Family members and friends of a dying loved one may wonder if the person knows they are dying. They may worry that if their loved one doesn’t know death is near, telling them might dash any hope and even make them die sooner. Here’s how to recognize the signs that someone is close to dying and why it is ok to acknowledge it.
The Important Tasks of Dying
It is natural to want to shield the ones we love from pain and sorrow. Trying to protect a loved one from the truth about their condition may initially seem like a good idea, but in fact withholding that information can lead to resentment and disappointment.
When a person knows they are dying, they have the opportunity to do five important things:1
- Apologize for past mistakes
- Forgive others for their mistakes
- Thank those people who matter most
- Say “I love you” to those they love
- Say goodbye
Without the opportunity to do these valuable things, your loved one could die with unfinished business.
Hope at the End of Life
It may seem like a dying person can’t possibly feel hopeful, but dying people do retain an amazing capacity to hope. While they may have stopped hoping for a cure or for a long life, they may still hope to mend relationships with loved ones and to die peacefully.
Keeping the truth about dying from the one who is nearing death could rob them of the chance to reflect on their lives and fulfill their final wishes.
Signs That Death Is Near
As someone nears the end of life, they usually experience certain specific physical and mental changes, including:2
- Fatigue or sleepiness
- Refusing food and drink
- Mental confusion or reduced alertness
- Anxiety
- Shortness of breath or slowed or abnormal breathing
- Hands, arms, feet, and legs that are cool to the touch
At the very end, the eyes may look glassy and the person may breathe noisily, making a gurgling sound known as a “death rattle.”
Awareness May Linger
It isn’t clear how long a person who is dying retains awareness of what is going on around them, but research suggests that some degree of awareness may remain even after the person slips from unconsciousness.
A 2014 study looked at 2,060 patients from 15 hospitals in the United Kingdom, the United States, and Austria who had been given CPR after going into cardiac arrest (in which the heart stops completely). Of those who survived, 140 were surveyed about their near-death experiences. Thirty-nine percent reported feeling some kind of awareness before their heart was restarted, but did not have an explicit recall of events.3
Often, people will lapse into a coma before they die—a deep state of unconsciousness and unresponsiveness. People in a coma may still hear people talking even when they can no longer respond. Because of this, the Hospice Foundation of America suggests that caregivers, family, and physicians should behave as if the dying person is aware of what is going on and is able to hear and understand voices.2
A 2020 study that investigated hearing in palliative care patients who were close to death provides evidence that some people may still be able to hear while in an unresponsive state. Electroencephalography (EEG) was used to measure the dying brain’s response to sound. The findings suggest that telling a person you love them in their final moments may register with them.4
They Know They’re Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn’t discuss their death, they most likely know it is coming.
In some cases, the person comes from a culture or a family in which death is simply not discussed. Furthermore, your loved one may sense that others feel uncomfortable recognizing the dying process so they don’t want to bring it up.
Death can then become the elephant in the room. Everyone knows it’s there but no one will acknowledge it. Family discussions may be awkward and superficial and never reach an intimate level. In this case, the important work of mending and completing relationships may not happen.
Talking About Dying
Talking about death is rarely easy. Many of us feel uncomfortable even saying the words “death” or “dying.” Talking about it with a loved one who has been diagnosed with a terminal illness can be especially awkward.5
First, remember that you are talking to someone who is still living, and that talking about memories and shared experiences honors the dying person’s life. Experiencing sadness with the loved one is appropriate; that’s part of life, too.
If necessary, a therapist or hospice social worker with experience in this area can make these conversations easier.
Frequently Asked Questions
What does dying feel like?
While we can observe another person’s death and perhaps imagine what it feels like for them, there is no way to know what it actually feels like to die.
What are the signs that death is near?
Someone who is very close to death will likely refuse food and water. Their breathing and heart rates will slow and/or be abnormal and their hands, arms, feet, or legs may be cool to the touch. They may also be agitated, anxious, and confused.
What should I say to someone who is dying?
There is no right or wrong thing to say to a dying person. You may want to share memories or make sure your loved one knows you love them. A therapist or hospice social worker can help make conversations about dying easier.
What are the five stages of death and dying?
According to one widely-accepted theory, originally conceived of by psychiatrist Elisabeth Kubler-Ross in 1969, the five stages of coping with realizing you are going to die are denial, anger, bargaining, depression, and acceptance.6
Some Final Thoughts
As uncomfortable as it can be to acknowledge openly that a person you love is dying, it’s important to realize that the person is most likely aware that they are dying, so you don’t have to struggle with “breaking the news.” In fact, dying people often appreciate being able to use the time they have left to tell people they love them and mend certain relationships if necessary.
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