird, 73, from the inner west in Sydney, believes her grandmother’s death fits in this category.

In 1985, Bird got a call to say that her grandmother Olive, 82, had been found in her nursing home room in Hobart with a serious head injury after falling. She died in hospital shortly after. Bird is convinced her grandmother’s death was suicide, knowing that her grandmother had been depressed and had been stockpiling her medication.

Trained nurse Helen Bird
Trained nurse Helen Bird believes her grandmother suicided in a nursing home, although the death was not recorded as such.

“Nothing stacked up,” she said. “I’m a nurse. But nobody ever asked a question. It was a fall, no one questioned it. It was something that really nobody wanted to hear about.

“It’s something that’s always been with me, with great sorrow really,” Bird says. “She felt, I suspect, there was just nothing more to live for, and that’s really, really sad.”

De Leo says there are very different assumptions around suicide for younger and older people. While suicide by a young person is treated as a tragedy and a mystery, an older person’s suicide is often seen as a rational decision.

“It’s this assumption: ‘he was making a balance between pros and cons in life and he discovered the cons were more than pros and he decided then to exit life’, it’s a rational balance,” he says.

Dr Rod McKay, a psychiatrist with a clinical practice focusing on older people, says it is sometimes assumed that someone dying through suicide later in life has less impact on people.

“Someone dying through suicide later in life does have a different impact on those who know them, but it’s not lesser,” he says.

Both McKay and De Leo are keen to draw a distinction between suicide among older people who are depressed and voluntary assisted dying (VAD), which is now legal in every state in Australia under tight restrictions.

“If someone comes to me and says ‘I want to die because I’m depressed and I see no solution to my depression’, well, as a physician I have to do my maximum best to intervene and try to improve the depression of this person, and I can,” says De Leo. “But [if someone comes with] chronic pain, chronic suffering, no hopes for improvement and inevitability of a progression of the suffering … then I feel different.”

McKay says well-meaning attempts to respect individual choices in regard to VAD, may have meant that physicians have not been proactive in referring older people for treatment of depression.

“That debate and the sensitivities everyone is feeling about trying to act respectfully, risks not identifying or investigating depression or reversible factors to the degree that we might,” he says.

A lifeline for men

Men die by suicide at much higher rates than women across all age groups. Among older men, loss of purpose and identity after retirement, weaker connections to children and grandchildren and to social networks can all be factors.

“We’ve never had anyone here who has taken their own life, or entertained that, that I know of,” says Bruce McLauchlan, president of the Peninsula Community Men’s Shed in Ettalong, an hour and a half’s drive north of Sydney, knocking on a wooden work bench. “Maybe, we hope, it’s the contribution of our shed that helps.

“We look for these things: a person who was lively and talkative goes quiet, then we say: ‘Mate, everything OK with you? Anything we can help with?’. Because we are a family,” McLauchlan says.

The Ettalong group, part of the global men’s shed movement, opens its metalworking and woodworking sheds three mornings a week. On a rainy Thursday, the men are just finishing their monthly barbecue lunch, which is sponsored by a local funeral home.

“It’s publicity for them,” laughs Graham Checkley, 84, a retired Baptist minister who is the group’s welfare officer. “We go to a lot of wakes.”

The group is a lifeline for a lot of men, especially after retirement or bereavement. McLauchlan started coming 12 years ago after his wife died. “The men’s shed helps me manage my grief. Otherwise, I’d be sitting at home watching TV all day.”

Garrick Hooper, 73, started coming three years ago after he retired as a taxi driver, and is still coming, “much to my amazement”.

“I always knew about it and I thought: ‘I’ll be avoiding that like the plague, I’m meaningfully employed.’ And then there comes a time that you’re not and you become officially elderly,” Hooper says. “When you retire, you’ve got to redefine yourself, and that’s just how it is.”

Having a laugh together is a big part of the Ettalong Men’s Shed.
Having a laugh together is a big part of the Ettalong men’s shed.

McKay says this sort of social intervention is incredibly important, and older people have far more resilience than they are often given credit for.

“The vast majority of older people don’t feel as old as other people view them as,” he says. “We look at older people, including older people with lots of problems and say ‘I couldn’t cope with that’. Whereas most older people cope well … so we project that on to them.”

