End-of-Life Dreams and Visions, also known as Deathbed Visions, Departing Visions or Near-Death Awareness are dreams and waking visions often experienced by those who are dying from natural causes or from a long-term illness. These ELE’s (end of life experiences) predominantly include messages of comfort from pre-deceased family members, and/or a sense of ‘going home’, both associated with a greater level of peace and acceptance of death. Arguably, more people will have a deathbed vision than a near-death experience, out-of-body experience, or past-life regression combined. And yet, deathbed visions are not as frequently discussed, studied or as well-accepted by the medical community. The Journal of Palliative Medicine has recently published two studies by Dr. Christopher Kerr and others that finally provide some of the desperately needed data on this phenomena. Quantifying and recording the experiences of those in hospice care has brought the frequency and importance of these experiences into sharp focus.
Below is the video of a TEDx talk where Dr. Kerr describes the result of the study. After the video, keep reading for more information on ELDVs, including quotes from hospice nurses on their experiences, and my analysis of the study’s conclusions.
Dr. Christopher Kerr introduces the results of his study in a TEDx talk
You can access both ELDV studies in their entirety published in the Journal of Palliative Medicine here:
- End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients’ Experiences
- End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients
End of Life Dreams and Visions/Nearing-Death Awareness
End of life visions and dreams have been reported throughout history by people of all cultures and faiths. They are experienced by children as well as by adults, by the religious and the non-religious alike. They can first occur several months to only several minutes before death, however they seem to increase in frequency as death approaches. Hospice nurses are well-acquainted with this nearly universal aspect of the dying process and claim they often gauge when to call family members based on their observation of these experiences.
Descriptions of deathbed visions experienced by hospice nurses (from allnurses.com):
I have worked for hospice for several years and it is normal and common for a dying person to have visions at the time of death but also once they ‘get close’ to the dying process. it is in preparation…their loved ones come to get them, tell them its ok, etc. it can be so unsettling for patients; we tell them it is a normal thing and its ok to talk to them; its ok to go with them. this brings people peace and calms them. – Angel1188
I work in hospice, and every patient I’ve had sees someone before they pass. In fact, my coworkers and I know the end is close when the patients move into this phase. I work with some patients who are from a culture that finds this phenomenon very, very disturbing. These patients often do not take comfort from it, but see it as something really scary. That kind of unsettles me, though I know they are seeing passed loved ones due to what they are saying (as translated by family members). It does make one think when all kinds of different people from a variety of backgrounds and cultural beliefs all experience the same phenomenon. -tencat
As a hospice nurse I’ve been with many, including my own father, who have deathbed visions. I have seen the peaceful and the terrified. I have listened to the confession of an elderly man who killed another as a young teen. The impetus of the confession came the morning the man awoke to find the victim sharing his bed. I’ve begun to have these visions myself. Now and then the dying appear to me in my dreams to tell me they will be going soon. Often that person will die just days later. My personal belief is that we forget that those things that we can see with our eyes and lay our hands upon are not the reality. Having served both laboring woman and the dying I cannot but see the connection between the two events. At those moments we are open and vulnerable, raw and aware. passages that must be traveled alone. –blondeoverboard
The term ‘nearing death awareness’ has also been use to describe the state of expanded awareness that some people obtain prior to death.
From an article in the Chicago Tribute, hospice nurse Maggie Callanan explains the following:
The state [Callanan] calls “nearing death awareness” is different [than near-death experiences]. Unlike people who are resuscitated and return to health, she said, those who experience nearing death awareness do indeed die. But before they do, she said, they enter a state of expanded awareness in which they appear to exist in two states of reality. This can be confusing to caregivers, she said. She recalled getting a frantic phone call from the mother of a patient in his 20s. In the background, she could hear the young man wailing, “Where is the map? I’m lost. I want to go home!” His parents thought he was confused because they had moved him from his bedroom to the first floor. They were hauling furniture down from his bedroom to reassure him that he was still home. Callanan, at the time new to hospice, also took his words literally. But his parents, on reflection, recalled that they spoke of heaven as an ultimate home. “His parents went in and said, ‘You will find the map. You will get home’ Callanan said. “The young man became calm and died within days.”
