Home » Misc » What are the four stages of death

What are the four stages of death


Methods Of Estimation Of Time Since Death - StatPearls

Function

Post-mortem interval (PMI) has traditionally been classified into immediate, early, and late stages.

Immediate PMI

In the immediate period, the body undergoes rapid biochemical and physiological changes that are primarily caused by the absence of circulation of blood and loss of regulatory mechanisms. These changes are principally detectable in the eyes and the skin. In the eyes, ‘trucking’ or segmentation of retinal blood vessels is one of the first observable signs. This sign presents as a break in the continual column of blood on ophthalmoscopic examination of the eyes and usually occurs within half an hour and may sometimes take as long as 2 hours after death.[1] The other changes in the eyes, in the immediate post-mortem phase, include loss of intraocular pressure and the clouding of the cornea. The intraocular pressure decreases drastically after death and reaches 4 mmHg or less within 6 hours after death. [2] The cornea begins to cloud within 2 hours after death and usually prevents intra-ocular examination with an ophthalmoscope.[3] The skin loses its elasticity and luster within the first few hours after death and appears pale. Histological examination of the skin, however, shows no morphological changes within 6 hours PMI.[4] Other examinations show a lack of cellular or biochemical changes within 3 to 6 hours post-mortem.[5] Emptying gastric contents is another method used for estimating the post-mortem interval. Small light meals get emptied from the stomach within 1 to 3 hours, and the time of consumption, if known – along with volume and type of meal, can be used to estimate the post-mortem interval.[6] Therefore, the immediate post-mortem phase can be termed as the post-mortem interval between somatic and cellular death, within 2 to 3 hours after death, and usually denotes a lack of discernible changes in the morphology or histo-chemistry.

Early PMI

The early post-mortem phase is probably the most important time period for PMI estimation as most medico-legal cases are examined in this time period. This period is also where the estimation of time since death is most relevant in establishing the timeline of events and developing a theory of circumstances of death. This period runs from 3 to 72 hours after death. The early post-mortem phase is most frequently estimated using the classical triad of post-mortem changes – rigor mortis, livor mortis, and algor mortis.

Algor Mortis

Algor mortis is the cooling of the body after death, primarily due to loss of homeostatic regulation by the hypothalamus, in conjunction with the loss of heat to the environment by conduction, convection, and radiation. Algor mortis is the most accurate method of estimating TSD in the early post-mortem phase. However, it involves a cumbersome procedure and requires intensive knowledge and research before it is accurately usable in the field; this is due to the numerous factors that affect the temperature gradient between body temperature and ambient temperature, the most inherent being the differences in the temperatures of different localities at different points of time. A rule of thumb states that there is a decrease of 1.5 degrees F every hour.[7] Several charts, formulae, and algorithms have been developed to estimate the PMI, Henssge’s nomogram being the most widely taught.[8] The estimation of TSD using algor mortis measures rectal temperatures. While they have been consistently used, nomograms for brain temperatures have also been developed by Brinkmann et al. in 1976 and 1978 and by Henssge et al. in 1984.[9]

Rigor Mortis

Rigor mortis is the post-mortem stiffening of muscles caused by the depletion of adenosine triphosphate (ATP) from the muscles, which is necessary for the breakdown of actin-myosin filaments in the muscle fibers. Actin and myosin are components of the muscle fiber and form a covalent bond during contraction. The cessation of oxygen supply causes the stoppage of aerobic respiration in the cells and leads to a lack of ATP production. Rigor mortis starts immediately after death and is usually seen in a sequence known as “march of rigor” and Nysten’s Law. While rigor mortis develops simultaneously in all muscle tissue in the body, voluntary and involuntary, the size of the muscle determines the perceptibility of changes by the examiner. Smaller muscles over the face – around the eyes, around the mouth, etc. are the muscles where rigor mortis first appears, followed by rigor mortis of the muscles in the hands and upper limbs and finally appears in the large muscles of the lower limbs. Rigor mortis appears approximately 2 hours after death in the muscles of the face, progresses to the limbs over the next few hours, completing between 6 to 8 hours after death.[10] Rigor mortis then stays for another 12 hours (till 24 hours after death) and then disappears.[11] In the last phase of Rigor Mortis, the actin-myosin complex that has formed starts disintegrating due to proteolysis, resulting in the dissolution of the stiffness. This process begins in all the cells at the same time. However, just like with the appearance, this change is perceptible first in the smaller muscles of the face, followed by muscles of the upper limbs, and finally, the large muscles in the lower limbs. Rigor mortis generally disappears 36 hours after death, followed by a phase known as secondary flaccidity.

Livor Mortis

The final change in the classical triad is livor mortis, which is the purplish-blue discoloration of the skin in the dependent parts of the body due to the collection of blood in skin vessels caused by gravitational pull. Hypostasis develops as spots of discoloration within half an hour to 2 hours. These spots then coalesce to form larger patches, which further combine to form a uniform discoloration of the body's dependant parts that have not been subject to pressure, which appears from 6 to 12 hours. The discoloration becomes ‘fixed’ after a certain period, owing to the disintegration of blood cells and the seepage of hemoglobin. This fixation is confirmed by applying pressure with thumbs and is traditionally used to denote a PMI greater than 12 hours.[12] This method of estimation of PMI required an objective and modern approach, leading to the development of colorimetric methods to estimate PMI from livor mortis. [13]

