The man turned blue before dying. Terminal states: preagonia, agony, clinical death

Regardless of the reasons that cause dying, the body, as a rule, undergoes a series of conditions called terminal before death. These include preagonal state, agony and clinical death.

Death can occur very quickly and without preagonal and atonal periods with injuries such as extensive traumatic brain injury, dismemberment of the body of various origins, for example, with a railway or aircraft injury, with certain diseases, especially with painful changes of cardio-vascular system(coronary vessels, spontaneous ruptures of aortic and cardiac aneurysms, etc.).

In other types of death, regardless of its cause, before the onset of clinical death, a so-called preagonal state occurs, which is characterized by disruption of the central nervous system. nervous system in the form of severe lethargy of the patient or victim, low or undetectable blood pressure; externally - pallor or spotting of the skin. The preagonal state (can last quite a long time) turns into agony.

The atonal state is more deep stage dying and is the last stage the body's struggle to preserve life. Increasing hypoxia leads to inhibition of the activity of the cerebral cortex, as a result of which consciousness gradually fades.

Physiological functions during this period are regulated by boulevard centers. During the period of agony, cardiac and respiratory functions are weakened, as a rule, pulmonary edema develops, reflexes are impaired and the physiological activity of the whole organism gradually fades. The atonal period can be short-lived, but can last for many hours and even days.

In acute death, there are pinpoint hemorrhages in the skin, under the mucous membranes, pleura, plethora is characteristic internal organs, acute, swelling of the gall bladder bed, blood in the vascular bed is dark, liquid. Cadaveric spots are well defined and form quickly. One of the signs of prolonged agony is the detection in the cavities of the heart and large vessels yellowish-white color of blood clots. During short-term agony, the bundles have a dark red color. With a long atonal period, the loss of threads slows down and the formed elements of the blood have time to settle, resulting in post-mortem. Blood clots consist mainly of fibrin strands, which have a yellowish-white color. During short-term agony, fibrin threads quickly fall out of the blood, the formed elements of the blood are retained in them (primarily), which is why red clots are formed. The process of formation of red blood clots is directly related to the increase in blood coagulation activity, and the formation of white and mixed blood clots also depends on the slowdown of blood flow.

The atonal period after cardiac arrest passes into a state of clinical death, which represents a kind of transitional state between life and death. The period of clinical death is characterized by the most profound depression of the central nervous system, extending to medulla, cessation of circulatory and respiratory activity. However, in the absence of external signs of life in the tissues of the body, at a minimal level, metabolic processes. This period, if promptly medical intervention may also be reversible. The duration of the period of clinical death is up to 8 minutes and is determined by the time of experience - the most recent in phylogenetic terms of the formation of the central nervous system - the cerebral cortex.

After 8 minutes, clinical death in normal conditions goes into biological death, which is characterized by the onset of irreversible changes, first in the higher parts of the central nervous system, and then in other tissues of the body.

What to expect and how to respond to the process of natural death.

No one can predict the moment of death. But doctors and nurses who care for the dying know certain symptoms of a dying body. These signs of approaching death are inherent in the process of natural dying (as opposed to symptoms of certain diseases that a person may suffer from).

Not all symptoms of dying occur in every person, but most people experience some combination of the following symptoms in their final days or hours:

1. Loss of appetite

Energy needs are reduced. The person may resist or refuse to eat or drink at all, or only take small amounts of soft food (such as warm porridge). The first ones will probably refuse meat that is difficult to chew. Even your favorite foods are consumed in small quantities.

Just before death, a dying person may be physically unable to swallow.

Reaction: don't push it; Follow the person's wishes even though you may be concerned about losing interest in food. Offer ice chips periodically ( so in the text - ice chips - I don’t know what they are, translator’s note,perevodika.ru), a popsicle, or a sip of water. Use a damp, warm tissue to wipe around your mouth and apply lip balm to keep your lips moist and flexible.

2. Excessive fatigue and sleep

A person may begin to sleep most of the day and night as metabolism slows and decreased food and water intake contributes to dehydration. It becomes difficult to awaken him or her from sleep. Fatigue increases so much that understanding and perception of the surrounding environment begins to blur.

Reaction: let him sleep, do not wake or push the sleeping person away. Assume that everything you say can be heard, as hearing is said to persist even when the person is unconscious, comatose, or otherwise unresponsive.

3. Increasing physical weakness

Decreased diet and lack of energy lead to a lack of physical strength to perform even such actions as lifting the head or moving on the bed. The person may have difficulty even taking a sip of water through a straw.

Response: Focus on making the person comfortable.

4. Brain confusion or disorientation

All organs, including the brain, begin to gradually fail. Higher order consciousness tends to change. "Only in rare cases do people remain fully conscious when they die," says palliative care physician Ira Biok, author of Dying Well.

The person may not know or understand where he or she is, or who else is in the room, talking to or responding to people who are not in the room (see "Passing Away: What to Expect When Witnessing a Loved One"s Death" - "Death: What to Expect When Being Present at the Death of a Loved One") may say seemingly meaningless things, may mix up the tenses, or may become restless and begin picking at the bed linen.

Response: Remain calm and comforting. Speak to the person softly, and identify yourself as you approach.

5. Difficulty breathing

Inhalation and exhalation become intermittent, irregular, and difficult. You can hear the specific “Cheyne-Stokes breathing”: a loud, deep inhalation, then a pause without breathing (apnea) lasting from five seconds to a minute, then a loud, deep exhalation and the cycle slowly repeats.

Sometimes the excessive secretions cause loud sounds in the throat when you inhale and exhale, what some people call the "death rattle."

Reaction: Stopping breathing or loud wheezing may alarm those present, but the dying person is not aware of this altered breathing; Focus on total comfort. Positions that may help: head, or top part The body, well supported, is slightly raised on the pillow, or the head or the lying body is tilted slightly to one side. Wipe your mouth with a damp cloth and moisturize your lips with lip balm or Vaseline.

If there is a lot of mucus, allow it to drain naturally from the mouth, as its selection may increase salivation. A humidifier in the room may help. Some people are given oxygen for comfort. Be calm, indicate your presence by stroking your hand or speaking soft words.

6. Withdrawal

As the body fails, the dying person may gradually lose interest in their surroundings. He or she may start mumbling unintelligibly or stop talking, stop answering questions, or simply turn away.

Sometimes, a few days before withdrawing for the last time, a dying person may startle his loved ones with a sudden outburst of anxious attention. This may last less than an hour or a whole day.