Studies show psychological wellbeing actually improves into older age, though depression goes up again in the over-85 age group.

When that happens, McKay says, social interventions are not enough.

“Older people have extremely low access to psychological treatments, the lowest of any age group,” he says.

This can be as a result of unconscious ageism among medical professionals and a sort of therapeutic nihilism that sees depression as an inevitable part of old age and not something that can be treated.

When older people do receive treatment for depression, it can make a huge difference.

“We know that when you look at things clinically, if there is mental illness there, the likelihood of response to treatment is similar to younger people,” McKay says. “There are a lot of social factors that can be addressed, sometimes there are simple medical factors that can be addressed that can make a huge difference in whether someone sees suicide as an option or not.

“It continues to amaze me sometimes when I meet people and see how poor their quality of life is and then with a good review from a geriatrician or a GP who has the time to do it – and it does take time – just the improvement they can have in their quality of life.”

Complete Article ↪HERE↩!

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Not all mourning happens after bereavement

– For some, grief can start years before the death of a loved one

By and

For many people, grief starts not at the point of death, but from the moment a loved one is diagnosed with a life-limiting illness.

Whether it’s the diagnosis of an advanced cancer or a non-malignant condition such as dementia, heart failure or Parkinson’s disease, the psychological and emotional process of grief can begin many months or even years before the person dies. This experience of mourning a future loss is known as anticipatory grief.

While not experienced by everyone, anticipatory grief is a common part of the grieving process and can include a range of conflicting, often difficult thoughts and emotions. For example, as well as feelings of loss, some people can experience guilt from wanting their loved one to be free of pain, or imagining what life will be like after they die.

Difficult to define, distressing to experience

Anticipatory grief has proved challenging to define. A systematic review of research studies on anticipatory grief identified over 30 different descriptions of pre-death grief. This lack of consensus has limited research progress, because there’s no shared understanding of how to identify anticipatory grief.

Therese Rando, a prominent theorist, has proposed that anticipatory grief can help prepare for death, contributing to a more positive grieving experience post-bereavement. Rando also suggests that pre-death mourning can aid with adjustment to the loss of a loved one and reduce the risk of “complicated grief”, a term that describes persistent and debilitating emotional distress.

But pre-death mourning doesn’t necessarily mean grief will be easier to work through once a loved one has died. Other research evidence shows that it’s possible to experience severe anticipatory grief yet remain unprepared for death.

Carers should seek support

Carers of people with life-limiting illnesses may notice distressing changes in the health of their loved ones. Witnessing close-up someone’s deterioration and decline in independence, memory or ability to perform routine daily tasks, such as personal care, is a painful experience.

It is essential, then, for carers to acknowledge difficult emotions and seek support from those around them – especially because caring for a loved one at the end of their life can be an isolating time.

Where possible, it can also be beneficial for carers to offer their loved one opportunities to reflect on significant life events, attend to unfinished business, and to discuss preferences for funeral arrangements. For some, this may involve supporting loved ones to reconnect with friends and family, helping them to put legal or financial affairs in order, talking about how the illness is affecting them, or making an advance care plan.

Talking is key

Living with altered family dynamics, multiple losses, transition and uncertainty can be distressing for all family members. It may be difficult to manage the emotional strain of knowing death is unavoidable, to make sense of the situation, and to talk about dying.

However, talking is key in preparing for an impending death. Organisations who offer specialist palliative care have information and trained professionals to help with difficult conversations, including talking to children about death and dying.

Navigating anticipatory grief can involve self-compassion for both the patient and carer. This includes acknowledging difficult emotions and treating oneself with kindness. Open communication with the person nearing the end of their life can foster emotional connection and help address their concerns, alongside support from the wider circle of family and friends.

Extending empathy and understanding to those nearing death – and those grieving their impending loss – will help contribute to a compassionate community that supports those experiencing death, dying and bereavement.

Complete Article ↪HERE↩!

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Death and money

— How do you talk to your parents about the uncomfortable conversation?

By Betty Lin-Fisher

Today’s topic: How do you talk to your parents about death and finances – without seeming like you are money-hungry?

Daughter wants to avoid repeat hardships after dad’s death

The dilemma: Last year, Melisa Gotto’s father died.