Histo-morphological Analysis

Other methods of estimating TSD in the early phase include histo-morphological and Bio-chemical analysis. Total and differential blood counts and the microscopic morphological examination of blood have been described as a method for estimation of the TSD. All blood cells were not identifiable beyond 84 hours after death. Similarly, blood cell counts were also found to decrease beyond 84 hours after death.[5] Histological studies of the skin have shown that degenerative changes appear in the skin 6 hours after death and first appear as vacuolating the corpus basale and spinosum. Dermo-epidermal separation is seen 9 hours after death, while dermis showed rarefaction and disintegration 6 and 18 hours after death, respectively. The glycogen in the basal membrane of the sweat glands, the secretory cells cytoplasm, and duct cells gets depleted within 3 hours PMI and leads to PAS-negative cells on histology. The basal membrane, however, continues to show a magenta staining up to 18 hours post-mortem. The eccrine sweat glands show vacuolation after 3 to 4 hours of PMI, and cells appear to have completely disintegrated 15 hours after death. The sebaceous glands appear normal till 18 hours post-mortem, seen as a separation of the layers and disintegration of hair papilla.[4] Studies have also shown that pleocytosis can estimate the PMI using a polynomial equation of the third order. The cells are primarily lymphocytes with a significant fraction of macrophages, which become vacuolated and unidentifiable after 12 hours.[14]

Biochemical Assessment

Biochemical blood assessment is non-significant in the immediate post-mortem phase due to the lack of cellular death. On the other hand, cellular death makes biochemical blood assessment in the early phase extremely difficult. Also, there is the redistribution of electrolytes from the cells into the plasma and serum, resulting in varying changes in the levels of these electrolytes. These variations and their implications are studied in the emerging field of thanato-chemistry. The biochemical assessment has been useful for estimating PMI from vitreous humor, synovial fluid, pericardial fluid, urine, and cerebrospinal fluid. Numerous factors, however, need to be accounted for when examining the PMI based on biochemistry, including, but not limited to, age, gender, biological background, lifestyle, cause of death, and a whole range of other intrinsic and extrinsic factors. Only a few biochemical markers (out of 388) were found to have had sufficient investigation with these considerations – namely potassium, sodium, urea as well as chloride, magnesium, hypoxanthine, and cardiac troponin T.  Assessment for their potential for use was found to be alarming, with 0 (zero) biochemical markers being judged to have had suitable research and suitable for use. Six were found to be suitably researched but not suitable for practical use. Meanwhile, 18 were found to have been poorly investigated and not suitable for the application, and a further 364 biochemical markers did not have sufficient information. [15]

Supra-vital Reactions

Supra-vital reactions have also been proposed as a means of estimation of PMI. The determination of the supra-vitality period, therefore, can help assist in the estimation of PMI. For this method, Madea defines the PMI into four stages - the latency period, where despite stoppage of circulation, the tissue still performs aerobic respiration till the depletion of its stores – the survival period, where there is loss of tissue function, but they can be re-activated using external stimuli, e.g., electrical stimulation of nerves – the resuscitation period, where the ability of the tissue to recover is completely lost, –  and the supra-vital period. Madea defines supra-vitality as the survival period of tissue after complete, irreversible ischemia. This concept states that the survival period encompasses the latency period. The resuscitation period encompasses both the latency period and the survival period and the supra-vitality period includes all the other three. Supra-vitality is also different from the resuscitation period in that the tissue is excitable irrespective of recovery of function. As an example, the resuscitation period of skeletal muscle is approximated to be 2 to 3 hours, but the supravital period in some cases may extend to 20 hours. Similarly, cardiac muscles have a resuscitation period of 3.5 to 4 min, while the supravital period may extend up to 2 hours.[16] A method for estimating the PMI was developed using the electric excitability of Orbicularis oculi using surface electrodes. A ratio of relaxation time and maximum force, called force-related relaxation time, was reliable for estimating the PMI. It is also important to consider the super-sensitivity of tissue in the immediate post-mortem phase, called Zsako’s phenomenon. Therefore, the supra-vital reaction examines the idio-muscular or local contraction and not the contraction of the entire muscle.[9]

Late PMI

The late post-mortem phase is when the body tissue starts disintegrating and is primarily describable as decomposition or putrefaction, adipocere formation, mummification, or skeletonization. Complex tissue in the body starts disintegrating into simpler molecular forms due to the breakdown of the tissue by the body’s enzyme or bacteria and bacteria that colonize the remains after death. The body primarily undergoes decomposition or putrefaction, resulting in greenish discoloration, bloating due to gas formation, and liquefactive necrosis. The decomposition of remains is dependent on the climate, the season, body weight, and clothing. Decomposition can divide into five stages – fresh, early decomposition, advanced decomposition, skeletonization, and extreme decomposition.

