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The machine itself looks like a giant metal gyroscope, consisting of a round metal core surrounded by 4 rotating spiked rings. The machine is almost fully immersed in a deep pool of blood, completed by a walkway leading to it. It was "invented" by Walter Sullivan when he was a young boy, the purpose of which is to kill anyone who gets near.
In the final battle, Eileen Galvin is completely possessed, walking slowly to the core. Her speed varies on how well Henry Townshend defended her throughout the game. If Eileen walks into the death machine, she will scream a horrifying shriek, resulting in a bad ending.
The core of the machine may represent Walter himself, and his wish to return to his "mother's" womb. The spiked rings may symbolize his wish for protection, believing that surrounding himself with spikes will keep him from harm.
The core of the device is surrounded with four spiked rings which may symbolize death as number four associated with death.
- The contraption appears on the soundtrack cover.
- If Eileen walks into the machine before Henry is able to save her, she will scream a horrific shriek.
- Even if Eileen is killed by the machine, the news proclaims that she passed away due to her injuries. This is because in the Real World, Eileen's physical body is still in St. Jerome's Hospital.
- One of the rooms in the Spiral Staircase below Building World may have foreshadowed the final battle and Eileen's sacrifice. The room has eight plates with pictures of eyes which may symbolize eight victims who watch the final battle, the bloody gurney may symbolize Eileen's sacrifice, and the door may symbolize Room 302's door which becomes opened for Walter if the 21 Sacraments is complete.
- There is a child's drawing near Room 105 representing a woman in the machine being chopped in pieces. It is most likely that this was drawn by Walter's younger self.
- If a Holy Candle is placed near Eileen while she is walking to the machine, its effect can slow her down, should the player feel her too possessed for safety.
- A rotating metal sphere with round holes on its surface is seen in Silent Hill during the battle with Split Head. It shares a similar construction to the Death Machine. It is also located in the center of the room where the battle takes place and surrounded by a ring with spikes.
- Other horror media have used similar looking devices:
- Thir13en Ghosts has a deadly series of spinning, concentric rings that serves as an engine to be driven by the souls of the ghosts in the house.
- The machine greatly resembles the gravity drive of the titular ship the Event Horizon in the 1997 science fiction horror of the same name. In the film, the gravity drive accidentally tears a hole into a universe of torture, pain, and insanity, which infects a derelict spaceship with its corruption. The Book of Lost Memories confirms that Event Horizon is an inspiration of the Silent Hill series.