End of Life: Near-Death Experiences
It’s time for health care professionals to develop knowledge about this common phenomenon.
Something was different about Greenie. During the two years she had lived at the skilled nursing facility, she’d kept to herself, rarely interacting with other residents, eating in her room, and never participating in activities.
Easily overwhelmed, she had occasional panic attacks and had been diagnosed with depression and an anxiety disorder. She was on psychotropic medications, and staff had learned to let her stay in as predictable a routine as possible amidst the hustle and bustle of life in a nursing home.
Since returning from the hospital where she’d been sent for a nearly fatal case of septicemia, she’d been engaging more with staff and other residents. Her flat affect had given way to smiles, and she was even going to an activity now and then. Her longstanding insomnia had abated, and her anxiety and depression seemed to have lifted.
Visiting with her one day, I asked about the contrast. After giving it some thought, she attributed the changes to “no longer being afraid of other people or of death.”
“What happened to the fear?” I asked. “Did something happen in the hospital?”
She gave me an enigmatic smile, as though saying, “Well, maybe.”
I smiled back, playfully asking her to let me in on the secret.
“If I tell you,” she said, her voice suddenly very serious, “promise that you won’t think I’m crazy? I’m not crazy; this really happened.”
I matched her serious tone and nodded, “I know you’re not crazy. What happened?”
It turned out that during her hospitalization her heart had temporarily stopped and she’d found herself looking down on a medical team doing compressions on her chest. She recalled watching the scene without fear, curious about why the team seemed to think she was in her body when she was clearly floating in one of the room’s corners.
She’d felt a gentle pull from somewhere “far away” and found herself moving rapidly through what looked like a tunnel formed by “a curtain of beautiful colored lights.” At the end of the tunnel she found herself face to face with her deceased mother.
“She was young, before she got old and sick. She was smiling and looking at me with so much love. I felt like there were others there too, but I couldn’t see them. Somehow I knew they were excited to see me, as though they had known me for a long time.”
She lost all sense of time, unsure how long she’d been away from her body. As her mother told her how loveable and beautiful she was, Greenie felt a deep sense of peace and love.
“I wanted to stay there forever,” she said. “But I knew from my mother’s face I’d have to go back.”
Before Greenie woke up on the hospital table and saw the same medical team staring at her, her mother gave her a beatific smile and said, “Stop worrying, girl. We’re always with you. We’ll be here when it’s time. There’s nothing to be afraid of.”
These kinds of near-death experiences (NDEs), first identified by Raymond A. Moody, Jr, MD, in 1975, are more common than many realize. Though precise incidence rates are hard to pin down, as many as 20% of those who’ve had a close brush with death may have experienced one or more features of an NDE.1
Though the details vary, common NDE features include the sensation of leaving one’s body, experiencing movement, and alterations in one’s sense of time. Many of those who experience NDEs report feelings of peace, joy, or unitive consciousness. Some recount reunions with deceased loved ones or spiritual beings, heightened spiritual insight, and/or seeing past life events in the form of a panoramic life review.
As Greenie’s case illustrates, NDEs can be profound and life-changing. According to Kelly and colleagues, an NDE “permanently and dramatically alters the person’s attitudes, beliefs, and values, often leading to beneficial personal transformations. Aftereffects most often reported include increases in spirituality, concern for others, and appreciation of life; a heightened sense of purpose; and decreases in fear of death, in materialistic attitudes, and in competitiveness.”2
On the other hand, these experiences can collide with a person’s values and sense of “reality” in ways that shatter assumptions about the world and challenge one’s identity. This can be confusing and anxiety-producing. Some find that having had an NDE can strain relationships and lead to a sense of isolation or feeling out of step with others. In some cases, aftereffects of NDEs can even include depression and questions about one’s sanity.
Sharing and processing an NDE with a supportive other the way Greenie did can reduce potentially troubling aftereffects and foster the assimilation of an NDE’s positive aspects. Many, however, hesitate to disclose them for fear of being ridiculed or of having the experience dismissed as hallucinations, wishful or imaginative thinking, or the effect of things such as opioid medications, delirium, anoxia, or hypercarbia.
Sadly, these fears can be well founded. A study by Holden, Kinsey, and Moore, for example, found that some who reported NDEs to health care workers felt dismissed or not taken seriously. Others felt stigmatized by attempts to diagnose a mental illness or underlying psychopathology. Some even felt demonized by those who felt threatened by NDE content that was perceived to be at odds with subjective world views or spiritual concepts.3
Since NDEs seem to defy “normal” experience, there can be a tendency for others to explain away any deeper meaning by reducing them to physiological or psychiatric events. Many assume that such explanations have already been proven by science or that it is somehow “scientific” to make such claims. Despite decades of research on NDEs, however, the origin of these events still seems very far from being solved.