Fresh Phase

The fresh phase can start as early as 24 hours and as late as 7 days after death, especially in colder winter months. This phase shows no insect activity other than the deposition of blowfly eggs in the cavities and areas of tissue dehiscence. Egg deposition has been documented in living patients, especially in immobile and debilitated subjects.[17]

Early Decomposition Phase

The early decomposition phase begins with the onset of skin slippage and hair loss. These changes usually begin from the first day after death to up to five days post-mortem. Maggots also begin to appear on the body, starting from the second-day post-mortem; the body appears grayish-green and marbling present (some parts of the body may still appear pinkish). The right iliac fossa is the first body part to show greenish discoloration and may be seen as early as the second-day post-mortem. This is due to the relatively superficial position of the caecum. The extremities appear brownish with the drying of the skin, especially over the fingers, nose, and ears, usually beginning on the second post-mortem day; the body appears greenish with distinct bloating. The greenish discoloration that started at the right iliac fossa progresses to encompass the entire abdomen, with concurrent bloating of the abdomen, which again may start on the second day. The bloating advances to the rest of the torso and subsequently the body, resulting in crepitations over the entire body on handling. This phase is also associated with purging – the release of decomposition fluid from the orifices – and a strong disagreeable odor. Bloating may be seen as early as three days after death and usually subsides by the second-week post-mortem, due to disruption of the abdominal gases; The body appears blackish-green by the second week; and finally, the body appears brownish-black with the leathery appearance of skin. This stage is usually seen until the end of the first month but may be prolonged to as long as two months. The underlying tissue also appears darkened, with the texture changing to a viscous, slimy paste. Between the tenth day and the end of the first month, maggot activity continues under the leathery skin. The skin further desiccates to form a hardened leathery shell, with loss of underlying soft tissue.

Advanced Decomposition Phase

The advanced decomposition phase begins with the appearance of loose, sagging skin and the collapse of the abdominal cavity. The body also shows extensive maggot infestation. These changes usually appear at the fourth-day post-mortem but may begin as late as ten days after death. Loss of soft tissue, including the loss of the desiccated leathery skin, results in exposure of less than half of the skeletal material. This phase is usually associated with the presence of pupal cases, as well as the appearance of molds over the body and clothing; this usually occurs in the second month but may occur six to nine months post-mortem. Desiccation of the outer skin could accompany the structural retention of internal organs or be accompanied by autolysis and loss of internal organs. Decomposition may progress rapidly in buried remains or in remains left in an environment with high humidity, resulting in extreme maggot activity, accelerated autolysis, and could progress directly to skeletonization or adipocere formation without desiccation and mummification of the skin and outer tissue.[18] The remains may undergo either saponification or desiccation, called adipocere formation and mummification, respectively, depending on the environment and conditions present. The presence of a warm, humid environment that lacks oxygen favors the development of adipocere – a waxy substance that results from anaerobic bacterial hydrolysis of body fat. The primary organism responsible for adipocere formation is Clostridium perfringens, causing causes aggregation of crystal of fatty acid, resulting in loss of cellular detail and the loss of epidermis.[19] The formation of adipocere and the time duration depend primarily on the pH, temperature, moisture, and lack of oxygen in the environment.[20]

Skeletonization Phase

The skeletonization phase results in exposure of more than half of the skeletal elements, which could still demonstrate soft tissue that is still attached. However, skeletonization is usually associated with desiccated tissue or adipocere over less than half of the body. The desiccated tissue most commonly appears at muscular or ligamental attachments along the vertebral column and ends of long bones. Meanwhile, adipocere is commonly seen over the thighs, having high subcutaneous fat deposits. This stage appears two months after the death, although it usually presents between two and nine months post-mortem. Continuation of decomposition leads to exposure of all osseous material, with only some greasy material left behind or exposing dry bones; this is usually seen after six months of exposure, although it has been reported to have occurred as early as the third week. This stage can last for years if the elements are not exposed, as is seen in buried remains or remains found indoors.

Extreme Decomposition Phase

The phase of extreme decomposition is seen only in remains that have been exposed to the environment and lead to erosion of the skeletal elements. This erosion begins with the process of bleaching of bones and is commonly seen six months after exposure, although it has been documented to appear as early as two months after death and as late as two and a half years post-mortem. The skeletal elements undergo further degeneration of the cortical structure, resulting in a metaphyseal loss in long bones and exposure of the cancellous part of spongy bones; this is seen commonly between a year to a year and a half after death, although it has been reported to have occurred as early as the fourth month. The metaphyseal loss was reported to have occurred at a PMI of five and a half years.[18]

Forensic Entomology

Forensic entomology analysis has been a routine practice for estimating PMI in the early and late post-mortem periods. There are two methods of estimation using forensic entomology – based on succession and based on development. A suitable succession model is chosen for use in a succession-based approach, one that corresponds to the environmental conditions, including the circumstances of death. Therefore, forensic research into the effect of environmental factors on decomposition and insect succession is needed.[21] Mañas-Jordá demonstrated that different taxa were found to be prevalent based on environmental conditions. The species diversity, as well as the number of individuals, were examined. They detected no species association with Stage I and II of decomposition, three species [Compsomyiops spp (Diptera: Calliphoridae) and C. irazuana, and Megagrapha sp1 (Hybotidae)] associated with Stage III, two species [Mesosphaerocera sp1. and Fannia sp1. (Fanniidae)] Stage IV and one species [Stilpon sp1 (Hybotidae)] are associated with Stage V at Huitepec Natural Reserve. At the City of San Cristóbal de las Casas, four species [Prochyliza brevicornis (Melander; Diptera: Piophilidae), C. latifrons, Lucilia mexicana (Calliphoridae) and Compsomyiops spp (Macquart)] were found to be associated with Stage II, three species [Synthesiomyia nudiseta (Vanderwulp), Musca sp1, and Hydrotaea sp1(Diptera)] were found to be associated with Stage III, only one species Chrysomya rufifacies (Macquart; Diptera: Calliphoridae) and Fannia sp1 associated with Stage IV and lastly, Stilpon sp1 was found to be associated with Stage V.[22]

