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  • Ophelia Ramirez

What is active dying?

Active dying is a term often used by hospice and health care workers to mark the final stages of end of life. What does it really mean and how can you identify when someone is in the active dying stage?

Simple stated, active dying is the final stage of dying and it can last anywhere from a few hours to a few days. And really, each death is different and these are only the most common timelines. One hospice nurse took care of a patient who was in the active dying stage for a couple weeks!

By definition, actively dying patients are typically very close to death. This is the time when we would encourage all loved ones who want to say their final goodbyes to gather around their loved one. And if, this stage of death lasts longer, it is a blessing to have any extra time.

Below is a list of some of the typical signs of active dying that can

occur as close as 48 hours to 3 minutes before death.

The signs and symptoms of active dying include:

  • Long pauses in breathing; patient’s breathing patterns may also be very irregular

  • Blood pressure drops significantly

  • Patient’s skin changes color (mottling) and their extremities may feel cold to the touch

  • Patient is in a coma, or semi-coma, or cannot be awoken

  • Urinary and bowel incontinence and/or decrease in urine; urine may also be discolored

  • Hallucinations, delirium, and agitation

  • Build-up of fluid in the lungs, which may cause unusual gurgling sound

Understanding what to expect by learning the signs and symptoms of active dying can be helpful. However, predicting active dying is still difficult. A patient may not exhibit all the signs above.

One of the clearest signs that active dying is occurring is when a patient verbally states that they believe they are dying. Another sign can include the patient’s position becoming rigid, indicating the time of death has approached. During the active dying stage, hospice care, as well as an End-of-Life Doula, become particularly important to ensure the patient’s and loved ones physical, emotional, and spiritual needs are met.

Written by Ophelia Ramirez End-of-Life Doula, Grief Facilitator

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