Response: Know that this is a natural part of the dying process and not a reflection of your relationship. Show your physical presence by touching the dying person and, if you feel the need, the need, then continue to talk without demanding an answer. if it feels appropriate, without asking for anything back. Cherish these moments of anxious attention if and when they happen, because they are almost always fleeting.

7. Changes in urination

A small entry (as the person loses interest in eating and drinking) means a small exit. Low blood pressure, part of the death process (and therefore not treated in this case like other symptoms), also contributes to kidney failure. Concentrated urine is brownish, reddish, or tea-colored.

In the later stages of dying, loss of bladder and bowel control may occur.

Response: Hospice providers sometimes decide that a catheter is needed, although not in the final hours of life. Kidney failure can increase the presence of toxins in the blood and contribute to a peaceful coma before death. Add a mattress pad, lay down new linens.

8. Swelling of the legs and ankles

Because the kidneys are unable to remove fluid, it can accumulate in parts of the body away from the heart - especially the legs and ankles. These areas, and sometimes also the hands and face, may become swollen and swollen.

Response: When the tumor appears directly related to the death process, usually no special treatment (eg diuretics) is used. (A tumor is the result of a natural death process, not its cause.)

9. Cooling hands and feet

Hours or minutes before death, circulation to the periphery of the body stops to help vital organs and therefore the extremities (arms, legs, fingers and toes) become cold. The nail beds may also appear pale or bluish.

Response: A warm blanket will help keep a person warm until he or she drifts off. The person may complain of heavy legs, so leave them uncovered.

10. Spotted Veins

One of the earliest signs of approaching death is that the skin, which was uniformly pale or ashen, develops many purplish/reddish/bluish spots. This is the result of reduced blood circulation. The first spots may appear on the soles of the feet.

Reaction: No special steps need to be taken.

Note: For different people, these general signs of impending death may appear in different sequences and in different combinations. If a person is on life support (respirator, feeding tube), the dying process may be different. The signs of death listed here describe the process of natural death.

The last stage of the disease turns into real agony for him, ultimately death inevitable. Relatives who are close to a cancer patient should know what symptoms and signs characterize this period. In this way, they will be able to create the appropriate conditions for the dying person, support him and provide assistance.

Death from cancer

All cancer diseases progress in stages. The disease develops in four stages. The last fourth stage is characterized by the occurrence of irreversible processes. At this stage, it is no longer possible to save the person.

The last stage of cancer is the process in which cancer cells begin to spread throughout the body and affect healthy organs. A fatal outcome at this stage cannot be avoided, but doctors will be able to alleviate the patient’s condition and slightly prolong his life. The fourth stage of cancer is characterized by the following signs:

• emergence malignant tumors throughout the body;
• damage to the liver, lungs, brain, esophagus;
• the occurrence of aggressive forms of cancer, such as myeloma, melanoma, etc.).

The fact that the patient cannot be saved at this stage does not mean that he will not need any therapy. On the contrary, properly selected treatment will allow a person to live longer and significantly alleviate his condition.

Symptoms that occur before death

Oncological diseases affect different organs, and therefore, signs of imminent death can be expressed in different ways. However, in addition to the symptoms characteristic of each type of disease, there are general signs that may occur in a patient before death:

1. Weakness, drowsiness. Most characteristic feature approaching death is constant fatigue. This occurs because the patient's metabolism slows down. He constantly wants to sleep. Don't bother him, let his body rest. During sleep, the sick person rests from pain and suffering.
2. Decreased appetite. The body does not need large quantities energy, so the patient does not feel the desire to eat or drink. There is no need to insist and force him to eat.
3. Difficulty breathing. The patient may suffer from lack of air, wheezing and heavy breathing.
4. Disorientation. Human organs lose their ability to function normal mode, so the patient becomes disoriented in reality, forgets basic things, and does not recognize his family and friends.
5. Immediately before death, a person's limbs become cold, they may even acquire a bluish tint. This happens because blood begins to flow to vital organs.
6. Before death, cancer patients begin to develop characteristic venous spots on their legs, the reason for this is poor circulation. The appearance of such spots on the feet signals imminent death.

In general, the process of death from cancer occurs sequentially in several stages.

1. Predagonia. At this stage, significant disturbances in the activity of the central nervous system are observed. Physical and emotional functions decline sharply. Skin turn blue arterial pressure falls sharply.
2. Agony. At this stage it comes oxygen starvation, as a result of which breathing stops and blood circulation slows down. This period lasts no more than three hours.
3. Clinical death. There is a critical decrease in the activity of metabolic processes, all body functions suspend their activity.
4. Biological death. The vital activity of the brain stops, the body dies.

Such pre-death symptoms are typical for all cancer patients. But these symptoms can be supplemented by other signs, which depend on which organs are affected by cancer.

Death from lung cancer

Lung cancer is the most common disease among all cancers. It is practically asymptomatic and is detected very late, when it is no longer possible to save the person.

Before dying from lung cancer, the patient experiences unbearable pain when breathing. The closer death is, the stronger and more painful the pain in the lungs becomes. The patient lacks air and feels dizzy. An epileptic attack may begin.

Liver cancer

The main cause of liver cancer is liver cirrhosis. Viral hepatitis is another disease that leads to liver cancer.

Death from liver cancer is very painful. The disease progresses quite quickly. In addition, pain in the liver area is accompanied by nausea and general weakness. The temperature rises to critical levels. The patient experiences excruciating suffering before the onset of imminent death from liver cancer.

Esophageal carcinoma

Esophageal cancer is a very dangerous disease. At the fourth stage of esophageal cancer, the tumor grows and affects all nearby organs. That's why pain symptoms can be felt not only in the esophagus, but even in the lungs. Death can occur from exhaustion of the body, since a patient suffering from esophageal cancer cannot eat food in any form. Nutrition is provided only through a tube. Eat regular products Such patients will no longer be able to.

Before death, everyone suffering from liver cancer experiences great agony. They open severe vomiting, most often with blood. Sharp pain in the chest causes discomfort.

Last days of life

Patients with stage four cancer They are usually not kept within the walls of a hospital. Such patients are sent home. Before death, patients take strong painkillers. And yet, despite this, they continue to experience unbearable pain. Death from cancer may be accompanied by intestinal obstruction, vomiting, hallucinations, headaches, epileptic seizures, hemorrhages in the esophagus and lungs.