The development-based approach looks at the presence of different stages of the insect on the body and the surrounding area to help estimate PMI. Matuszewski used L. caesar (Diptera: Calliphoridae), Thanatophilus sinuatus, and N. littoralis (Coleoptera: Silphidae) in his research to demonstrated that the presence of a developmental stage and absence of the subsequent developmental stages of carrion insects could be used in conjunction with the estimation of their pre-appearance interval (PAI) to develop a reliable estimation of PMI. It is, therefore, essential to establish known PAI values for different insects in the environment under examination.[23]

Molecular Assessment

Recent advances in molecular biology have led to various advances in the estimation of PMI. The degeneration of mRNA, DNA, and proteins is evaluated and used to estimate the PMI. RNA transcripts were found to be the most relevant due to their rapid degeneration and temporal correlation. Multiple studies demonstrated a linear correlation between PMI and degeneration. This correlation was found to be temperature and tissue-dependent.[24]

A study from Porto, Portugal, examined 11 gene transcripts for correlation with TSD. 8 murine tissues were divided into three groups based on the stability of the RNA - first group (I) comprising of tissue samples from the heart, spleen, and lung, second group (II) consisted of femoral quadriceps, liver and stomach and the third group (III) Pancreas and skin. Samples from groups I and II were serially analyzed. The analysis showed RNA degeneration was time-dependent for the entire 11 hours, although no statistical significance was demonstrable for the first four hours. Researchers selected 11 genes for quantitative PCR analysis. While RNA in the heart was found to be most stable, it showed no correlation with PMI. Six genes were found to correlate with PMI, four in the femoral quadriceps (Actb, Gapdh, Ppia, and Srp72) and two genes in the liver (Alb and Cyp2E1). Mathematical models were developed to estimate PMI with an error mean of 51.4 minutes.[25]

References

1.

Jaafar S, Nokes LD. Examination of the eye as a means to determine the early postmortem period: a review of the literature. Forensic Sci Int. 1994 Feb;64(2-3):185-9. [PubMed: 8175090]

2.

Van den Oever R. A review of the literature as to the present possibilities and limitations in estimating the time of death. Med Sci Law. 1976 Oct;16(4):269-76. [PubMed: 979556]

3.

Wróblewski B, Ellis M. Eye changes after death. Br J Surg. 1970 Jan;57(1):69-71. [PubMed: 4904161]

4.

Bardale RV, Tumram NK, Dixit PG, Deshmukh AY. Evaluation of histologic changes of the skin in postmortem period. Am J Forensic Med Pathol. 2012 Dec;33(4):357-61. [PubMed: 21897193]

5.

Babapulle CJ, Jayasundera NP. Cellular changes and time since death. Med Sci Law. 1993 Jul;33(3):213-22. [PubMed: 8366783]

6.

Madea B. Methods for determining time of death. Forensic Sci Med Pathol. 2016 Dec;12(4):451-485. [PubMed: 27259559]

7.

Nokes LD, Flint T, Williams JH, Knight BH. The application of eight reported temperature-based algorithms to calculate the postmortem interval. Forensic Sci Int. 1992 May;54(2):109-25. [PubMed: 1639277]

8.

Henssge C. Death time estimation in case work. I. The rectal temperature time of death nomogram. Forensic Sci Int. 1988 Sep;38(3-4):209-36. [PubMed: 3192144]

9.

Henssge C, Madea B. Estimation of the time since death in the early post-mortem period. Forensic Sci Int. 2004 Sep 10;144(2-3):167-75. [PubMed: 15364387]

10.

Anders S, Kunz M, Gehl A, Sehner S, Raupach T, Beck-Bornholdt HP. Estimation of the time since death--reconsidering the re-establishment of rigor mortis. Int J Legal Med. 2013 Jan;127(1):127-30. [PubMed: 22015934]

11.

BATE-SMITH EC, BENDALL JR. Factors determining the time course of rigor mortis. J Physiol. 1949 Dec 15;110(1-2):47-65. [PMC free article: PMC1392765] [PubMed: 15406381]

12.

Kaatsch HJ, Schmidtke E, Nietsch W. Photometric measurement of pressure-induced blanching of livor mortis as an aid to estimating time of death. Application of a new system for quantifying pressure-induced blanching in lividity. Int J Legal Med. 1994;106(4):209-14. [PubMed: 8038114]

13.

Vanezis P. Assessing hypostasis by colorimetry. Forensic Sci Int. 1991 Dec;52(1):1-3. [PubMed: 1783332]

14.

Wyler D, Marty W, Bär W. Correlation between the post-mortem cell content of cerebrospinal fluid and time of death. Int J Legal Med. 1994;106(4):194-9. [PubMed: 8038112]

15.

Meurs J, Krap T, Duijst W. Evaluation of postmortem biochemical markers: Completeness of data and assessment of implication in the field. Sci Justice. 2019 Mar;59(2):177-180. [PubMed: 30798866]

16.

Madea B. Importance of supravitality in forensic medicine. Forensic Sci Int. 1994 Dec 16;69(3):221-41. [PubMed: 7860008]

17.

Keh B. Scope and applications of forensic entomology. Annu Rev Entomol. 1985;30:137-54. [PubMed: 3882048]

18.

Galloway A, Birkby WH, Jones AM, Henry TE, Parks BO. Decay rates of human remains in an arid environment. J Forensic Sci. 1989 May;34(3):607-16. [PubMed: 2738563]

19.

