As a person nears the end of life, their ability to communicate often declines. However, some dying people may retain the ability to talk until their final hours or moments. The ability to speak depends on the individual’s specific condition and progression of their illness.
What affects a dying person’s ability to talk?
Several factors influence whether a dying person can continue to talk:
- The illness or condition causing decline – Different diseases affect speech and communication differently. Conditions directly impacting the brain, nerves, muscles, throat, and vocal cords are most likely to impair speech.
- Progression of illness – More advanced disease typically causes greater impairment. However, progression is variable and difficult to predict.
- Strength and energy level – Weakness, fatigue, and low energy make speech more difficult. These often increase as illness worsens.
- Medications – Some medications used at end of life have side effects like sleepiness, low energy, dry mouth, and confusion. These can indirectly inhibit speech.
- Emotions – Anxiety, depression, and sadness may cause someone to withdraw and speak less near death.
While these factors impact speech, a dying person often retains some ability to talk and communicate if they wish until very close to death.
How do different terminal illnesses affect speech?
The effects on speech and communication vary based on the type of terminal illness:
Dementia
Alzheimer’s disease and other dementias directly impair cognition, memory, word-finding, and expression over time. Communication becomes increasingly difficult as the disease progresses. In the later stages, speech is very limited, but simple words or phrases may still be possible.
Stroke
A severe stroke can damage brain areas controlling speech and language. This results in problems like slurred speech, difficulty finding words, or inability to speak understandably. Some stroke survivors retain the ability to speak single words or short phrases.
ALS
Amyotrophic lateral sclerosis (ALS) gradually paralyzes muscles, including those involved in speaking and swallowing. As breathing muscles weaken, speech becomes difficult. However, some people with ALS can still communicate through technology and aids late into their illness.
Cancer
Brain, throat, mouth, and lung cancers can directly obstruct speech. Cancers elsewhere often do not directly impair speech. However, indirect effects of cancer like fatigue, weakness, and medications can make communication more challenging.
Organ Failure
Conditions like heart, kidney, or liver failure generally do not directly prevent speech. If the illness causes confusion (encephalopathy) or swelling in the throat or vocal cords, speech may be affected. But in many cases, other factors like exhaustion or medication side effects have a larger influence.
What allows some dying people to continue talking?
Some dying people retain the ability to speak relatively clearly and understandably up until their final hours or moments. What factors allow them to continue communicating?
- Type of illness – Diseases that do not directly impair speech centers of the brain or vocal cords allow for clearer communication later on.
- Slow progression – Gradual decline over weeks to months allows some adaptation and retention of speech.
- Alertness – When energy, cognition, and orientation are maintained, communication is easier.
- Determination – Strong motivation and will to talk enables some to communicate despite limitations.
- Supportive care – Medications for pain and anxiety, speech therapy, and assistive devices enable ongoing speech.
With the right circumstances, communication with words is possible even when death is imminent. Simple phrases, requests, or statements may be manageable.
What are some examples of dying people talking at end of life?
Here are some examples of terminally ill individuals who spoke in the final hours or moments:
- A hospitalized cancer patient barely able to speak for days who suddenly became alert and conversational hours before dying.
- A man with late-stage ALS who could only slightly move a finger but used technology to slowly type messages to his family on the night before his death.
- A woman with dementia who could not form full sentences for weeks, but just before passing was able to say “I love you” to her husband.
Even barely audible or intelligible words can carry great meaning. Brief conversations, expressions of love, requests for basic needs, or the chance to say goodbye can provide comfort and closure.
What are some famous examples of dying people’s last words?
Some well-known figures in history spoke final words on their deathbeds that give insight into their lives, minds, or hopes. Here are a few famous examples:
| Person | Last Words |
|---|---|
| Steve Jobs | “Oh wow. Oh wow. Oh wow.” |
| John Adams | “Thomas Jefferson still survives.” (Jefferson had died earlier that same day.) |
| Pablo Picasso | “Drink to me.” |
| Jesus | “Father, into your hands I commit my spirit.” |
These last remarks offer a unique glimpse into the dying individual’s personality, relationships, interests, and beliefs right up until the end.
How can medical providers help a dying person communicate?
For patients nearing the end of life who wish to talk, medical providers can help optimize communication through several approaches:
- Treating medical conditions obstructing speech, like infections or swelling.
- Adjusting medications to maximize alertness and cognition.
- Providing speech therapy or assistive devices.
- Positioning the patient upright to ease breathing and speaking.
- Addressing pain, anxiety, or depression that affects interaction.
- Making accommodations for nonverbal communication like writing.
Small adjustments to care can sometimes help a dying person regain their voice and ability to connect in their final days.
Conclusion
Speech and communication are often affected as a terminal illness progresses. However, some dying people retain the ability to talk until very near the end. Brief conversations, simple phrases, or single words can carry great significance. Factors like the type and course of disease, retained alertness, determination, and supportive care allow some individuals to communicate in their final hours and moments. Medical providers can optimize interaction for dying patients when possible through treatment and adaptations. With effort and compassion, a dying person’s last words can provide comfort and meaning at life’s end.