By the time the last stage occurs, almost the entire body is affected by metastases. The patient is entitled to sleep and rest, then the pain torments him to a lesser extent. The care of loved ones is very important for a dying person at this stage. It is the close people who create for the patient favorable conditions, which at least briefly ease his suffering.

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Signs of imminent death of a patient

It is not customary to talk about death out loud in our time. This is a very sensitive topic and not for the faint of heart. But there are times when knowledge is very useful, especially if there is a cancer patient or a bedridden person at home old man. After all, this helps to mentally prepare for the inevitable end and notice the changes taking place in time. Let's discuss together the signs of death of a patient and pay attention to their key features.

Most often, signs of imminent death are classified into primary and secondary. Some develop as a consequence of others. It is logical that if a person begins to sleep more, then he eats less, etc. We will look at all of them. But, cases may be different and exceptions to the rules are acceptable. The same as options for a normal median survival rate, even with a symbiosis of terrible signs of a change in the patient’s condition. This is a kind of miracle that happens at least once in a century.

What signs of death do you know?

Changing your sleep and wake patterns

Discussing initial signs As death approaches, doctors agree that the patient has less and less time to stay awake. He is more often immersed in superficial sleep and seems to be dozing. This saves precious energy and reduces pain. The latter fades into the background, becoming, as it were, background. Of course, the emotional side suffers greatly. The paucity of expression of one’s feelings, the self-isolation of the desire to remain silent more than to speak leave an imprint on relationships with others. The desire to ask and answer any questions, to be interested in everyday life and the people around you disappears.

As a result, in advanced cases, patients become apathetic and detached. They sleep almost 20 hours a day if not acute pain and serious irritating factors. Unfortunately, such an imbalance threatens stagnant processes, mental problems and accelerates death.

Swelling

Very reliable signs of death are swelling and spots on the legs and arms. We are talking about malfunctions of the kidneys and circulatory system. In the first case of oncology, the kidneys do not have time to cope with toxins and they poison the body. In this case, metabolic processes are disrupted, blood is redistributed unevenly in the vessels, forming areas with spots. It is not for nothing that they say that if such marks appear, then we are talking about complete dysfunction of the limbs.

Problems with hearing, vision, perception

The first signs of death are changes in hearing, vision and normal sensation of what is happening around. Such changes may be against the background severe pain, cancerous lesions, blood stagnation or tissue death. Often, before death, you can observe a phenomenon with the pupils. The eye pressure drops and when pressed, you can see how the pupil is deformed like a cat's.

Regarding hearing, everything is relative. He can recover in last days life or even worsen, but this is more agony.

Reduced need for food

When a cancer patient is at home, all her loved ones note the signs of death. She gradually refuses food. First, the dose decreases from a plate to a quarter of a saucer, and then the swallowing reflex gradually disappears. There is a need for nutrition through a syringe or tube. In half of the cases, a system with glucose and vitamin therapy is connected. But the effectiveness of such support is very low. The body tries to use up its own fat reserves and minimize waste. This makes it worse general state the patient becomes drowsy and has difficulty breathing.

Urinary dysfunction and problems with natural needs

It is believed that problems with going to the toilet are also signs of approaching death. No matter how funny it may seem, in reality there is a completely logical chain in this. If defecation is not carried out once every two days or with the regularity to which a person is accustomed, then feces accumulate in the intestines. Even stones can form. As a result, toxins are absorbed from them, which seriously poison the body and reduce its performance.

It's about the same story with urination. It's harder for the kidneys to work. They allow less and less fluid to pass through and eventually the urine comes out saturated. In it high concentration acids and even blood is noted. For relief, a catheter can be installed, but this is not a panacea in the general context. unpleasant consequences for a bedridden patient.

Problems with thermoregulation

Natural signs before the death of a patient are impaired thermoregulation and agony. The limbs begin to get very cold. Especially if the patient has paralysis, then we can even talk about the progress of the disease. The blood circulation decreases. The body fights for life and tries to maintain the functioning of the main organs, thereby depriving the limbs. They may turn pale and even become blue with venous spots.

Weakness of the body

Signs near death Everyone's may be different depending on the situation. But most often, we are talking about severe weakness, weight loss and general fatigue. A period of self-isolation begins, which is aggravated by internal processes of intoxication and necrosis. The patient cannot even raise his arm or stand on a duck for natural needs. The process of urination and defecation can occur spontaneously and even unconsciously.

Foggy mind

Many see signs of approaching death in the way the patient’s normal reaction to the world around him disappears. He can become aggressive, nervous, or vice versa – very passive. Memory disappears and attacks of fear may occur due to this. The patient does not immediately understand what is happening and who is nearby. The areas in the brain responsible for thinking die. And obvious inadequacy may appear.

Predagonia

This defensive reaction all vital systems in the body. Often, it is expressed in the onset of stupor or coma. The main role is played by regression of the nervous system, which causes in the future:

Decreased metabolism

Insufficient ventilation of the lungs due to breathing problems or alternating rapid breathing with stopping

Serious damage to organ tissue

Agony

Agony is usually called a clear improvement in the patient’s condition against the background of destructive processes in the body. In fact, these are the last efforts to save necessary functions for continued existence. May be noted:

Improved hearing and restored vision

Establishing a breathing rhythm

Normalization of heart contractions

Restoring consciousness in the patient

Muscle activity like cramps

Decreased sensitivity to pain

The agony can last from several minutes to an hour. Usually, it seems to foreshadow clinical death, when the brain is still alive, and oxygen ceases to flow into the tissues.

These are typical signs of death in bedridden people. But you shouldn’t dwell too much on them. After all, there may be another side of the coin. It happens that one or two such signs are simply a consequence of an illness, but they are completely reversible with proper care. Even a hopelessly bedridden patient may not have all these signs before death. And this is not an indicator. So, it is difficult to talk about mandatory rules, as well as to impose death sentences.

Signs of imminent death in a cancer patient

Anyone who is faced with a serious illness feels in a difficult situation. It’s also difficult for his friends and family. Of course, modern medicine located on high level, however, some situations can be changed through pills, operations, etc. already unrealistic.

It happens that a cancer patient anticipates his death, thinks, perhaps dreams, and can accurately determine the time period when the irreparable will happen, without telling anyone, so as not to upset them even more.

In order to be able to personally monitor the condition, it is useful for relatives and friends to know not only the signs of a cancer patient’s imminent death, but also what is hidden behind the ornate statements of the treating staff.