Byard RW. Adipocere-The Fat of Graveyards. Am J Forensic Med Pathol. 2016 Sep;37(3):208-10. [PubMed: 27356012]

20.

Jopp-van Well E, Augustin C, Busse B, Fuhrmann A, Hahn M, Tsokos M, Verhoff M, Schulz F. The assessment of adipocere to estimate the post-mortem interval - a skeleton from the tidelands. Anthropol Anz. 2016;73(3):235-47. [PubMed: 27189778]

21.

Jarmusz M, Bajerlein D. Decomposition of hanging pig carcasses in a forest habitat of Poland. Forensic Sci Int. 2019 Jul;300:32-42. [PubMed: 31075565]

22.

Mañas-Jordá S, León-Cortés JL, García-García MD, Caballero U, Infante F. Dipteran Diversity and Ecological Succession on Dead Pigs in Contrasting Mountain Habitats of Chiapas, Mexico. J Med Entomol. 2018 Jan 10;55(1):59-68. [PubMed: 29186358]

23.

Matuszewski S. A general approach for postmortem interval based on uniformly distributed and interconnected qualitative indicators. Int J Legal Med. 2017 May;131(3):877-884. [PMC free article: PMC5388707] [PubMed: 28054103]

24.

Scrivano S, Sanavio M, Tozzo P, Caenazzo L. Analysis of RNA in the estimation of post-mortem interval: a review of current evidence. Int J Legal Med. 2019 Nov;133(6):1629-1640. [PubMed: 31317317]

25.

Sampaio-Silva F, Magalhães T, Carvalho F, Dinis-Oliveira RJ, Silvestre R. Profiling of RNA degradation for estimation of post mortem [corrected] interval. PLoS One. 2013;8(2):e56507. [PMC free article: PMC3577908] [PubMed: 23437149]

What Are the Three Stages of Dying?

For many people, death is an unfamiliar process. Terminally ill patients and their caregivers may wonder what to expect during this stage and how to make this time more comfortable. Having a better understanding of what happens during this process can help everyone involved to better prepare for this transition and each of the stages of dying.

Three Main Stages of Dying

There are three main stages of dying: the early stage, the middle stage, and the last stage. These are marked by various changes in responsiveness and functioning. However, it is important to keep mind that the timing of each stage and the symptoms experienced can vary from person to person. Outlined below is a general look at what to expect during each stage.

Early Stage of Dying

In the early stage of dying, a patient will begin eating and drinking markedly less. This period can last anywhere from a few days to several weeks.

What You Will See

The first sign of this stage of dying will be a noticeable drop in interest in food. For many patients, eating becomes more of a burden than a joy at this point. They may also occasionally choke on their fluids and will start to feel full rather quickly.

What Is Actually Happening

During this stage, the body starts conserving energy and does not need as much nourishment as it did in the past. Although it may be troubling to witness, it does not cause the patient any pain or suffering. This is a natural process where the body shuts down hunger, and artificial feeding at this time does not prevent death and can even lead to physical distress.

To provide comfort, loved ones can offer patients bits of food, sips of fluid or ice chips, but it is important to respect the patient’s wishes when it comes to eating and drinking.

Middle Stage of Dying

The middle stage of dying is marked by changes in the patient’s physical appearance that could last a few hours or several days.

Signs You Will Notice

The person will become increasingly less responsive to their surroundings and those around them, to the point where they will eventually become unable to speak or move at all. This is typically seen during the last days of life.

What Is Occurring In Stage Two

As the body’s circulation slows down, blood is reserved for helping major internal organs function. The patient’s hands and feet might feel cold and could become darker in appearance.

During this stage, loved ones can offer blankets to increase comfort as the patient’s circulation changes. However, heating pads and electric blankets are not advised because the patient will be unable to judge if they are becoming too hot.

The detachment from their surroundings and relationships is the body’s physical and spiritual response to the process of dying and is perfectly normal.

Loved ones should assume the patient can hear everything they say. Experts suggest speaking softly to the patient and touching them gently only if they normally like being touched. This is a good time for prayer or meditation. It is not recommended to ask the patient questions that require answers.

Last Stage of Dying

During the final stage of dying, disorientation and restlessness will grow. There will be significant changes in the patient’s breathing and continence.

What You Will Notice

The patient’s bowel movements may stop entirely, or they may become incontinent. Their breathing may become shallow and irregular, with long pauses that grow frequent as death approaches. There may also be sounds of chest congestion and throat rattling in the last hours.

What Their Bodies Are Doing

The restlessness noted in this stage is attributed to changes in metabolism, while the kidney and bowel functions are affected by decreasing circulation. Relaxing muscles can lead to incontinence. The slowing of blood circulation to internal organs causes the lungs to lose their power to clear out fluids as well as the relaxation of the throat muscles.

When a patient enters the final stage of dying, it is helpful to talk to them reassuringly. Again, gentle touch is acceptable if the patient likes being touched. Even when they are not responsive, the patient might be able to hear those around them, so it is important to speak respectfully. Although this can be a distressing time for loved ones, it is best to try to stay calm.

Some patients may need medication for restlessness, diapers, a catheter, or underbody pads. At this point, administering oxygen will not help. However, it may be useful to elevate the head of the patient’s bed or use pillows to help lift their head; turning the patient on their side may also increase comfort.

Talk With Hospice Care About the Stages Of Dying

If your loved one has a life-limiting illness, hospice care can help improve their quality of life during their final months. Get in touch with Traditions Health to find out how we can help your family and your loved one physically, emotionally and spiritually each step of the way.

