Being With Someone at the Moment of Death: What to Expect and What You Can Do

Many people hope to be with a loved one at the end, and many fear it. You may worry you won’t know what’s happening, that you’ll do something wrong, or that you’ll see something upsetting. This guide describes what hospice and medical sources say about the final minutes and what you can do, in plain language. It focuses on the moment itself; for the hours and days before, see what to expect in the final hours. It isn’t a substitute for your hospice team, who can tell you what to expect for your loved one.

Is death a single moment?

Not usually. The National Institute on Aging explains that end-of-life care doesn’t happen only in the moments before breathing ceases and the heart stops beating; people often need care for days, weeks, or months before death. The very end is typically the last stage of a gradual process in which the body slows down.

What happens with breathing near the end?

Breathing is often the clearest change. The NIA notes that a dying person may have an abnormal breathing pattern, known as Cheyne-Stokes breathing, which alternates between deep, heavy breaths and shallow breaths or even no breaths. Some people very near death have noisy breathing, sometimes called a death rattle; in most cases, the NIA says, this noisy breathing does not upset the dying person, though it may alarm family and friends. See the science behind the death rattle.

MedlinePlus lists breathing changes in which breathing may stop for a bit and then continue as several quick, deep breaths. Michigan State University’s end-of-life resource says a person may not breathe at all for as long as ten to twenty seconds before beginning again. It adds that this is long enough that you may mistakenly think the person has died and then be startled by a sudden deep breath. A hospice provider’s guide describes the very end as breathing becoming shallower, with longer pauses, until the pauses grow longer than the breaths themselves and then breathing stops. If you can’t tell what you’re seeing, that’s okay; ask a hospice team member, as MedlinePlus advises.

What does death look like?

Michigan State’s resource lists what happens when death has occurred:

• The heart stops beating and breathing stops
• The body color becomes pale
• The body cools
• Urine and stool may be released
• The eyes may remain open
• The jaw can fall open

These can be startling to see, but they’re expected. You don’t need to be certain that death has occurred; the hospice nurse will confirm it. See how a doctor or nurse pronounces death.

What can I do in the moment?

You don’t have to do anything except be there. Some people find comfort in:

• Holding a hand and speaking. The NIA advises always talking to, not about, the person, and identifying yourself when you enter the room; some doctors think dying people can still hear even if they’re not conscious. See the science of hearing near the end of life
• Saying what you want to say. See what to say to someone who is dying
• Music, reading aloud, or prayer. Hospice nurse Barbara Karnes told TIME that watchers can talk as if the person can hear, and Dr. Kate Brazzale suggests reading aloud from a beautiful book if you run out of words
• Staying quiet. Silence is a legitimate way to be present
• Faith and cultural practices. Many traditions have particular words, prayers, or rites at the time of death. The NIA notes that unless your cultural or religious traditions require it, you don’t have to stay with the person all the time, and in some traditions presence is required. Tell your hospice team in advance what matters to your family, and see our guides on Catholic, Jewish, Muslim, and Buddhist traditions

Do I call 911 or the hospice?

This is the most practical question, and the answer depends on preparation.

Michigan State’s resource says that if the death occurs at home, it’s important to have a plan in place with the healthcare team so you know who to call, and that there is no need to call 911 when death is expected. Sample hospice guidance from the Minnesota Medical Association asks families to call the hospice for urgent concerns and avoid calling 911. A hospice provider’s guide says that if a hospice team member isn’t already present, call your hospice provider, and a nurse will come to confirm the death and guide you through the next steps.

Here’s the catch. The Merck Manual explains that first responders are almost always required to initiate life support unless a valid DNR order or portable medical order (often called a POLST) is in place and presented to them. Every state has a protocol for out-of-hospital DNR orders or portable medical orders, which typically require signatures from both the clinician and patient (or surrogate) and a special identifier, such as a bracelet or brightly colored form worn by or kept near the patient. If responders see an intact identifier, they will provide comfort care only and not attempt resuscitation.

So before the final days, ask your hospice team:

• Is a DNR or POLST in place, and is it signed?
• Where is the form kept, and can it be displayed where responders will see it?
• Who exactly do we call at the moment of death, and what’s the number at night and on weekends?
• What will happen when the nurse arrives?

See DNR and POLST/MOLST forms. If you’re not under hospice care, if there’s no DNR or POLST, or if the death is unexpected, call 911 and follow the dispatcher’s instructions; see what to do when someone dies at home unexpectedly.

What should I do right after?

For an expected death at home with hospice, the usual sequence is:

1. Take a moment. A hospice provider’s guide says there’s no rush, and you may sit in the quiet for as long as you need. Even when expected, the moment can feel surreal
2. Note the time if you can
3. Call the hospice so a nurse can come and confirm the death
4. Let family know when you’re ready
5. Call the funeral home after the nurse has been, when you’re ready. Karnes suggests that, before you call the funeral home, anyone who wants to can go in alone one last time to say goodbye

See what to do when someone dies at home (expected), who to call first in the first 24 hours, and what happens to the body in the first 24 hours.

What if I’m not there?

If you miss the moment, you haven’t failed. The NIA says that, unless your cultural or religious traditions require it, you shouldn’t feel that you must stay with the person all the time. See what families can do near the end of life.

What if I feel frightened or overwhelmed?

You can call your hospice team at any time, including to ask whether what you’re seeing is expected. Afterward, you may feel numbness, relief, sadness, or nothing at all. All of this is normal. Hospice provides bereavement support to the family for up to a year after the death; see who does what on an end-of-life care team and finding grief support.

This is general educational information, not medical advice. Every death is different, and processes for calling, pronouncement, and emergency response vary by state, county, and hospice. Your hospice team can give you specific instructions for your loved one; if there is any doubt about whether someone has stopped breathing and no plan is in place, call 911.