Signs of imminent death of a person with cancer - what are they?

Professional medical staff They know that even with seemingly successful treatment, which is not accompanied by frequent manifestations of cancer, the patient dies. Even innovative anti-cancer drugs that are produced and released in countries with developed medicine are becoming useless in resisting a cruel disease.

The deterioration of the condition, as well as the possible impending death of a seriously ill person, can be traced to the following factors (most often they are observed in combination):

• loss of appetite;
• fatigue;
• incredible apathy (moral and physical);
• nervous breakdowns;
• difficult breathing;
• sudden fluctuations in weight;
• ensuring your own isolation;
• difficulty urinating;
• disruption of vascular activity;
• rapid freezing.

Each of them is discussed separately. Difficulties eating food take priority. Refusal or extremely unexpected loss of habits. Now he likes fish, and a day later he completely turns away from it.

This is explained by the fact that the need to eat food disappears, and an ever smaller share of the energy that a healthy person is used to getting from food is spent. Meat is removed from the diet. The fact is that it is difficult for an organism weakened by a serious illness to digest it. Because of this, many doctors switch to cereals and increase the consumption of increased amounts of liquid: juices, broths, compotes. At the moment when the patient can no longer independently swallow what is in his mouth, those close to him, unfortunately, can prepare for the worst ending.

Fatigue, weakness and breakdowns can be added and collected into a single aspect, since they develop simultaneously, which is quite natural. Caused by nothing more than exhaustion. On the basis of this, the rest develops. It is difficult for the patient to move even short distances. The defining stage in the development of the above is a disorder of the central nervous system. There is a loss in space when the dying person forgets the people and the place where he was located more than once.

The dying person gives up and decides that there is no reason or strength to cope. From this point, a neurologist and a psychologist are connected, whose work is aimed at motivation and further fight against the disease. If you do not take these actions, the seriously ill patient will definitely give up.

If we are talking about breathing problems, then you need to study Cheyne-Stokes syndrome. Thus, they indicate that they mean intermittent and superficial inhalations and exhalations, which deepen and then return to their original character. This cycle is repeated more than once. Then it becomes complicated by developing wheezing and acquires a permanent appearance.

Changes in weight are characteristic and quite logical precisely because of the difficulties that arise. Therefore, they rarely stop at this point. The efforts of those around them and their determination to provide drinking water are commendable. But there must be an understanding that all the signs of death of a cancer patient are interconnected.

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The closer the inevitable outcome is, the more the sick person strives to be alone with himself and get as much sleep as possible. This may be perceived as normal. This is explained by psychological and physical reasons. He doesn't want his family to see him weak. There is no desire to provoke anyone’s pity or indignation at the fact that care will need to be adjusted.

The urine takes on a strange color - red or dark brown. This is due to the fact that practically no fluid enters the body, and the kidneys, which serve as a filter, slow down their functioning.

Problems with blood vessels are reflected in regular swelling and blue spots, which are commonly called venous spots. The skin turns pale, which leads to easy display of veins and even small capillaries. Edema appears due to the fact that the body is deprived of natural filtration.

The last sign is considered to be a decrease in body temperature. Blood begins to rush towards the heart and vital organs in order to increase its lifespan. When your feet and fingers get cold in a second, the end is near.

What do we have to do?

Of course, loved ones do not agree to accept this outcome. Although medications cannot always completely cope with the tragedy, there are still ways.

As for the loss of interest in food, the caregiver will need to be patient. It is prohibited to use coercive force, and even more so to show irritability and hostility. You can occasionally offer water, fruit drinks, fresh juices, etc. That's what it's wise to keep an eye on, so that your lips don't dry out. While a person refuses to drink, it is necessary to at least lubricate them with balm or a damp cloth.

The advice regarding fatigue is much the same. You must not disturb sleep, forcibly awaken the patient, or artificially prolong the period of wakefulness.

Fatigue also cannot be influenced by force. There is no need to worry a person unnecessarily. Still, there is no reason for this. All you can do is increase comfort and try to give him a rest, increase the dose of joyful emotions and organize a good environment around him.

Increased sensitivity of the nervous system requires a special approach. It makes sense to invite an experienced psychologist. He must be friendly. Indicative for him will be meetings with those people who were able to defeat cancer. The main thing is to be able to motivate to continue the struggle, which will certainly end in success. And disorientation can be solved in this way - when visiting, a caring person needs to repeat his name, do not show aggression and try to express himself too softly. The same applies to the desire for isolation - do not interfere and introduce additional negativity. Gentle and calm intonations will help to gradually return the patient to the social environment.

Breathing will be restored special exercises. They are performed under supervision professional worker providing support. A change in position is rational. Turning on its side - best elimination Problems.

Vascular dysfunction, swelling and rapid freezing can be included in one list. They are fought against with a massage or a warm blanket.

But relatives should know that all of the above are, unfortunately, signs of a cancer patient’s imminent death and it is not always possible to win the battle against them.

It is important to know:

comments 4

Hello, my dad has cancer prostate gland, now he has fallen ill, has not eaten anything for 10 days (only water and tea 2 times a day), urine flows by itself (he does not feel that he is urinating), black stool, shortness of breath (there was water in the lungs, they pumped it out in January), in intestines strong rumbling(as he himself says, it’s as if soda was poured into his intestines), he vomits bile 2-4 times a day, his complexion is pale yellow, he has lost a lot of weight... Doctors refuse to come. .Can you tell me how much longer he will suffer? He refuses pills.

Hello! My daughter is 9 years old, she has a brain tumor and metastases in abdominal cavity. Also vomiting, black stool. It's better now. Contacted alternative medicine, drink herbal tinctures and special water. Look on the Internet for Doctor Tai, Petr Alekseevich Shablin. If you have anything please email me

alcohol tinctures?

Beetroot enemas. Herbal decoctions. Freshly squeezed carrot juice

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The information on the site is presented for informational purposes only! Apply the described treatment methods and recipes cancer diseases It is not recommended to do it on your own and without consulting a doctor!

None of us can predict exactly when death will occur. However, doctors and nurses who deal with seriously ill people know that the approach of death is accompanied by certain symptoms.

Signs of impending death vary from person to person, and not all of the symptoms listed below are “must haves.” But there is still something in common.