“We did talk about death and sort of what accounts he had and what his desires were for when he passed, but we didn’t really get into the nitty-gritty of it,” said Gotto, of Green, Ohio.

But Gotto said she – and her father, Dave, – were unprepared for all that came with tying up everything from funeral arrangements to his financial affairs.

Melisa Gotto, right, said she was not prepared to handle financial for her dad, Dave Gotto, right, left after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said,
Melisa Gotto, right, said she was not prepared to handle financial for her dad, Dave Gotto, right, left after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said.

For instance, her dad had a burial plot in California but died in Nevada. She didn’t know it cost $10,000 and required special health department permission to transport a body over state lines.

Gotto’s parents were divorced. Now, Gotto wants to avoid the headaches and heartache she dealt with after her dad’s death. She has begun talking to her 69-year-old mom, Kim Slingluff, about how Slingluff will afford to live the rest of her life – and how the two of them prepare for her mom’s death.

“It is a very uncomfortable conversation when you start talking about a taboo topic,” said Gotto, CEO of Scandal Co-Active, a boutique public relations and marketing agency. “As a society, we don’t really talk about death, but it’s something that we all will experience. I think it’s something we should all start talking about.”

Gotto’s dad had communicated verbally that she’d be the executor of his estate when he died. But he left no other instructions for her and her brother, such as his medical wishes or details of what exactly to do after his death.

“He was pretty organized and had everything in a safe, but I didn’t know where that was,” she said.

Melisa Gotto, left, said she was not prepared to handle financial affairs for her dad, Dave Gotto, at right, after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said,
Melisa Gotto, left, said she was not prepared to handle financial affairs for her dad, Dave Gotto, at right, after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said.

Gotto said her dad also didn’t have enough finances to cover his funeral expenses. And seven months after his death, she’s still trying to get the title for his car.

Gotto says she doesn’t want to seem greedy discussing her mom’s finances or wishes after her death, but she doesn’t want to repeat what happened with her dad.

She has begun telling friends with kids to “do them a huge favor. Get all of this settled before you get older because it’s so important.”

Gotto said she has been approaching the subject with her mom with compassion and empathy. Slingluff has been verbally telling her things, but Gotto knows she needs to get things in writing.

Melisa Gotto, right, is having the uncomfortable conversation about death and finances with her mom, Kim Slingluff, left, to avoid similar hardship she faced after her dad's death.
Melisa Gotto, right, is having the uncomfortable conversation about death and finances with her mom, Kim Slingluff, left, to avoid similar hardship she faced after her dad’s death.

Gotto’s advice to others: “Make a list of everything you want to ask them because you don’t want to have to keep revisiting the conversation.

“Try to have some patience and understanding. And then if they don’t want to have those conversations, you have to respect that, too.”

Don’t leave grieving relatives with a mystery to solve

The expert advice: Talking about death and finances is an uncomfortable conversation and one that some of certified financial planner Jan G. Valecka’s clients are more willing to have than others.

Some clients feel “they have to disclose everything: their bank accounts, how much … they have, and that’s where I think it becomes uncomfortable and they feel a little bit vulnerable,” said Valecka of Valecka Wealth Management in Dallas.

“If I had to talk to somebody about estate planning, financial planning, legacy (planning), I would start from the benefit of your loved one. ‘Who would you want to take care of or help if all of a sudden something happened to you? … And it doesn’t have to be dollar signs, it just has to be more of what are your wishes,” said Valecka.

Having that conversation and letting your loved one know where the important documents are can be so helpful after a death, she said.

Valecka’s family had its own experience with this subject. Her husband, Bob, knew that he would be the executor of his uncle’s estate. However, his uncle did not want to discuss details of his death or his financial affairs.

Bob Valecka’s uncle, Joseph Valecka, was found dead the day after Christmas in 2022, with his wife who has dementia next to him unaware that he had died.

Bob and Jan Valecka had to quickly work to gain guardianship of the aunt and tend to the uncle’s estate.

But they had no instructions. They couldn’t find a will or any estate documents. It turned out there had been a will and Power of Attorney and other documents drawn up. They didn’t find them until after they went to court for emergency guardianship of the aunt.

