People often look like they are sleeping just after dying, having a neutral facial expression. But one of my relatives, who had intense pain the hours leading up to his death and lacked access to medical care, had a radiant, ecstatic expression. For decades, I have wondered whether the last minutes of life can be euphoric. Could dying perhaps trigger a flood of endorphins, in particular in the absence of painkillers? Asked by Göran, 77, Helsingborg, Sweden.

The poet Dylan Thomas had some interesting things to say about death, not least in one of his most famous poems:

And you, my father, there on the sad height,

Curse, bless, me now with your fierce tears, I pray.

Do not go gentle into that good night.

Rage, rage against the dying of the light.

It is often assumed that life wages a battle to the last against death. But is it possible, as you suggest, to come to terms with death?

As an expert on palliative care, I think there is a process to dying that happens two weeks before we pass. During this time, people tend to become less well. They typically struggle to walk and become sleepier – managing to stay awake for shorter and shorter periods. Towards the last days of life, the ability to swallow tablets or consume food and drinks eludes them.

It is around this time that experts in palliative care say people are “actively dying”, and we usually think this means they have two to three days to live. A number of people, however, will go through this entire phase within a day. And some people can actually stay at the cusp of death for nearly a week before they die, something which usually is extremely distressing for families. So there are different things going on with different people and we cannot predict them.

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The actual moment of death is tricky to decipher. But an as yet unpublished study by my own group suggests that, as people get closer to death, there is an increase in the body’s stress chemicals. For people with cancer, and maybe others, too, inflammatory markers go up. These are the chemicals that increase when the body is fighting an infection.

You suggest that there may also be an endorphin rush just before someone dies. But we just don't know as nobody has yet explored this possibility. A study from 2011, however, showed that the levels of serotonin, another brain chemical that is also thought to contribute to feelings of happiness, tripled in the brains of six rats as they died. We can't rule out that something similar could happen in humans.

It is an interesting suggestion, however, and the technology to look at endorphin and serotonin levels in humans does exist.

Nevertheless, getting repeated samples, especially blood, in the last hours of someone’s life is logistically challenging. Getting the funding to do this research is hard, too. In the UK, cancer research in 2015-2016 was awarded £580m ($756m) whereas palliative care research was awarded less than £2m ($2.6m).