What is Active Dying?

Active dying is the final stage of the dying process that lasts roughly three days. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death. Actively dying patients are often unresponsive and their blood pressure often drops significantly.

In this article is a list of the typical signs of active dying that can occur as close as 48 hours to 3 minutes before death. While a patient may not experience all these symptoms, this list will help the patient’s family members and loved ones in recognizing and defining active dying. Additionally, if you have more questions about "what is active dying" and how to identify and help your loved one through this natural process, you can talk to a hospice care expert by calling 855-327-4677 for 24/7 support or contact us online.

How long is the active stage of dying?

The dying process can last roughly three days, though this can vary depending on the individual and their condition. This stage follows the pre-active stage of death, which lasts for about three weeks. During the active dying phase, the body begins its final shutdown, which is a crucial time for comfort care and emotional support for both the individual and their loved ones.

What are the signs and symptoms of active dying?

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 sounds

Predicting active dying.

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.

As a loved one and/or caregiver of the patient, it’s important that you talk with a hospice nurse regarding their condition. They can identify when someone is actively dying and help you and your loved one during this time.

If you haven’t done so already, we recommend reviewing hospice eligibility criteria to see if your loved one's quality of life could be improved by hospice care.

You can also find a local hospice provider when ready.

What shuts down first when dying?

As a person enters the final days or hours of life, one of the first systems to slow down is the digestive system. Appetite decreases significantly, and individuals may no longer have the desire—or ability—to eat or drink. This is a natural part of the dying process, not something that needs to be forced or corrected.

Another early change involves the circulatory system, which begins to reduce blood flow throughout the body. As the heart slows and blood pressure drops, there’s less oxygen being delivered to vital organs—including the brain. This can lead to increased sleepiness, confusion, or moments of unresponsiveness.

Understanding which systems shut down first can help families and caregivers know what to expect and provide reassurance that these changes are normal and peaceful steps in the body’s transition.

What are the three stages of active dying?

Active dying typically occurs in the final hours to days of life and can be understood in three general phases: early, middle, and final stages. Each phase brings its own changes in physical function and awareness.

Early stage (days to hours before death).

During this phase, the person may begin to withdraw socially and sleep more often. They may become less responsive or enter a semi-conscious state. Breathing may start to change, becoming slower or more irregular. There may also be a noticeable decrease in appetite and fluid intake.

What the body is doing:
The body is shifting into survival mode, conserving energy by reducing blood flow and non-essential functions. Brain activity slows, and the metabolic rate drops, prompting fatigue and withdrawal from the environment.

Middle stage (hours before death).

As the body continues to slow down, the person may become completely unresponsive. Breathing may become more labored or exhibit a distinct pattern called Cheyne-Stokes breathing, where periods of rapid breaths alternate with moments of no breathing at all.

What the body is doing:
Organ systems are steadily shutting down. The brain is receiving minimal oxygen, breathing rhythms are controlled by the lower brainstem, and physical movement becomes limited or absent.

Final stage (minutes before death).

In the last minutes of life, breathing becomes shallow and may stop altogether. The heartbeat slows and eventually ceases. The body may make reflexive movements, such as small twitches, but these are not signs of pain or distress. Death occurs peacefully for most individuals in this phase.

What the body is doing:
The brain and organs have reached the point where they can no longer sustain life. There is no longer enough oxygen or circulation to maintain vital functions, and the body completes its natural transition.

A deeper analysis of the last 24 hours of life is available at the end of this page.

How does hospice help during the active dying stage?

During the active dying stage, hospice care becomes particularly important to ensure the patient’s physical, emotional, and spiritual needs are met. A hospice team assists patients who are actively dying and their families by providing:

Pain and symptom management: Hospice professionals are skilled in alleviating any pain and other distressing symptoms that occur in the active dying stage.
Comfort and dignity: Hospice staff are trained to prioritize the patient’s comfort and dignity with tasks like bed repositioning, bathing, and maintaining personal hygiene.
Emotional support: Hospice offers emotional and psychological support to both patients and their family members via social workers, counselors, and spiritual care providers.
Decision-making: Hospice teams facilitate open and honest communication between the patient, family, and medical professionals and help guide them in making informed decisions about care options.
Grief support: Hospice programs offer grief support to family members and loved ones after the person’s passing. This includes counseling, support groups, and other resources to help individuals cope with their loss.

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End-of-Life signs by disease.

Learn about the specific end-of-life signs of common diseases and terminal illnesses:

More end-of-life resources.

The final 24 hours: What to expect in the last stages of life.

When a loved one is in the last 24 hours of life, changes become more pronounced. This period is often referred to as the final phase of active dying. Understanding what to expect can help families prepare emotionally, provide comfort, and support their loved one with dignity and compassion.

How do you know someone is in their final hours?

In the final hours of life, signs of the body shutting down become more apparent. These may include:

Irregular or shallow breathing (Cheyne-Stokes respiration)
Coolness in the hands, feet, or limbs
Mottled skin, often starting on the legs and spreading upward
Periods of unresponsiveness or complete unconsciousness
Gurgling sounds or “death rattle” due to buildup of fluids in the throat
Extremely low blood pressure and weak or absent pulse

These symptoms signal that the body is no longer able to sustain normal function and is entering its final shutdown.

Recognizing the transition: When active dying begins

The transition into active dying typically begins when a person stops eating and drinking, becomes mostly unresponsive, and shows significant physical decline. Breathing patterns may shift dramatically—pausing for long intervals or becoming more rapid and shallow. Eyes may remain partially open and unfocused, and there may be little to no response to touch or sound.

Families may notice their loved one withdrawing inward. While this can be difficult to witness, it is a natural part of the dying process.

What are the three stages of death within the final 24 hours?

Healthcare professionals often refer to three general stages that occur during the last day of life:

1. Pre-active phase (hours to days before death)
Increased restlessness, decreased appetite and fluid intake, changes in breathing, and confusion or agitation.

2. Active phase (last hours before death)
Unresponsiveness, slowed or erratic breathing, cool extremities, and changes in skin coloration.

3. Clinical death (moment of death)
Breathing and heartbeat stop, pupils become fixed, and the body becomes still. This marks the physical end of life.

Signs the end is near.

Common indicators that a person is nearing the end of life include:

Minimal or no verbal communication
Extended periods of unconsciousness
Labored breathing or long pauses between breaths
Pale or bluish skin tone
Absence of reflexes or response to stimuli

These signs typically appear in the hours leading up to death and can vary slightly for each individual. Hospice professionals are trained to guide families through this final stage with compassion and care.