Terminal lucidity in adults: A new case collection

At the end of life, the dying person may have experiences that are difficult to explain in terms of the prognosis of their health condition. Some of these experiences have been termed ‘transpersonal’ and may involve visions of deceased friends and relatives whose purpose seems to be to ease spiritual suffering and anxiety prompted by their imminent demise. Other ELEs have been termed ‘final meaning’ and seem to enable the dying person to put their affairs in order and have closure with the people that have been important to them in life. Because ELEs are poorly understood, their occurrence can be confusing or even distressing for unprepared witnesses. Mapping the circumstances, phenomenology and impacts of ELEs could thus have important implications for how we care for people in their final days and weeks. In this chapter, I describe a project that focuses on better understanding terminal lucidity, a final meaning ELE. Terminal lucidity can be defined as unusual or unexpected periods of mental clarity occurring in confused, drowsy, or otherwise nonresponsive patients in the hours or days before death. I describe some of the characteristic features of such cases, and reflect on the degree to which they might be attributable to the underlying health condition or changes in treatment or medication. I present examples of transpersonal elements that can occur in terminal lucidity episodes, and note the preferred interpretations of witnesses tend to invoke spiritual or dualistic constructs.