Why is Research into End-of-Life Experiences Important?
Although many hospice nurses have witnessed the incredible comfort and peace that ELDVs bring to patients and their families, doctors have tended to dismiss these in the medical literature as hallucinations, delirium, dementia, or the consequence of morphine. Unfortunately, many otherwise great doctors don’t qualify these experiences as therapeutic and will attempt to medicate these experiences away thinking they are signs of delusion. Dr. Kerr not only validates these patient experiences, but admits that the common practice of viewing ELDVs as something to be suppressed could be harmful, depriving patients the opportunity to release painful life traumas and find acceptance of death. According to Dr. Kerr, ELDVs are part and parcel of a natural death, not an anomaly.
Read the study conclusion from End of Life Dreams and Visions: A Qualitative Perspective from Hospice Patients [emphasis mine]
Patients may be reluctant to share their personal experience of end-of-life dreams and visions due to fear of ridicule, distress to family, or outsider misinterpretation of mental acuity. The current study supports the idea that ELDVs are prevalent in individuals without delirium or other psychotic disorders and that they are a mostly comforting and a valid part of the dying experience. Patients, families, and health care providers alike can benefit from recognizing and understanding these dreams and visions at the end of life. These experiences need to be viewed as a normal transition from life to death. In normalizing these experiences, the patient is better able to share and process important issues at the end of life. Health care personnel can support patients and families by encouraging, rather than avoiding, discussion of end-of-life dreams and visions.
Also, read the study conclusion from End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients’ Experiences
ELDVs are commonly experienced phenomena during the dying process, characterized by a consistent sense of realism and marked emotional significance. These dreams/visions may be a profound source of potential meaning and comfort for the dying, and therefore warrant clinical attention and further research.
Interesting Statistics from the Study
The study included 59 patients ranging in age from 34 to 99. 88% reported having at least one dream or vision, with nearly half occurring while the patients were asleep. Approximately 15% happened while patients were awake, with 39% happening in a period described as between sleep and wakefulness. Patients were interviewed daily and asked to report on the content of their experiences, rate the comfort level, and indicate if the dreams included the deceased only, both the deceased and the living, or the living only. 81% reported one ELDV experience every day, though some reported more than one event per day.
ELDV content was rated on a scale of 1-5. Although 18% rated some ELDVs as distressing, the content of dreams became steadily more comforting as death approached, also almost exclusively involving dreams of predeceased loved ones. Distressing dreams often involved life experiences or trauma not previously confronted, or quarrels with family and friends not resolved. Once the patient ‘made peace’ with these events, the distressing dreams ceased and were replaced by comforting dreams of deceased loved ones.
There are five powerful statements concluded from these studies:
- ELDVs often help patients confront life-long trauma, regret, guilt or anger before their death.
- Frequency of dreaming of the deceased increases dramatically in the last two weeks prior to death whereas dreaming of the living is low throughout the 11 weeks studied.
- Dreaming of the deceased is associated with the greatest comfort.
- Patients are typically lucid when having or describing ELDVs; the dreams are ‘ultra-real’ and have organized and meaningful content. By contrast, delusions or hallucinations produce disordered thinking and anxiety.
- 99% of people who experienced ELDVs believed them to be real.
Medically, ELDVs cannot be wholly classified as hallucinations or delusions of the dying. While it would be disingenuous to summarily pronounce these events as supernatural or ‘proof’ of the afterlife, it is reasonable to change the way caregivers – both medical and familial – look at end of life experiences. These studies do prove that ELDVs are extremely common, provide therapeutic comfort and peace to the dying and their family, and contribute positively to what we might call ‘a good death’.
How to Approach ELDVs as a Caregiver (Q & A)
Question: What if I don’t believe in an afterlife?
Answer: These important emotional and spiritual events; regardless of your individual belief of the afterlife, should be considered a normal, natural part of dying. If your loved one wants to discuss their experiences, be open to what they have to say for their benefit, if not for yours. According to the study, 99% of dying patients believe in these experiences and derive much comfort from them. Regardless of your belief, it would be harmful to dismiss them to the patient or ask for sedation in an effort to stop them. They do contribute to a peaceful death, which is better for the patient and for caregivers.