1. Loss of appetite

The body's need for energy becomes less and less. A person may begin to resist eating and drinking or only eat certain foods (for example, cereal). First of all, a dying person refuses meat, since it is difficult for a weakened body to digest it. And then even the most favorite foods no longer cause any appetite. At the end of his life, it happens that the patient is even physically unable to swallow what is in his mouth.

You cannot force feed a dying person, no matter how worried you may be that he does not eat. You can periodically offer the patient some water, ice or ice cream. To prevent his lips from drying out, moisten them with a damp cloth or moisturize them with lip balm.

2. Excessive fatigue and drowsiness

On the verge of death, a person begins to sleep atypically a lot, and it becomes increasingly difficult to wake him up. Metabolism slows down and insufficient consumption food and water contribute to dehydration of the body, which turns on the defense mechanism and goes into hibernation. The patient cannot be denied this - let him sleep. You shouldn't push him so that he finally wakes up. What you say to a person in such a state, he may well hear and remember, no matter how deep the sleep may seem. In the end, even in a coma, patients hear and understand the words that are addressed to them.

3. Physical weakness

Due to loss of appetite and the resulting lack of energy, the dying person is unable to do even the simplest things - for example, he cannot roll over on his side, raise his head, or suck in juice through a straw. All you can do is try to provide him with maximum comfort.

4. Brain fog and disorientation

Organs begin to fail, including the brain. A person may stop understanding where he is and who is next to him, start talking nonsense, or rush around the bed. At the same time, you need to remain calm. Every time you approach a dying person, you should call yourself by name and speak to him extremely gently.

5. Difficulty breathing

The breathing of dying people becomes intermittent and uneven. They often experience so-called Cheyne-Stokes breathing: superficial and sparse breathing movements gradually become deeper and longer, weaken and slow down again, then a pause follows, after which the cycle repeats. Sometimes the dying person wheezes or breathes louder than usual. You can help in such a situation by raising his head, putting an extra pillow, or sitting him in a semi-lying position so that the person does not fall over on his side.

6. Self-isolation

As vitality fade away, a person loses interest in what is happening around him. He may stop talking, answer questions, or simply turn away from everyone. This is a natural part of the dying process and not your fault. Show the dying person that you are there by simply touching him or taking his hand in yours, if he does not mind, and talk to him, even if this conversation is your monologue.

7. Urinary problems

Since little water enters the body, and the kidneys are working worse and worse, the dying person really “walks little”, and concentrated urine has a brownish or reddish tint. This is why hospices often place a catheter in a terminally ill patient’s last days of life. Due to kidney failure, the amount of toxins in the blood increases, which contributes to the dying person’s quiet fall into a coma and a peaceful death.

8. Leg swelling

When the kidneys fail biological fluids Instead of being excreted, they accumulate in the body - most often in the legs. Because of this, many people swell before death. Nothing can be done here, and it makes no sense: swelling is a side effect of approaching death, and not its cause.

9. “Icing” of the tips of the fingers and toes

A few hours or even minutes before death, blood is drained from peripheral organs to support vital ones. For this reason, the limbs become noticeably colder than the rest of the body, and the nails may take on a pale or bluish tint. A warm blanket will help provide comfort to the dying person; you need to cover him loosely with it so as not to create a feeling of being swaddled.

10. Venous spots

A characteristic “pattern” of purple, reddish or bluish spots appears on pale skin - the result of poor circulation and uneven filling of the veins with blood. These spots usually appear first on the soles and feet.

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Signs that a person is approaching death

If you are dying or caring for someone who is dying, you may have questions about what the dying process will be like physically and emotionally. The following information will help you answer some questions.

Signs of approaching death

The process of dying is as diverse (individual) as the process of birth. Impossible to predict exact time death, and how exactly the person will die. But people facing death experience many of the same symptoms, regardless of the type of illness.

As death approaches, a person may experience some physical and emotional changes, such as:

A dying person may experience other symptoms depending on the disease. Talk to your doctor about what you can expect. You can also contact the program for helping the hopelessly ill, where all your questions regarding the dying process will be answered. The more you and your loved ones know, the more prepared you will be for this moment.

As death approaches, a person sleeps more and it becomes more and more difficult to wake up. Periods of wakefulness are becoming shorter and shorter.

As death approaches, your caregivers will notice that you are unresponsive and that you are in very deep sleep. This condition is called coma. If you are in a coma, you will be confined to a bed and all your physiological needs (bathing, turning, eating and urinating) will have to be supervised by someone else.

General weakness is a very common occurrence as death approaches. It is normal for a person to need assistance with walking, bathing, and going to the toilet. Over time, you may need help turning over in bed. Medical equipment, such as wheelchairs, a walker or a hospital bed can be of great help during this period. This equipment can be rented from a hospital or care center for the terminally ill.

As death approaches, periods rapid breathing may be followed by periods of breathlessness.

Your breath may become wet and congested. This is called the "death rattle." Changes in breathing usually happen when you are weak and normal discharge from your respiratory tract and the lungs cannot come out.

Although noisy breathing may be a signal for your family, you will probably not feel pain and notice stagnation. Since the fluid is deep in the lungs, it is difficult to remove it. Your doctor may prescribe oral tablets(atropines) or patches (scopolamine) to reduce congestion.

Your loved ones may turn you on your other side to help the discharge come out of your mouth. They can also wipe this discharge with a damp cloth or special tampons (you can ask for it at a help center for the hopelessly ill or buy it at pharmacies).

Your doctor may prescribe oxygen therapy to relieve your shortness of breath. Oxygen therapy will make you feel better, but will not prolong your life.

Visual impairment is very common in last weeks life. You may notice that your vision has become difficult. You may see or hear things that no one else notices (hallucinations). Visual hallucinations- A common occurrence before death.

If you are caring for a dying person who is hallucinating, you need to reassure them. Acknowledge what the person sees. Denying hallucinations can be distressing to a dying person. Talk to the person, even if he or she is in a coma. It is known that dying people can hear even when they are in deep coma. People who came out of comas said that they could hear the entire time they were in the coma.

Hallucinations are the perception of something that is not actually there. Hallucinations can involve all the senses: hearing, seeing, smelling, tasting or touching.

The most common hallucinations are visual and auditory. For example, a person may hear voices or see objects that another person cannot see.

Other types of hallucinations include gustatory, olfactory and tactile.

Treatment for hallucinations depends on the cause.

As death approaches, you are likely to eat and drink less. This is associated with a general feeling of weakness and a slower metabolism.