What research has convincingly shown is that NDEs are typically perceived as real by those who have had them. And when given an opportunity to process them in a safe, nonjudgmental context, they can change people’s lives in positive ways.
This suggests that people working in settings in which residents or patients may be near death should familiarize themselves with the frequency, characteristics, and impact of NDEs. They should also be trained in how to respond compassionately when the topic arises. Those whose roles include counseling or mental health responsibilities should know how to assess for NDEs and be prepared to facilitate explorations of NDE content if this is desired by a patient or resident.
This, of course, includes professional staff working in skilled nursing and assisted living facilities. Given that residents in these settings tend to be older, sicker, and more likely to experience acute life-threatening medical events than the population as a whole, long term care staff are on the frontlines when it comes to serving a population in which there is a high likelihood that many have had, but not disclosed, NDEs.
Most, however, receive little or no training in these matters. In some cases, what passes for training only serves to reinforce a bias that dismisses these events as unimportant, denies residents the power to decide the meaning of an NDE for themselves, or views NDEs as signs of pathology.
In a study in Archives of Gerontology and Geriatrics, Fenwick and colleagues surveyed professionals working in hospices and nursing homes and found that more than 90% stated that they "would like to see more widely available information for staff, patients, and relatives" related to NDEs and other end-of-life phenomena.4
It’s time for professionals working in long term care (as well as those in settings such as hospice, palliative care, oncology, cardiac, and emergency medicine) to get serious about developing knowledge and skills when it comes to NDEs and other common end-of-life transpersonal experiences, such as end-of-life dreams and visions or after-death communications.
Such training should be a standard part of professional education and staff orientation and embraced and supported at the highest levels of the agencies and institutions in which emergency or end-of-life care is provided. And it should include all staff who interact with residents, patients, and their loved ones.
In a recent article in the journal Narrative Inquiry in Bioethics, Samoilo and Corcoran offer some suggestions upon which long term care staff and others can build a foundational knowledge about NDEs and enhance their ability to respond in a helpful manner.5 These suggestions include the following:
• Know the characteristics and aftereffects of an NDE.
• If a patient or resident survives a potentially life-threatening event such as surgery, cardiac arrest, or trauma, ask whether they experienced anything unusual. If so, encourage them to talk about it if they desire to do so.
• Listen to patients and residents without judging, demeaning, challenging, or superimposing your personal views.
• Validate and normalize NDEs. For example: “Patients often report having these types of events. They are called near-death experiences.”
• Offer patients, residents, and loved ones educational materials and resources about NDEs.
• Facilities and medical settings should have staff, such as chaplains and social workers, who are specifically trained in providing education about NDEs and facilitating opportunities to process them and flesh out their personal meaning.
• Staff can direct interested residents and their loved ones to organizations that provide education about NDEs and offer support for those who have experienced them, such as the International Association for Near-Death Studies and the American Center for the Integration of Spiritually Transformative Experiences.
There can be many complex challenges for older adults living in nursing homes and assisted living facilities. Institutional rhythms and routines can feel dehumanizing, leaving little privacy and undermining a sense of independence and control. Separation from one’s home and loved ones, as well as losses and health issues often associated with aging such as the death of a spouse, cognitive changes, or a terminal illness, can lead to sadness, loneliness, anxiety, and grief.
These challenges should not include barriers to sharing and finding meaning in NDEs. Indeed, when these events are experienced as comforting and profound, providing a safe and affirming context for telling the story and assimilating its meaning can reduce feelings of fear and isolation, enhancing a resident’s overall quality of life.
— Scott Janssen, MA, MSW, LCSW, is a social worker at University of North Carolina Hospice. He frequently writes about transpersonal experiences at the end of life and is a member of the National Hospice and Palliative Care Organization’s Trauma-Informed Care Work Group.
2. Kelly EF, Kelly EW, Crabtree A, Gauld A, Grosso M, Greyson B. Irreducible Mind: Toward a Psychology for the 21st Century. Lanham, MD: Rowman & Littlefield; 2007.
3. Holden JM, Kinsey L, Moore TR. Disclosing near-death experiences to professional healthcare providers and nonprofessionals. Spiritual Clin Pract (Wash D C). 2014;1(4):278-287.
4. Fenwick P, Lovelace H, Brayne S. Comfort for the dying: five year retrospective and one year prospective studies of end of life experiences. Arch Gerontol Geriatr. 2010;51(2):173-179.
5. Samoilo L, Corcoran D. Closing the medical gap of care for patients who have had a near-death experience. Narrat Inq Bioeth. 2020;10(1):37-42.