Normal Death: A Comprehensive Multidisciplinary Review of the Physiological Mechanisms, Molecular Pathways, Clinical Course, Geriatric Considerations, and Ethical Frameworks of the Natural Dying Process

Death is an inevitable biological event, yet modern healthcare often struggles to acknowledge normal dying as a natural culmination of life. Misunderstandings about the physiological and molecular pathways involved can lead to unnecessary interventions, patient distress, and family confusion. This review aims to synthesize current evidence on the physiological mechanisms, molecular pathways, clinical course, geriatric factors, psychosocial aspects, and ethical frameworks that define normal dying. It highlights how this knowledge can guide compassionate, evidence-based palliative care and shape healthcare policy. A multidisciplinary narrative review was conducted, social sciences. Key sources include primary research articles, clinical guidelines, and landmark conceptual works relevant to end-of-life care. The review identifies terminal physiological decline as an orchestrated process involving homeostatic failure, multi-organ shutdown, and regulated cellular pathways such as senescence and apoptosis. Molecular contributors include telomere shortening, mitochondrial dysfunction, oxidative stress, and chronic inflammation. Clinically, signs of the active dying phase, appropriate symptom management, and sensitive communication with families are critical. Geriatric considerations reveal how frailty, comorbidities, and cultural factors uniquely shape dying in older adults. Gaps in prognostication tools, molecular biomarkers, and cross-cultural research remain. Normalizing the concept of natural dying can reduce medicalization, improve quality of life at the end stage, and empower families and healthcare teams to honor patient preferences. Ongoing education, policy support, and research into molecular and cultural dimensions are essential for dignified, person-centered end-of-life care.