Since nutrition is important social significance, it will be difficult for your family and friends to watch you not eat anything. However, changes in metabolism mean that you do not need the same amount of food and fluid as before.

You can consume small amounts of food and liquid as long as you are active and able to swallow. If swallowing is a problem for you, you can prevent thirst by moistening your mouth with a damp cloth or a special swab (available at a pharmacy) soaked in water.

Often the kidneys gradually stop producing urine as death approaches. As a result, your urine turns dark brown or dark red. This is due to the inability of the kidneys to properly filter urine. As a result, the urine becomes very concentrated. Its quantity is also decreasing.

As appetite decreases, some changes also occur in the intestines. The stool becomes harder and more difficult to pass (constipation) as the person takes in less fluid and becomes weaker.

You should tell your doctor if you have bowel movements less than once every three days or if your bowel movements cause you discomfort. Stool softeners may be recommended to prevent constipation. You can also use an enema to cleanse your colon.

As you become more and more weak, it is natural that you find it difficult to control bladder and intestines. They may put it in your bladder urinary catheter as a means of continuous drainage of urine. Also, the program for helping hopelessly ill patients can provide toilet paper or underwear (these can also be purchased at the pharmacy).

As death approaches, the area of ​​the brain responsible for regulating body temperature begins to function poorly. You may have heat, and in a minute you will feel cold. Your hands and feet may feel very cold to the touch and may even become pale and blotchy. Changes in skin color are called mottled skin lesions and are very common in the last days or hours of life.

The person caring for you can monitor your temperature by rubbing your skin with a wet, slightly warm washcloth or giving you the following medications:

Many of these medications are available in the form rectal suppositories if you have difficulty swallowing.

Just as your body prepares physically for death, you must prepare for it emotionally and mentally.

As death approaches, you may lose interest in the world around you and individual details everyday life, such as date or time. You may withdraw into yourself and communicate less with people. You may only want to communicate with a few people. This kind of introspection can be a way of saying goodbye to everything you knew.

In the days before your death, you may enter a unique state of conscious awareness and communication that may be misinterpreted by your family and friends. You can talk about how you need to go somewhere - “go home” or “go somewhere.” The meaning of such conversations is unknown, but some people think that such conversations help prepare for death.

Events from your recent past may be mixed with distant events. You can remember very long ago events in great detail, but not remember what happened an hour ago.

You may be thinking about people who have already died. You may say that you heard or saw someone who has already died. Your loved ones may hear you talking to the deceased person.

If you are caring for a dying person, you may be upset or frightened by this strange behavior. You may want to bring your loved one back to reality. If this kind of communication is bothering you, talk to your doctor to better understand what's going on. Your close person may fall into a state of psychosis, and it may be scary for you to watch. Psychosis occurs in many people before death. It may have one cause or be the result of several factors. Reasons may include:

Symptoms may include:

Sometimes delirium tremens can be prevented with alternative medicine, such as relaxation and breathing techniques, and other methods that reduce the need for sedatives.

Palliative care can help you relieve physical symptoms associated with your illness, such as nausea or difficulty breathing. Controlling pain and other symptoms is an important part of your treatment and improving your quality of life.

How often a person feels pain depends on their disease. Some fatal diseases, such as bone cancer or pancreatic cancer, can be accompanied by severe physical pain.

A person may become so afraid of pain and other physical symptoms that they may consider physician-assisted suicide. But the pain before death can be effectively dealt with. You should tell your doctor and loved ones about any pain. There are many medications and alternative methods (such as massage) that can help you cope with the pain of death. Be sure to ask for help. Ask a loved one to tell the doctor about your pain if you are unable to do so yourself.

You may want your family not to see you suffer. But it is very important to tell them about your pain if you cannot bear it so that they see a doctor immediately.

Spirituality means a person's awareness of the purpose and meaning of his life. It also denotes a person’s relationship with higher powers or the energy that gives life meaning.

Some people don't think about spirituality often. For others, it is part of everyday life. As you approach the end of your life, you may be faced with your own spiritual questions and challenges. Connecting with religion often helps some people achieve comfort before death. Other people find solace in nature, in social work, strengthening relationships with loved ones or creating new relationships. Think about what can give you peace and support. What questions concern you? Seek support from friends, family, programs, and spiritual guides.

Caring for a dying relative

Physician-assisted suicide refers to the practice of medical professionals assisting a person who voluntarily chooses to die. This is usually done by prescribing a lethal dose of medication. Although the doctor is indirectly involved in the death of a person, he is not the direct cause of it. Oregon is currently the only state to have legalized physician-assisted suicide.

A person with a terminal illness may consider suicide with the assistance of a physician. Among the factors that can cause such a decision are severe pain, depression and fear of dependence on other people. A dying person may consider himself a burden to his loved ones and not understand that his family wants to provide him with their help as an expression of love and sympathy.

Often a person with a terminal illness contemplates suicide with the assistance of a doctor when his physical or emotional symptoms don't get it effective treatment. Symptoms associated with the dying process (such as pain, depression or nausea) can be controlled. Talk to your doctor and family about your symptoms, especially if your symptoms bother you so much that you think about dying.

Control of pain and symptoms at the end of life

At the end of life, pain and other symptoms can be managed effectively. Talk to your doctor and loved ones about the symptoms you are experiencing. Family is an important link between you and your doctor. If you yourself cannot communicate with a doctor, your loved one can do this for you. There is always something that can be done to relieve your pain and symptoms so that you feel comfortable.

There are many painkillers available. Your doctor will choose the easiest and most atraumatic drug to relieve pain. Usually applied first oral medications, as they are easier to take and less expensive. If your pain is not severe, painkillers can be purchased without a doctor's prescription. These include drugs such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. It is important to stay ahead of your pain and take your medications as scheduled. Irregular use of medications is often the cause of ineffective treatment.

Sometimes pain cannot be controlled with over-the-counter medications. In this case, more are needed effective forms treatment. Your doctor may prescribe painkillers such as codeine, morphine, or fentanyl. These medications can be combined with others, such as antidepressants, to help you get rid of your pain.

If you cannot take the pills, there are other forms of treatment. If you have trouble swallowing, you can use liquid medications. Medicines can also be in the form of:

Many people who suffer from severe pain fear that they will become dependent on painkillers. However, addiction rarely occurs in terminally ill people. If your condition improves, you can slowly stop taking the medicine to prevent dependence.

