Near-Death Experiences and Nearing Death Awareness in the Terminally Ill
by Pamela M. Kircher, M.D., Maggie Callanan, RN, CRNH, and the IANDS Board of Directors
This page is also available as a brochure (PDF) suitable for
printing and distribution, though generally this page is kept more
up-to-date. (If you have trouble reading the PDF file,
the Adobe Acrobat Reader is available for free
The terminally ill may have had a Near- Death Experience
(NDE) prior to the final phase of their illness, but the remarkable
experiences that they have as death approaches are called Nearing
Death Awareness (Callanan & Kelley, 1992) or NDAs. NDAs are similar to, but have
profound differences from the NDE.
- The NDA experience can occur without the sudden shift in
physical condition that usually precedes an NDE in an acute setting
such as a heart attack, a near drowning, or a car accident.
- Meeting deceased relatives is almost universal, whereas in the
acute setting this occurs only occasionally.
- The purpose of the NDAs in terminal illness seems to be to
prepare a person for death; generally these NDAs are quite
reassuring. In the acute setting, the purpose of the NDE
seems to be to teach the person how to live better.
- Like NDEs that occur in the acute situation, the terminally ill
person may have a NDE when he or she is in a coma or an
unresponsive state. However, some NDAs occur when the person
is fully conscious. The person can stop conversing with a
deceased relative and can immediately pay attention to what is
happening in the room.
- Visitations differ from hallucinations, in that people
experiencing hallucinations cannot suspend their hallucinatory
reality momentarily to converse with people in their room.
- Living, absent relatives never seem to be perceived by the
dying person. However, persons whom the patient knew to be
alive sometimes do appear if they have actually died since the time
the patient last heard about them.
- If the dying are reassured that their experiences are perfectly
normal for this stage of life, they can take great comfort from
As people approach death, they often participate in several
- They consciously review the life they have lived, often in
great detail. Aspects that are of greatest interest to them
- Dying people look for themes in their lives, often for the
first time. They want to identify what they have learned and
what they have contributed. Sometimes they are surprised at
what they find.
- Forgiveness emerges as a chief concern. Dying people
often realize that forgiveness is an important aspect of completing
- They begin the process of saying good-by to all aspects of this
life. They start to let go of things, one at a time.
Categories of letting go include activities, signs of independence,
roles they have played, and finally relationships.
Things to consider when communicating with the dying.
- Be straightforward and honest, but let them lead the way.
- They may talk about going on a journey or going home as a
metaphor for preparing to die.
- Be sensitive about how close they want you to sit to them, how
much company they want, and how much talking is comfortable for
them. People vary widely on this, and it is important to ask
each one what is comfortable for him or her.
- People's skin seems to become more sensitive as they approach
death. Even gentle stroking may be irritating at such
times. Merely gently holding their hand may be the most
- Understand that as they approach death, they may withdraw as
part of the process of saying good-by to this life and all that it
has meant. This means that they may be unable to focus or
absorb what is going on around them or with family members, and
they may not want to visit as much with loved ones as they did
before. It is important not to have your feelings hurt, but
to understand that this may be a necessary part of their
preparation for death.
- It seems that the dying often have the ability to choose the
actual moment of dying and so it is not uncommon for people to die
when their loved ones are out of the room, even for the briefest of
times to spare them. It appears as if some people who are
dying find it easier to let go when they are alone. Not
understanding this, families often feel unnecessarily guilty under
- Terminally ill people may remain close to death for a long
period of time if they are waiting for a significant relative or
friend to come to the bedside, in order to complete unfinished
business with them before going into spirit.
- Many dying people like to have someone with them, but they may
not wish to (or be able to) interact very much. Your quiet
presence may be all that they want.
- Allow them to talk about their NDEs and their NDAs if they have
occurred, and know that not every dying person has such
experiences. There are no studies yet that explain why some
people have them and others don't.
- Please know that most dying people can be kept quite
comfortable. If your loved one appears to be uncomfortable,
please notify their health care provider.
- Know that this last stage of life often provides the most
powerful interactions that loved ones will have in their entire
After the person has died, it is common for surviving loved ones
to sense their presence.
- Some people may feel notified of the death by the person who
has just died.
- The bereaved often feel the presence of their recently deceased
loved ones who seem to be checking in on them. They may hear
words, see their image, smell a familiar aroma such as a favorite
shaving lotion, or merely sense their presence.
- Deceased loved ones may alert friends or family about some
- Such contact with the deceased usual
Books about NDEs, NDAs and dying that might be helpful:
Tuesdays with Morrie: An Old Man, A Young Man, and Life’s Greatest Lesson by Mitch Albom. New
York: Doubleday, 1997. (Also available as a video with Jack Lemmon.)
Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan and Patricia Kelley. New York: Poseidon Press, 1992.
Grace in Dying: How We Are Transformed Spiritually As We Die by Kathleen Dowling Singh. San Francisco: Harper, 1996.
Hello from Heaven: A New Field of Research Confirms that Life and Love are Eternal by Bill Guggenheim and Judy Guggenheim. Longwood, FL: The ADC Project, 1995.
Love is the Link: A Hospice Doctor Shares Her Experiences with Near-Death and Dying by Pamela M. Kircher, MD. New York: Larson Publications, 1995.
On Death and Dying by Elisabeth Kubler-Ross, MD. New York: Macmillan Publications, 1997.
One Last Hug Before I Go: The Mystery and Meaning of Deathbed Visions by Carla Wills-Brandon, PH.D. Deerfield Beach, FL: Health Communications, 2000.