What is a death rattle?

When a loved one is nearing the end of life, you may notice changes in their breathing. One of the most distressing sounds for family and caregivers is something called the death rattle — a gurgling, rattling or wet sound coming from the throat as a person breathes. While it may seem alarming, the death rattle is a natural part of the dying process and does not necessarily mean the person is in pain.

What causes a death rattle?

As the body shuts down, a person loses the ability to clear fluids from their throat and airways. Normally, we swallow or cough to get rid of saliva and mucus, but when someone is very weak or unconscious, these reflexes slow down or stop. As air moves through the throat and lungs, it passes over these fluids, creating the distinctive rattling sound.

This usually happens in the final hours or days of life and is a common sign that the body is preparing to shut down completely.

Does the death rattle mean the person is in pain?

The good news is that the death rattle itself is not believed to cause pain or discomfort. At this stage, most dying individuals are unconscious or only minimally aware of their surroundings. They are not choking or struggling to breathe — even though it may sound that way to loved ones.

The reason for this is how the brain functions at the end of life. As the body weakens, awareness of physical sensations like discomfort, hunger or thirst diminishes. By the time the death rattle occurs, the person is usually in a deeply unresponsive state and does not feel distress in the same way a healthy person would.

Why does the death rattle sound so disturbing?

Hearing the death rattle can be upsetting for family members because the sound is unusual and can seem like a sign of suffering. However, it is important to remember that while it may sound distressing, it is simply a physiological response to the body’s natural process of shutting down.

Can anything be done to reduce the death rattle?

While it isn’t always possible to completely stop the sound, caregivers and medical professionals can take steps to minimise it…

• Turning the person onto their side may help fluids drain more effectively and reduce the rattling noise.
• In the final stages of life, giving a person more fluids may actually increase secretions, so doctors often recommend limiting unnecessary hydration.
• Doctors may prescribe medications such as anticholinergic drugs to help dry up secretions and lessen the sound.
• In some cases, a healthcare provider may try to suction out excess fluid, but this is not always effective and can sometimes cause more discomfort.

How can loved ones cope?

It’s natural to feel anxious or upset when hearing a loved one’s breathing change in their final days. Understanding that the death rattle is a normal and painless part of the dying process can help ease some of this distress.

If you are supporting someone at the end of life, it’s important to focus on their comfort rather than the sounds they are making. Holding their hand, speaking softly, playing soothing music or simply sitting with them can provide reassurance and love in their final moments.

The death rattle is one of the final signs that the body is shutting down. While it can be difficult to hear, it does not mean that the person is suffering. Instead, it is a natural part of the dying process. By understanding what is happening and focusing on providing comfort, families can help their loved one pass peacefully and with dignity.

If you’re after a list of resources to help you during this period of time, please refer to the following resources.

Beyond Blue — 1300 22 4636

Mental Health Emergency — 13 14 65

Lifeline — 13 11 14