4 stages of birth and 4 stages of death according to the scientist

Doctor Igor Ivanovich Vetrov is rightfully considered the founder of the study and dissemination of Ayurveda in Russia . The results of many years of research in areas such as astropsychology, signaturerology, Tibetan medicine, marmatherapy was the creation of the Dhanvantari center in 1993.

Igor Ivanovich Vetrov outlined the main types of human suffering in the materials of lecture “4 stages of birth and 4 stages of death”. nine0004

The scientific work is based on the cosmogonic concept based on the Vedic canons. The main idea of ​​the lecture is that in the spiritual world there is only the present, past and future - in the material universe. The most severe suffering, according to Ayurveda, is birth. All stages described in the lecture are inevitable for any person.

Fundamentals of the Vedic canons

The virtual world, recreated by the illusory ideas of people in their desire to get closer to God, has 33 thousand universal layers. Virtuality is only a quarter of the spiritual universe. nine0007

Each of the living people is spiritually connected with the Almighty. Communication is due to races (relationships). According to the Vedic canons of Srimad Bhagavatam, separation from the Creator is the cause of dissatisfaction and despair.

The material world for a living being is represented by a dense forest, in which it is easy to lose the true path. According to the Vedic teachings, the material world is made up of levels of consciousness. It is believed that there are 8,400 thousand of them. Each of the levels is a kind of evolution of the spirituality of the material world. nine0007

For the transition of consciousness from one turn of the matrix to the next, the jiva (living being) must work out certain karmic tasks. Ayurveda believes that one life is not enough to complete the process of evolution, and during the passage of each of the coils a person is able to reincarnate several times.

In many ways, karma is determined by the family to which everyone is attached.

4 insurmountable sufferings:

  1. birth; nine0038
  2. disease;
  3. old age;
  4. death.

4 stages of birth

Vedic canons divide human birth into 4 perinatal matrices: Awakens the consciousness of the embryo. The duration of the period is 5 - 6 months before the start of contractions. The subtle bodies of the mother and fetus form a single whole, so the psycho-emotional connection during this period is the closest. The mental state, actions and experiences of the mother, mental contact with the fetus are important. What will be the “oceanic” stage for the child depends on this. A person whose consciousness is fixed on this turn of the matrix will become open to the world, but often prone to infantilism. nine0007

The second stage is called “expulsion from paradise” or “apocalypse”

It occurs at the moment of the onset of labor activity – contractions. At this moment, the fetus has a feeling of anxiety and fear of the unknown, akin to a natural disaster, since the birth canal is still closed. Personalities whose consciousness is clearly fixed on the “apocalypse” become ascetics, and more often than others are prone to depression.

Third stage "breakthrough" or "light at the end of the tunnel"

This stage lasts no more than an hour, but for the fetus it can seem like an eternity, intensified by the struggle for survival. The dynamic stage is accompanied by anguish, fear and severe pain. Personalities, whose consciousness is fixed at this stage, become strong people, purposeful fighters, but may acquire a tendency to violence, aggression. nine0007

Perinatal matrix number 4 – “liberation”, “symbolic reversal of life”

The period of cutting the umbilical cord is characterized by the manifestation of symbols of karma. The day from birth symbolizes a year of life. These symbols are worth looking at. Having gone through all the stages of the perinatal matrix, a person becomes a separate anatomical unit. After passing through the fourth round of the birth matrix, the child feels one with his own body and the surrounding environment.

After 2 - 3 months the child begins to distinguish himself from the outside world, and by the age of 12 - 16 determines the psyche. At the end of life, one's own amta (spiritual essence). This whole process is self-realization. nine0007

According to the Vedic teachings, the closest exchange of information occurs at the 4th stage. The ability to absorb any information like a sponge is very significant. Therefore, in ancient times it was believed that it was possible to show a child to relatives only 72 days after birth, and sometimes even after 108 days.

It was considered unacceptable to try to look into the future of a child before the age of 3 months. Drawing up a zodiac map during this period is equated with an attempt to interfere with karma. nine0004

The stages of death considered in II Vetrov's lecture are exactly like 4 perinatal matrices with a difference in time intervals.

4 Stages of Death

Sankhya, the system of Hindu philosophy underlying Ayurveda, states that the first stage of death begins 2 to 3 months after birth.

First stage

All the years of life passed by a person from the moment of his awareness of himself in the surrounding world, refer to the first turn of the matrix of death. nine0007

Ayurveda believes that it is not given to a person to increase the duration of his stay in the earthly world. Each living being has to fulfill his task, called drachma-karma. A person can shorten his term by destroying his own physical body.

The second stage

The exit from the physical body is the second stage. The first 9 days after the onset of clinical death, the soul experiences fear. The soul of the departed needs the support of loved ones. Sending mentally good memories, living loved ones help the departed to pass the insurmountable stage of the matrix. nine0007

The classical Gita says: “ Thoughts at the moment of death determine our future ”.

Death occurs at the moment of cardiac arrest. The lack of oxygen and glucose leads to a stop of vital processes. Most people feel nothing, as if falling into a dark abyss. Some, on the contrary, can see their lifeless body.