Painkillers can be used to control the pain and help keep it at a tolerable level. But sometimes painkillers make you drowsy. You can only take a small amount of medication and therefore endure little pain and still remain active. On the other hand, maybe weakness doesn't matter to you. of great importance and you are not bothered by drowsiness caused by certain medications.

The main thing is to take medications on a specific schedule, and not just when “the need arises.” But even if you take medications regularly, you may sometimes feel severe pain. These are called "breakthrough pain." Talk to your doctor about what medications you should always have on hand to help manage breakthrough pain. And always tell your doctor if you stop taking your medicine. Sudden cessation may cause serious side effects and severe pain. Talk to your doctor about ways to relieve pain without using drugs. Alternative medical therapy may help some people relax and get rid of pain. You can combine traditional treatment With alternative methods, such as:

For more detailed information, see section Chronic pain

While you are learning to cope with your illness, short-term emotional distress is normal. Depression that lasts more than 2 weeks is no longer normal and should be reported to your doctor. Depression can be treated even if you have a terminal illness. Antidepressants in combination with counseling from a psychologist will help you cope with emotional distress.

Talk to your doctor and family about your emotional distress. Although feelings of grief are a natural part of the dying process, this does not mean you have to endure severe emotional pain. Emotional distress can increase physical pain. They can also have a negative impact on your relationships with loved ones and prevent you from saying goodbye to them properly.

As death approaches, you may experience other symptoms. Talk to your doctor about any symptoms you may experience. Symptoms such as nausea, fatigue, constipation or shortness of breath can be managed with medication, special diets And oxygen therapy. Have a friend or family member describe your symptoms to a doctor or emergency services worker. It is helpful to keep a journal and write down all your symptoms.

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Anyone who is faced with a serious illness feels in a difficult situation. It’s also difficult for his friends and family. Of course, modern medicine is at a high level, but some situations can be changed through pills, operations, etc. already unrealistic.

It happens that a cancer patient anticipates his death, thinks, perhaps dreams, and can accurately determine the time period when the irreparable will happen, without telling anyone, so as not to upset them even more.

In order to be able to personally monitor the condition, it is useful for relatives and friends to know not only, but also what is hidden behind the ornate statements of the treating staff.

Leading clinics abroad

Signs of imminent death of a person with cancer - what are they?

Professional medical staff know that even with seemingly successful treatment that is not accompanied by frequent complications, the patient dies. Even innovative anti-cancer drugs that are produced and released in countries with developed medicine are becoming useless in resisting a cruel disease.

The deterioration of the condition, as well as the possible impending death of a seriously ill person, can be traced to the following factors (most often they are observed in combination):

• loss of appetite;
• fatigue;
• incredible apathy (moral and physical);
• nervous breakdowns;
• difficult breathing;
• sudden fluctuations in weight;
• ensuring your own isolation;
• difficulty urinating;
• disruption of vascular activity;
• rapid freezing.

Each of them is discussed separately. Priority is given to difficulty eating. Refusal or extremely unexpected loss of habits. Now he likes fish, and a day later he completely turns away from it.

This is explained by the fact that the need to eat food disappears, and an ever smaller share of the energy that a healthy person is used to getting from food is spent. Meat is removed from the diet. The fact is that it is difficult for an organism weakened by a serious illness to digest it. Because of this, many doctors switch to cereals and increase the consumption of increased amounts of liquid: juices, broths, compotes. At the moment when the patient can no longer independently swallow what is in his mouth, those close to him, unfortunately, can prepare for the worst ending.

Fatigue, weakness and breakdowns can be added and collected into a single aspect, since their formation is simultaneous, which is quite natural. Caused by nothing more than exhaustion. On the basis of this, the rest develops. It is difficult for the patient to move even short distances. The defining stage in the development of the above is a disorder of the central nervous system. There is a loss in space when the dying person forgets the people and the place where he was located more than once.

The dying person gives up and decides that there is no reason or strength to cope. From this point, a neurologist and a psychologist are connected, whose work is aimed at motivation and further fight against the disease. If you do not take these actions, the seriously ill patient will definitely give up.

If speech about breathing problems, then you need to study Cheyne-Stokes syndrome. Thus, they indicate that they mean intermittent and superficial inhalations and exhalations, which deepen and then return to their original character. This cycle is repeated more than once. Then it becomes complicated by developing wheezing and acquires a permanent appearance.

Changes in weight are characteristic and quite logical precisely because of the difficulties that arise. Therefore, they rarely stop at this point. The efforts of those around them and their determination to provide drinking water are commendable. But there must be an understanding that all the signs of death of a cancer patient are interconnected.

The closer the inevitable denouement, the more the sick person seeks to be alone with himself and get as much sleep as possible. This may be perceived as normal. This is explained by psychological and physical reasons. He doesn't want his family to see him weak. There is no desire to provoke anyone’s pity or indignation at the fact that care will need to be adjusted.

Urine turns strange color– red or dark brown. This is due to the fact that practically no fluid enters the body, and the kidneys, which serve as a filter, slow down their functioning.

Vascular problems reflected in regular swelling and blue spots, which are usually called venous. The skin turns pale, which leads to easy display of veins and even small capillaries. Edema appears due to the fact that the body is deprived of natural filtration.

The last messenger is considered decrease in body temperature. Blood begins to rush towards the heart and vital organs in order to increase its lifespan. When your feet and fingers get cold in a second, the end is near.

Leading specialists from clinics abroad

What do we have to do?

Of course, loved ones do not agree to accept this outcome. Although medications cannot always completely cope with the tragedy, there are still ways.

As for the loss of interest in food, the caregiver will need to be patient. It is prohibited to use coercive force, and even more so to show irritability and hostility. You can occasionally offer water, fruit drinks, fresh juices, etc. That's what it's wise to keep an eye on, so that your lips don't dry out. While a person refuses to drink, it is necessary to at least lubricate them with balm or a damp cloth.

The advice regarding fatigue is much the same. You must not disturb sleep, forcibly awaken the patient, or artificially prolong the period of wakefulness.

Fatigue also cannot be influenced by force. There is no need to worry a person unnecessarily. Still, there is no reason for this. All you can do is increase comfort and try to give him a rest, increase the dose of joyful emotions and organize a good environment around him.