Bob Valecka, left, knew his uncle, Joseph Valecka, wanted him to be executor of his estate after his death. But his uncle left no instructions, including whether there were any estate documents.
Bob Valecka, left, knew his uncle, Joseph Valecka, wanted him to be executor of his estate after his death. But his uncle left no instructions, including whether there were any estate documents.

The unanswered questions ranged from the significant to the mundane. Had he wanted to be buried or cremated? The uncle and aunt had a lake house. But the Valeckas had no key and didn’t know the security code to get into it, or how to turn on the wells, or if someone plowed the driveway.

“It was a mystery to us,” she said. “It could have been so much easier with planning and an uncomfortable conversation.”

Gotto’s approach to talking to her mom with compassion is a good one, said Valecka.

Some people are just uncomfortable talking about their death, she said. Some clients say it makes death too real.

Approach your loved one with the idea that they are sharing their wishes and helping the people they love after their death, Valecka suggested.

In that conversation, talk about getting a will, health directives and even user names and passwords for digital accounts, she said. Valecka didn’t know she would need a copy of the uncle and aunt’s marriage license to get the aunt on the uncle’s Social Security benefits. Valecka has now added that to her estate documents.

Complete Article ↪HERE↩!

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A Compassionate Journey

— The Transition from Palliative Care to Hospice

By Mazhar Abbas

The transition from palliative care to hospice is a journey marked not just by the end of life, but by the culmination of a lifetime’s worth of relationships, memories, and the profound need for compassion. In the case of Elaine Arazawa, a 62-year-old woman diagnosed with pancreatic cancer that had metastasized to her liver, the value of community and personalized care in her final days comes into sharp focus. Diagnosed with a condition that led to over a dozen tumors, Elaine’s story underscores not only the medical but also the emotional dimensions of transitioning to hospice care.

Understanding the Transition: From Palliative Care to Hospice

The journey from receiving life-prolonging treatments to focusing solely on quality of life is a critical period for patients with terminal illnesses. This transition necessitates a holistic approach that encompasses open communication and thorough assessment of patient needs. Healthcare professionals play a pivotal role in guiding families through this change, ensuring that care is not only medically appropriate but also aligns with the patient’s and family’s emotional and psychological needs. The story of Elaine Arazawa illustrates the profound impact of a well-coordinated care plan, facilitated by a team of dedicated healthcare providers, death care workers, doulas, nurses, grief counselors, and social workers. Together, they create an environment where patients can find solace and families can navigate the complexities of grief and acceptance.

Key Indicators for Hospice Care

Recognizing the right time to transition to hospice care is crucial for ensuring that patients receive the most appropriate support as they approach the end of their lives. Key indicators include a significant decline in health despite receiving treatment, frequent hospitalizations, and a clear preference from the patient to focus on comfort rather than cure. For Elaine, the decision to enter hospice care came after a candid discussion with her healthcare team and family, highlighting the necessity of open dialogue in making informed choices about end-of-life care. This transition allowed her to spend her final days surrounded by love, reflecting on her life, and engaging in meaningful farewells, emphasizing the importance of timing and communication in hospice care decisions.

Building a Supportive Community

Elaine Arazawa’s experience brings to light the significance of community and emotional support in the hospice care process. Unlike many who faced the end of life alone during the pandemic, Elaine had the fortune of being surrounded by her family and a compassionate care team. This communal approach to end-of-life care not only provided Elaine with comfort and love but also offered her family the emotional support needed to cope with their loss. The involvement of death care workers, doulas, and grief counselors ensured that Elaine’s journey was not only about managing physical symptoms but also about caring for the emotional and spiritual well-being of both the patient and her family.

Complete Article ↪HERE↩!

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What Dying Feels Like

— Palliative Care Doctor

Although a dying person tends to spend more and more time asleep or unconscious, there may be a surge of brain activity just before death

By Denyse O’Leary

Wednesday was Ash Wednesday in the Western Catholic tradition. It marks the beginning of Lent, a season of reflection and repentance. A common custom is that, during the service, the priest traces the sign of the cross in ashes on the penitent’s forehead, saying “You are dust and you will return to dust” (Gen 3:19). It’s one of many customs worldwide that offer a sobering reflection on the inevitability of death for all of us — unless, of course, we are transhumanists who genuinely believe that technology can grant us immortality.

