Death is not necessarily a painful experience, even though the illnesses or traumas that cause it can produce intense suffering. This is one of the conclusions drawn from medical research on the last days and hours of life. Studies show that many patients gradually lose consciousness, and some do not experience significant pain before death. However, scientists admit that they cannot prove whether the moment of death itself is completely painless.
An article picked up by Yahoo Health looks at what medicine knows about the dying process, based on studies of patients in palliative care, neurological research and the accounts of people who have survived cardiac arrests.
One of the most important distinctions made by specialists is that between the pain caused by the disease leading to death and the experience of permanent loss of consciousness.
Although the two phenomena are often confused, they are not necessarily identical.
What the researchers discovered after analyzing 315,000 people
A large study in Sweden, which included about 315,000 people, showed that pain is common in the last week of life, but does not occur in all cases.
According to the results, pain was recorded at:
- 81% of cancer patients;
- 69% of people with dementia;
- 68% of patients with heart failure;
- 57% of people with chronic obstructive pulmonary disease.
These percentages reflect the presence of pain at some point in the last week of life and do not prove that the respective persons were suffering at the exact moment of death.
Another systematic review found that about half of patients in the last two weeks of life experienced pain.
Common symptoms included shortness of breath and confusion.
The researchers point out that the intensity of the suffering depends largely on the disease causing the death, the general condition of the patient and the treatments administered.
What happens to the brain in the last hours of life
One of the most important phenomena observed in people approaching the end of life is the progressive reduction of the state of consciousness.
As blood circulation, metabolism and organ function deteriorate, patients often become increasingly drowsy.
They spend longer periods sleeping, communicate less and may become unresponsive to surrounding stimuli.
According to specialists, the diminished state of consciousness could reduce the range in which pain is consciously perceived.
However, the lack of reactions does not automatically mean that a person no longer feels anything.
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Doctors continue to assess the possible presence of pain even when the patient can no longer speak or answer questions.
For this, facial expressions, muscle tension, body movements and breathing changes are monitored.
Specialists recognize that there is no perfect method by which one can determine what a person who has lost the ability to communicate feels.
Loud breathing before death does not necessarily mean suffering
Another phenomenon that can cause concern for families is the change in breathing in the last hours of life.
Some people develop noisy breathing, sometimes described as wheezing.
The phenomenon occurs when the patient can no longer swallow or eliminate normally the secretions accumulated in the airways.
For those at the bedside, the sound can create the impression that the person is suffocating.
However, doctors explain that this type of breathing often occurs when the patient is already in a deep state of unconsciousness.
Therefore, the noise is not, in itself, evidence that the person is experiencing suffocation or intense pain.
In such situations, the medical staff may recommend changing the patient’s position or certain medications to reduce secretions.
But there are also cases where shortness of breath causes considerable distress, especially in people with lung disease or advanced heart failure.
The brain can also show electrical activity near death
Neurological research has shown that the cessation of blood circulation is not always accompanied by the instantaneous cessation of all electrical processes in the brain.
In some studies, researchers have detected brief episodes of brain activity near cardiac arrest.
Among them are changes in gamma waves, associated under certain conditions with complex cognitive processes.
The discovery caught the attention of scientists because it suggests that neurological activity during death may be more complex than previously thought.
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However, the mere presence of electrical signals does not prove that the person is conscious or perceives pain.
The brain can generate electrical activity without it being accompanied by conscious experiences.
For this reason, scientists cannot say with certainty whether the episodes in question correspond to perceptions, memories or sensations.
What people who were resuscitated after a cardiac arrest say
Another source of information comes from people who have survived life-threatening situations.
Some patients resuscitated after cardiac arrest have reported unusual experiences, such as feeling profoundly calm, seeing an intense light, or feeling as if they were outside their own body.
Others described memories that seemed to happen in rapid succession or the feeling that they were watching events from their own lives.
Interestingly, some such accounts are associated with feelings of calm, not intense pain.
However, near-death experiences are not universal and occur only in some of the survivors.
Researchers have proposed several neurological explanations, which include changes in brain oxygenation, neural network activity, and neurotransmitters.
These accounts do not prove what happens after irreversible death, because all the people who described them survived.
Therefore, they provide information about certain extreme states of the brain, not about a possible after-death experience.
Doctors can considerably reduce pain in the last days of life
An important aspect highlighted by the research is that severe suffering is not an inevitable feature of the dying process.
Palliative medicine has treatments that can reduce pain and other bothersome symptoms in terminally ill patients.
Among the drugs used are opioids, including morphine, which can relieve both severe pain and breathing difficulties in certain situations.
Doses are set individually, depending on the symptoms and condition of the patient.
Doctors stress that morphine administration in palliative care aims to reduce suffering, not hasten death.
In exceptional situations, when symptoms remain intolerable despite appropriate treatments, palliative sedation may be considered.
This involves the controlled reduction of consciousness to relieve suffering that cannot be controlled by other means.
The procedure is considered a last resort and must be differentiated from interventions aimed at causing death.
However, access to quality palliative care differs significantly between countries and medical systems, and complete pain relief cannot be guaranteed in all cases.
Why can’t scientists prove if death is completely painless
The most important limitation of research is the impossibility of obtaining a direct account from a person after the onset of irreversible death.
Doctors can analyze symptoms, monitor brain activity and talk to patients who have survived serious medical emergencies.
But none of these methods can accurately establish the subjective experience at the moment of definitive death.
There are also major differences between death that occurs gradually as a result of an illness and death that occurs in traumatic circumstances or as a result of medical emergencies.
Some situations involve very intense pain before loss of consciousness, while others are characterized by a progressive deterioration of alertness.
Therefore, the claim that death is always painless cannot be scientifically supported.
Nor is the idea that all people go through extreme suffering before death supported by medical evidence.
The conclusion of the research is that the process of death does not necessarily involve intense pain. Although suffering is common in the last days of life, especially in the case of certain serious diseases, the progressive decrease in the state of consciousness and palliative treatments can considerably limit the discomfort. However, the exact experience of the moment of irreversible death remains impossible to demonstrate by current scientific methods.