At the onset of clinical death, the ethereal matrix, the soul, along with thin shells, separates from the body. There is a fear similar to that experienced by a creature at the stage of the apocalypse. There is a painful feeling of destruction and loss of connection with everything that was in earthly life. nine0007

At such a moment, the soul calls for help from loved ones, but they are unable to hear and understand. The ethereal sheath and the subtle body aspire to those who think about the departed. It is believed that the thoughts of the living become clear to the soul in the first 9 days.

The future stages of death are formed in this period. Determine his aspirations, desires and actions of the individual. In ancient times, brahmins were invited to help the deceased to read the sacred canons. This helped a person to leave with dignity and overcome the fear of the unknown. nine0007

The cremation of the dead body was usually carried out on the third day. It was believed that this helps the soul to quickly leave the attachment to the physical shell. Due to ignorance, the souls, not ready for the transition to the second stage, made attempts to return to the body. This explains the appearance of ghosts, which is nothing more than a compacted ethereal matrix, repeating the outlines of the deceased when moonlight hits.

Instant death is the most difficult stage for a creature. Having not experienced suffering before the onset of the separation of the soul from the body, the fear of destruction increases many times over. nine0007

6 categories that are “delayed” on the second death matrix and cannot make the transition to the next turn:

  1. Suicides. For example, if a person is allowed to live 60 years, and he ends his life at 16, then for 44 years (unfinished period) his soul, according to the canons of Ayurveda, will be near the earth's surface, experiencing severe suffering;
  2. Dictators, maniacs who have committed murders are unable to leave the etheric body for hundreds, sometimes thousands of years; nine0038
  3. The deceased in a dream , since such a transition is ignorant and unconscious;
  4. Those who left the world in alcoholic or drug intoxication cannot leave the ethereal shell for many years. It is necessary to help them with the help of special rites;
  5. Missing and dead at the hands of villains cannot make the transition due to the fact that relatives are not ready to let them go and accept the news of death. Too strong attachment does not allow the departed to take a new birth; nine0038
  6. Black magicians and people who are fond of this kind of occultism. Their communication with the organic world does not allow them to leave the etheric body, and continues after the second stage of death.

All categories of the departed become a cause for concern for the living. The souls of such people experience suffering. Some of them attempt to enter the body of a living being with a weak will. Ayurveda considers this to be the cause of possession.

Third stage

It is generally accepted that further comes the passage through “hell” and “paradise”. However, according to Ayurvedic canons, there is neither one nor the other. The light at the end of the tunnel is the path that the soul takes to enter one of the 350,000 nadi channels.

The form of God - Paramatma illuminates each of the channels with a certain light. Hue can indicate the purpose of the soul in the following stages. Earthly existence ends on the 40th day after the first 9. It is wrong to commemorate the deceased on the 40th day - you need to add another nine days to 40. Therefore, it is correct to commemorate the departed precisely on the 49th day after physical death.

At its discretion, the soul of the deceased is able to contact the information field of the ancestors. The symbolic form "Pitry" encodes all information, like a storage device.

By the end of the period, the final destruction of the ethereal shell takes place. Only the accumulated information is saved.

Job's words: "The living envy the dead" symbolize the absence of heaven and hell, represented by people during existence.

The fact is that neither "hell" nor "heaven" exists in the outside world. They are inside us and are like a dream. Someone chuckles: “So what? It's just a dream" . But don't we wake up in a cold sweat and scream when we have nightmares?

So, we are going on a journey through one of the channels nadis in order to go through our inner "hell" and "heaven". What is better in the beginning? It probably depends on how godly or sinful the person has been in their life. nine0007

All our desires are first "nourished" by certain thoughts, and then "watered" by appropriate actions. This is how we generate the so-called "elementals" (thought images). Pious elementals resemble angelic beings, while negative elementals resemble monsters like those seen in computer games or horror films.

When we pass through one of the channels nadis we find ourselves on various "stages" where all these monsters that we ourselves have created appear. For example, in the Vedic canons it is said that if a person eats meat, i.e. takes the flesh of a living creature killed by him or for him, he generates the corresponding mental image that it will meet at the time of death. Meat is called " mamsa " in Sanskrit. This means: "In this life I will eat you, in the next life you will eat me." Thus we give the sanction that we ourselves become food for others.

All this will take place during the third stage of death. Some say: "But I don't kill myself!" However, the Vedas indicate that those who kill, those who authorize the killing, those who trade in meat, those who butcher it, and those who cook or eat it, commit one sin. nine0007

If you condemned or hated someone, showed excessive greed or pride, know that you have created terrible monsters that can only be destroyed by special mantras or spiritual practices.

Righteous activity, on the contrary, will give us "heavenly" pleasures. On our way, fabulous groves and gardens will appear, exuding amazing floral aromas and filled with beautiful birdsong. Amazingly beautiful men and women will meet along the blue lakes, and we will be able to experience "heavenly pleasures" , hundreds of thousands of times greater than any earthly joys. However, this will end sooner or later, and we will have to part with the illusions of this wonderful world.

The fourth stage

Liberation is the last stage of death, similar to the one in the birth matrix. Comes after 49 days. Ayurvedic canons claim that after the destruction of the etheric body, the soul sees its new destiny. It is given to her to know where and when she will receive rebirth. nine0007

“ When the soul leaves this physical body along with all the attributes of the surrounding world, a new place is already prepared for it ,” says one of the tatras of Ayurveda.

The waiting time for rebirth is from several weeks to several months. Individuals with unique abilities can expect to be reincarnated for hundreds of years before their time comes.