Increased sensitivity of the nervous system requires a special approach. It makes sense to invite an experienced psychologist. He must be friendly. Indicative for him will be meetings with those people who... The main thing is to be able to motivate to continue the struggle, which will certainly end in success. And disorientation can be solved in this way - when visiting, a caring person needs to repeat his name, do not show aggression and try to express himself too softly. The same applies to the desire for isolation - do not interfere and introduce additional negativity. Gentle and calm intonations will help to gradually return the patient to the social environment.

Breathing will be restored by special exercises. They are performed under the supervision of a professional support worker. A change in position is rational. Turning on its side is the best solution to the problem.

Vascular dysfunction, swelling and rapid freezing can be included in one list. They are fought against with a massage or a warm blanket.

But relatives should know that all of the above is, unfortunately, signs of imminent death of a cancer patient and in a battle with them it is not always possible to win.

It is not customary to talk about death out loud in our time. This is a very sensitive topic and not for the faint of heart. But there are times when knowledge is very useful, especially if there is a cancer patient or a bedridden elderly person at home. After all, this helps to mentally prepare for the inevitable end and notice the changes taking place in time. Let's discuss together the signs of death of a patient and pay attention to their key features.
Most often, signs of imminent death are classified into primary and secondary. Some develop as a consequence of others. It is logical that if a person begins to sleep more, then he eats less, etc. We will look at all of them. But, cases may be different and exceptions to the rules are acceptable. The same as options for a normal median survival rate, even with a symbiosis of terrible signs of a change in the patient’s condition. This is a kind of miracle that happens at least once in a century.

What signs of death do you know?

Changing your sleep and wake patterns
Discussing the initial signs of approaching death, doctors agree that the patient has less and less time to stay awake. He is more often immersed in superficial sleep and seems to be dozing. This saves precious energy and reduces pain. The latter fades into the background, becoming, as it were, background. Of course, the emotional side suffers greatly. The paucity of expression of one’s feelings, the self-isolation of the desire to remain silent more than to speak leave an imprint on relationships with others. The desire to ask and answer any questions, to be interested in everyday life and the people around you disappears.
As a result, in advanced cases, patients become apathetic and detached. They sleep almost 20 hours a day unless there is acute pain or serious irritating factors. Unfortunately, such an imbalance threatens stagnant processes, mental problems and accelerates death.

Swelling

Edema appears on the lower extremities

Very reliable signs of death are swelling and spots on the legs and arms. We are talking about malfunctions in the kidneys and circulatory system. In the first case of oncology, the kidneys do not have time to cope with toxins and they poison the body. In this case, metabolic processes are disrupted, blood is redistributed unevenly in the vessels, forming areas with spots. It is not for nothing that they say that if such marks appear, then we are talking about complete dysfunction of the limbs.

Problems with hearing, vision, perception

The first signs of death are changes in hearing, vision and normal sensation of what is happening around. Such changes can occur against the background of severe pain, cancer, blood stagnation or tissue death. Often, before death, you can observe a phenomenon with the pupils. The eye pressure drops and when pressed, you can see how the pupil is deformed like a cat's.
Regarding hearing, everything is relative. It can recover in the last days of life or even worsen, but this is more agony.

Reduced need for food

Deterioration of appetite and sensitivity are signs of imminent death

When a cancer patient is at home, all her loved ones note the signs of death. She gradually refuses food. First, the dose decreases from a plate to a quarter of a saucer, and then the swallowing reflex gradually disappears. There is a need for nutrition through a syringe or tube. In half of the cases, a system with glucose and vitamin therapy is connected. But the effectiveness of such support is very low. The body tries to use up its own fat reserves and minimize waste. This worsens the patient’s general condition, causing drowsiness and difficulty breathing.
Urinary dysfunction and problems with natural needs
It is believed that problems with going to the toilet are also signs of approaching death. No matter how funny it may seem, in reality there is a completely logical chain in this. If defecation is not carried out once every two days or with the regularity to which a person is accustomed, then feces accumulate in the intestines. Even stones can form. As a result, toxins are absorbed from them, which seriously poison the body and reduce its performance.
It's about the same story with urination. It's harder for the kidneys to work. They allow less and less fluid to pass through and eventually the urine comes out saturated. It contains a high concentration of acids and even blood is noted. For relief, a catheter can be installed, but this is not a panacea against the general background of unpleasant consequences for a bedridden patient.

Problems with thermoregulation

Weakness is a sign of imminent death

Natural signs before the death of a patient are impaired thermoregulation and agony. The limbs begin to get very cold. Especially if the patient has paralysis, then we can even talk about the progress of the disease. The blood circulation decreases. The body fights for life and tries to maintain the functioning of the main organs, thereby depriving the limbs. They may turn pale and even become blue with venous spots.

Weakness of the body

The signs of imminent death may be different for everyone, depending on the situation. But most often, we are talking about severe weakness, weight loss and general fatigue. A period of self-isolation begins, which is aggravated by internal processes of intoxication and necrosis. The patient cannot even raise his arm or stand on a duck for natural needs. The process of urination and defecation can occur spontaneously and even unconsciously.

Foggy mind

Many see signs of approaching death in the way the patient’s normal reaction to the world around him disappears. He can become aggressive, nervous, or vice versa – very passive. Memory disappears and attacks of fear may occur due to this. The patient does not immediately understand what is happening and who is nearby. The areas in the brain responsible for thinking die. And obvious inadequacy may appear.

Predagonia

This is a protective reaction of all vital systems in the body. Often, it is expressed in the onset of stupor or coma. The main role is played by regression of the nervous system, which causes in the future:
- decreased metabolism
- insufficient ventilation of the lungs due to breathing failures or alternating rapid breathing with stopping
- serious damage to organ tissue

Agony

Agony is characteristic of the last minutes of a person’s life

Agony is usually called a clear improvement in the patient’s condition against the background of destructive processes in the body. Essentially, these are the last efforts to maintain the necessary functions for continued existence. May be noted:
- improved hearing and restored vision
- adjusting breathing rhythm
- normalization of heart contractions
- restoration of consciousness in the patient
- muscle activity like cramps
- decreased sensitivity to pain
The agony can last from several minutes to an hour. Usually, it seems to foreshadow clinical death, when the brain is still alive, and oxygen ceases to flow into the tissues.
These are typical signs of death in bedridden people. But you shouldn’t dwell too much on them. After all, there may be another side of the coin. It happens that one or two such signs are simply a consequence of an illness, but they are completely reversible with proper care. Even a hopelessly bedridden patient may not have all these signs before death. And this is not an indicator. So, it is difficult to talk about mandatory rules, as well as to impose death sentences.