Question: My loved one is talking about going somewhere, or keeps trying to get out of bed and leave the hospice. Is this normal?
Answer: Yes. Some people don’t dream of the deceased, but will have a strong urge to ‘get ready’ for something or they might feel like they have to pack to go somewhere – on a trip, or on a vacation, perhaps. This is symbolic of the anticipation they feel for their transition. Stay in their reality and be creative when attempting to placate them.
From Hospice Nurse Maggie Callanan via the Chicago Tribute article:
“Talking about having to get ready for a trip is common; people often use travel metaphors for death, she said. But when it comes to destinations, “everyone is seeing a different place.” One man, for instance, was an avid golfer who told her he had just gotten an invitation to play a tournament in a foursome with his father and two brothers, all of whom were dead. People shouldn’t dismiss such remarks, Callanan said, but use them to start conversations. “I said, ‘Tell me, do you know where you’re teeing off?’ He said, ‘No, because I don’t have my things together.” She interpreted that to mean that he wasn’t going to die immediately, which turned out be true.”
Question: I just had a dream about a deceased family member; does that mean I’m going to die soon?
Answer: Highly unlikely. A single dream featuring the deceased is more likely to be an After-Death Communication, or simply a dream about someone you had a shared connection with in life. ELDVs happen to terminal patients, but even in those who were considered terminal and then regained their health for a time, the ELDVs slowed or ceased. Dreams about the deceased are not an indication of impending death, even in those who are ill. The frequency of dreaming and the content of the dreams combined with a terminal diagnosis is what characterizes an ELDV.
Question: Why did my loved one not have an ELDV when they were terminally ill?
Answer: Although ELDVs are very common, not everyone has them. Alternatively, a patient may be experiencing them but may think they will be considered ‘crazy’ or fear they will be unnecessarily medicated if they share their experiences. Other patients might be apprehensive or afraid of their experiences, thinking themselves to be hallucinating. Finally, a person may be too ill or too medicated or sedated to express their experiences to their family. The best thing you can do is provide a safe, loving, positive and calming atmosphere. Don’t place expectations on the dying, simply being there and providing an environment of total acceptance is enough.
Question: My loved one is experiencing terrifying visions! What do I do?
Answer: Although it is rare, some people do unfortunately have scary or fearful experiences with ELDVs. Additionally, some people confront sad, scary or frightening events in their life (such as war experiences) through dreams. If your loved one is troubled by dreams of past events, therapy might be available to help them process their emotions. If the fear is based on a religious belief – such as fear of going to hell or dying in sin -do whatever you need to within the context of the patient’s beliefs in order to calm the fear. For example, ask for a religious leader of their faith for a confession or a blessing. If the visions don’t fit into the above categories and you cannot determine why they are fearful, try to speak with them about what they are seeing. It’s possible they are seeing deceased family members but don’t understand why. Explain that they are here to help and welcome them and they mean no harm. Finally, consider that the patient is not having an ELDV but instead truly hallucinating, perhaps as an effect from medication or illness. Consult a doctor if you feel that your loved one’s distress is acute and causing significant harm. Sedation or the administration of anti-anxiety medication in that case might be preferred.
Question: My loved one hasn’t seen any deceased family or friends, but he/she is seeing her deceased pets. Is that considered an ELDV?
Answer: Yes! Many people see deceased pets in addition to, or instead of human family. The comforting effect is the same and the patient is typically just as happy to have these ELDV reunions.
Question: Where can I get more information on ELDVs?
Additional articles on ELDVs:
- New York Times Article: https://www.nytimes.com/2016/02/02/health/dreams-dying-deathbed-interpretation-delirium.html?_r=0
- Article by Carla Will-Brandon at near-death.com http://www.near-death.com/experiences/triggers/deathbed-visions.html
- Scientific American article on Dr. Kerr’s study https://www.scientificamerican.com/article/vivid-dreams-comfort-the-dying/
- Huffington Post article http://www.huffingtonpost.com/entry/end-of-life-dreams_us_562e297fe4b0ec0a3894ed6a