II Vetrov's lecture is based on the ancient science of Ayurveda, the system of Hindu medicine. In addition to the material, you can add a quote from the book of the doctor "Fundamentals of Ayurvedic Medicine":

“Knowledge will allow you to change your attitude towards death, which will lead to the fact that your attitude to life will change - it will become richer and more meaningful. People will stop spending so much effort on fuss, things are secondary and unimportant, they will reconsider their relationships with relatives and friends.”

4 stages of death

Yoga is the ability to direct the mind exclusively on the object and keep this direction without being distracted.

Encyclopedia of Yoga. Yoga is a way of life on earth. > Yoga and Life > LIFE AND DEATH, KARMA AND REINCARNATION >
4 stages of death

First stage.

In the Ayurvedic tradition, the first stage of death is the years of our life. It is divided into four main periods.
1. Period of isolation from the surrounding world: the child ceases to identify himself with his parents, the room in which he is, birds and trees outside the window, sounds and smells (usually this occurs during the first year of life).
2. Puberty: here we live the fruits of our past life - we get a certain type of body, family, race, nation, country, city and everything else
environment; Whether these fruits are “bitter” or “sweet” completely depends on our actions in the past incarnation (pious and sinful).
3. Maturity period: we are entering the so-called "cosmic corridor", filled with various trials. During this period, we must fulfill the tasks assigned to us and fulfill our duty, realize the lessons of fate, in addition, we can “scatter” the seeds of new desires
4. The period of evolutionary maturity: we have fulfilled our duty and all the tasks set; we are internally ready for death, for the transition to a new state: death does not frighten us; we have come close to the next stage of evolutionary development. nine0007

When the time of our life is exhausted (from the point of view of Ayurveda, birth and death are considered absolutely fatal dates), the second stage of death begins, which lasts 9 days. It is with this that the tradition is connected to commemorate the deceased on the 9th day.

At the beginning of this period, when the heart stops and breathing stops, we experience clinical death. Deficiency of oxygen and glucose leads primarily to mass death of neurons in the cerebral cortex. A little later, subcortical and endocrine centers, bone marrow and other tissues die. At the moment of clinical death, our soul, along with other "thin" shells and the ethereal matrix, is separated from the physical body, and it, left without a vital principle, gradually begins to decompose. nine0007

Most of the dead in the first minutes and even hours after death, as a rule, do not see or realize anything. They seem to fall into darkness. However, some are able to observe their body and the place where they died almost immediately. Others gradually come to consciousness, and remaining in the ethereal shell, acquire the former activity of the senses, mind and intellect.

Second stage.
The second stage of death resembles the second stage of birth - the world is collapsing, and it seems that there is no way out. At this time, we realize that everything that was connected with us - our family, home, work, country, accumulated material wealth - we lose along with our physical body. Some call for help from relatives and friends, but they, of course, do not hear them. nine0007

We do not know what awaits us next, so our soul is filled with fear. However, you should know that those who have passed into the "other world" can read the thoughts of other people and immediately move to the one who thinks about him. Therefore, for the first 9 days, thinking about the deceased, you can send him good thoughts and thus really support him. Of course, his perception of the world during this period will be mixed with the most vivid memories of a past life. In Bhagavad Gita
it is said: "Whoever thinks about anything at the time of death will go there." nine0007

Some people think that they can lead their lives as they please, but if death comes, then I will think about God. However, one must know that at the second stage of death, the further path of the individual will be finally determined. And from how we lived, what we dreamed about, what we aspired to, what desires we cultivated and what actions we performed, this will dominate in our consciousness, this in combination will determine our future.

In ancient times, the relatives of the deceased invited a priest or priest, who during the first 9days they read the sacred canons, helping the soul of the deceased to pass the transitional period with dignity, without fear. By reading, they convinced the deceased that his existence was not completed, that he should calm his mind and concentrate on spiritual things and pray to God. The texts he read described the next stages of the transition period that he would have to go through.

Not later than the third day, the body was cremated, and the ashes were scattered over one of the sacred rivers. The rite of cremation helped the deceased to move away from attachment to the physical body and significantly reduced his period of otherworldly suffering. After all, some of the dead, due to their ignorance, even try to re-enter their already decaying physical body. Therefore, ghosts are sometimes seen in cemeteries and morgues, which in fact is the thin body of the deceased, a condensed ethereal shell. Due to their attachment, they cannot leave their physical body in any way, and their ethereal matrix luminesces at a certain direction of moonlight (the ethereal body exactly repeats the contours of the physical body of a person, animal, plant or other form
life).

Sometimes one thinks that instant death is the most fortunate. This is not true. A person suffering before death is morally more prepared for it than dying immediately, because at its second stage he experiences a strong shock and cannot come to terms with her coming.

Third stage.
The third stage of death - "the light at the end of the tunnel" - is associated with the exit of the soul through one of the 350,000 nadi channels. In accordance with the chosen program, which floats in the mind, like bubbles on water, we enter that channel that is illuminated by the Paramatma, the localized form of God, which accompanies us throughout our entire material existence. According to the level of our consciousness, we can see the appearance of the Paramatma, or simply the light emanating from God. Each channel has its own hue - purple, blue, red, green, orange, etc. The Tibetan Book of the Dead explains the meaning of these shades. Depending on the color, you can understand what form of life and what place in the Universe we are going to. nine0007

The third stage of death in earthly chronology is 40 days, although subjectively it may seem like an eternity. Commemoration of the deceased on the 40th day is a mistake, because you need to add another 9 days to 40.

Learn more