People who have survived a near-death experience tell very different stories about their experience of being ‘dead’. Although many describe moving towards a bright light and a welcoming environment which they find hard to resist, others describe sinking or floating into nothingness.

Many people feel that they don’t know exactly what will happen to their mind after their death. Some people feel that their soul or consciousness will live on (perhaps in a new form) or go to another place. Other people feel that once they have died that is the end and their mind just stops.

When death is due to cancer it is usual to gradually get weaker and more tired over several weeks or months. As it is not possible to accurately predict what will happen, it is helpful to do important things such as getting your affairs in order sooner rather than later. However, as with all other seemingly healthy people, there is a small risk that you may die suddenly.

The changes that occur in the body are discussed in this section. It can be hard to understand how cancer can cause death. The changes it causes in your body will depend on the type of cancer and where it is in the body.

Body changes

Most cancers affect the body’s ability to use the food that we eat to make energy. This can make you feel exhausted and weak, and no longer able to fight. The cancer cells can prevent the body from working normally, and may cause a change in the chemical balance in the body and sometimes a build up of waste chemicals.

These chemical changes can make people begin to lose weight, no matter how much they eat. Your appetite for food will gradually reduce. Your appearance may change and you may also start to look older. Once a person stops eating they usually only live for a couple of weeks.

As you become weaker and less able to do things, just trying to carry out ordinary daily activities such as getting up and dressing can make you feel exhausted. Your muscles may waste away. You will feel gradually more and more tired and will need to rest or sleep more during the day.

Loss of interest

During this time, it is common for people to lose interest in things that were previously important to them. It is sometimes as though people need to withdraw their attention from the world in order to prepare for death.

Care and support

People may need quite a lot of physical help and support during this time as they get weaker and less able to do things. However, a lot of the time they may just want to lie still and may want other people to just sit with them, without necessarily having to talk.

Occasionally, a dying person stays aware and able to talk right up until very close to the end, and can have a meaningful conversation with people around them. However, this is the exception rather than the rule, and it is important to say all the things that you want to at an early stage.

As all these changes continue, there comes a time when people feel very weak and are not able to get out of bed at all. From needing to sleep and rest a lot, people move into a phase where their sleep becomes deeper and they spend time drifting in and out of consciousness.

At times you may become confused, and not recognise your family or friends. You may also hear or see things which are not there (hallucinations). You may have thoughts or experiences which are like dreams, in which you are not sure whether things that you experience are real or not.

The drowsiness and confusion can be due to the chemical changes that are happening in the body and the build up of waste chemicals (toxins). They may sometimes be partly due to the medicines that you need to keep you comfortable. Sometimes, to the people around you, you may appear distressed and restless.

Sensations

Your feet and hands may feel cold, or your skin may feel very sensitive to any touch. People looking after you may need to be very gentle when moving or touching you.

Coma

The drowsiness and sleepiness usually gradually develops into a phase where people become unconscious and can’t respond at all to anything around them. You may seem to be peacefully asleep or may move, twitch or grimace occasionally as though you are dreaming. Although you will not be able to respond to the people around you at this time it is likely that you will be aware that they are there. It is likely that you will be able to hear them if they talk to you. This phase may last only a few hours or can continue for a few days.

At this stage, food and drink are not necessary as your body is no longer able to absorb or use them. Moistening your lips or mouth are all that is needed. Once a person stops drinking they usually only live for a few days.

Breathing

If a person is not moving around, the fluid normally produced by their lungs is not able to drain away and may collect in the air passages, so that when they breathe they make a slight groaning (rattling) noise. This can be upsetting for the people around, but does not seem to be uncomfortable for the dying person themselves. Their breathing may also become irregular, with long gaps between the breaths.

For most people, the final moments of life are very peaceful, with their breathing becoming gradually slower and more irregular, before stopping. With some people this seems to take a long time, while for others it happens over a few minutes.

It can be difficult to pinpoint the exact moment of death. Often the person’s body will relax completely and their face will look very peaceful. People often say that they can sense when the person’s consciousness has gone from the body.

In some cultures and religions, it is believed that the person’s mind (consciousness) stays around the body for some time after death. In other cultures and religions it is thought that the consciousness moves on to another place quickly. Some people believe that once the person has died there is nothing left of their mind (consciousness).

If you have a faith where the moments leading up to death and the actual moment of death are important for your future, it is important that the people who are looking after you are aware of your needs. It’s important to let them know if you need special practices to be done or if you don’t want to be touched or moved in any way for some time before or after death.

The staff in hospital or hospices will try to find out what is appropriate for people of different cultures in their final hours. However, it may be easier if you or your family make the staff aware of your needs. This will allow them to make arrangements for your spiritual or religious adviser to visit if you feel that this is helpful, and to make sure that your body is treated in the appropriate way after death.

This list of questions can help you to think about how and where you would like to die, so that you can have discussions with your relatives or friends and feel confident that you’ll be cared for in the way that you wish.

• Where would you prefer to die? At home/in a hospice/in hospital/in a nursing home/in a family member’s home?
• How would you like things around you to be as you are dying?
• What information do you need about your condition and what may happen to you
• Are there particular treatments that you do not want to have?
• Do you want to write an advance decision (advanced directive) or lasting power of attorney?
• How do you want to be treated by the people around you when you are dying?
• Who would you like to have around you? Are there people you do not want around?
• Are there issues that you would like to sort out with particular people?
• Is there anything that is very important to you at that time?
• Are there any spiritual practices or religious practices that you would like to be carried out? Who do you need to ask to make sure this happens?
• Are there particular practices that you would like carried out at the time of death or once you have died?
• Is there anything that you want done for the people that you love?
• What funeral arrangements would you like to be made?
• Who do you want to make the arrangements?
• Do you want to be cremated or buried?
• Have you made a will?