What does dying actually feel like?

Most human beings have always believed that the essence of a human being survives the death of the body though the outcome is envisioned in a variety of ways. But, assuming that pain and distress are controlled, what does dying actually feel like? Can science tell us anything about that?

Caregiver supporting sick woman with cancer dying in the hospital

At BBC Science Focus, palliative care doctor Kathryn Mannix offers a few thoughts from long experience, including:

A dying person spends progressively less time awake. What looks like sleep, though, gradually becomes something else: dipping into unconsciousness for increasing periods. On waking, people report having slept peacefully, with no sense of having been unconscious…
As dying progresses the heart beats less strongly, blood pressure falls, skin cools down and nails become dusky. Internal organs function less as blood pressure drops. There may be periods of restlessness or moments of confusion, or just gradually deepening unconsciousness…
Breathing moves from deep to shallow and from fast to slow in repeating cycles; eventually breathing slows and becomes very shallow; there are pauses; and, finally, breathing ceases. A few minutes later, the heart will stop beating as it runs out of oxygen.
Kathryn Mannix, “What does dying feel like? A doctor explains what we know” BBC Science Focus, February 10, 2024

Surge of brain activity just before death

We are also learning that, contrary to what we might have expected, the brain does not necessarily just die down quietly. Researchers have recorded a surge of activity just before death:

To that end, the brain activity of four people who passed away in hospitals while being monitored by an EEG (electrogram) device was studied.
“The data generated, even though it’s only four patients, is massive, so we were able to only report a fraction of the features that it’s actually showing on the data,” Prof. Borjigin said.
At the time of death, brain activity was detected in the TPJ region of the brain — named because it’s the junction between the temporal, parietal and occipital lobes in the back of the brain.
Dan Gray, “Study finds evidence of increased brain activity in people right before they die,” Medical News Today, May 5, 2023. The paper is open access.

There may be a correlation between the surge of activity and near-death experiences, though that wouldn’t account for the NDEs of people who showed no neurological activity.

In any event, cells deprived of oxygen are doomed. But that does not mean that all of the body’s cells cease to function immediately when a person dies:

The brain and nerve cells require a constant supply of oxygen and will die within a few minutes, once you stop breathing. The next to go will be the heart, followed by the liver, then the kidneys and pancreas, which can last for about an hour. Skin, tendons, heart valves and corneas will still be alive after a day. White blood cells, which are more independent, can keep going for almost three days.
Luis Villazon, “When we die, does our whole body die at the same time? ”BBC Science Focus, nd.

So when a medic declares a person dead, that means that the death process is past the point of no return, not that every cell in the body is dead.

Terminal lucidity — getting in the last word

There are many stories through the ages of people near death suddenly waking up and saying something lucid. Researchers who study the phenomenon call it terminal lucidity. At Psychology Today in 2018, nurse educator Marilyn Mendoza noted regarding research to date::

So far, the response rate to the questionnaire he distributed has been limited. While the results are in no way definitive, out of the 227 dementia patients tracked, approximately 10 percent exhibited terminal lucidity. From his literature review, Nahm has reported that approximately 84 percent of people who experience terminal lucidity will die within a week, with 42 percent dying the same day.
Marilyn Mendoza, “Why Some People Rally for One Last Goodbye Before Death,” Psychology Today, October 10, 2018

As to why it happens, she offers,

There is as yet no logical scientific answer to this medical mystery. There is just not enough information to postulate a definitive mechanism for terminal lucidity. The fact that it occurs in people with different diseases suggests that there may be different processes occurring. Some speculate that this could be a spiritual experience or divine gift. It certainly is a gift for family members attending the death to have one last opportunity to be with their loved one and to say their last goodbyes. Both family members and caregivers who have been witness to this state that they feel changed by the experience.
Mendoza, “One Last Goodbye”

One interesting trend is this: Fifty years ago, slick media commentators expected to report that research into death and dying would explod all those myths about a soul or the hereafter or the human mind. But the opposite has happened. Topics like terminal lucidity and near-death experiences are conventionally researched now. And it’s just as clear now as it was fifty years ago that life is a journey and death is not, itself, the destination; rather, it’s a gateway to one.

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