# 118 Near Death Awareness


Author(s): Lucille Marchand MD, BSN

Background  Near death awareness (NDA) is a term to describe a dying person’s experiences of the dying process. Information comes from broadly reported anecdotes. Patients appear to describe what dying is like and what they need for a peaceful death. The language patients use to communicate NDA may be symbolic. If caretakers are not aware that NDA can occur, patients may be treated condescendingly, ignored, or inappropriately medicated for delirium. Family, friends, and health professionals may respond with annoyance, frustration or fear. This, in turn, may cause isolation, suffering, and impair the dying person’s ability to communicate meaningful experiences at the end of life.

NDA vs. Delirium   The distinction between NDA and delirium can be difficult; NDA communications, such as reports of patients seeing and speaking to dead relatives, can be misinterpreted as delirium. Delirium presents with deficits in orientation, attention, and short-term memory and should be assessed carefully and treated appropriately.

Near Death Phenomena   The recognition of NDA requires attentive listening. Health professionals, family, friends and caregivers can help decipher NDA messages. Two broad categories of messages have been described.

  • Attempts to describe what dying is like:
    • Communicating with or experiencing the presence of someone who is not alive.
    • Preparing for travel or a change.
    • Describing a place they can see in another realm.
    • Knowing when death will occur.
  • Requests for something to ensure a peaceful death:
    • Achieve closure in a personal or spiritual relationship, or in an ethical matter..
    • Remove a barrier to achieving closure.
    • Prepare for death via specific items or rituals.

Pearls for Listening for NDA Phenomena

  • Evaluate for causes of delirium and treat when appropriate. Be careful to evaluate for agitation arising from a message not being understood or addressed.
  • Gently ask patient about messages you do not understand.
  • Accept and validate what the patient is telling you; do not challenge or argue.
  • Be honest when you do not understand, but let patient know you will keep trying.
  • If you do not know what to say, say nothing – but be present.

Health Professional Responses to NDA Phenomena

  • Help the patient find closure, relieve suffering and anxiety, and help the patient achieve a peaceful, fulfilling death.
  • Help families, friends and health professionals gain comfort and important knowledge about dying.
  • Lessen our own fears about dying.

Further Resources   See the following references for clinical examples. Examples in the Callahan and Kelley text provide guidance for caretakers on how to help patients who are experiencing NDA.


  1. Callahan M, Kelley P. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. New York, NY: Bantam Books; 1992.
  2. Moody R. Life after Life. New York, NY: Bantam Books; 1975.
  3. Greenberg D. Preventing Delirium at end of life: lessons from recent research. Primary care companion. J Clin Psychiatry. 2003; 5(2):62-67.

Fast Facts and Concepts are edited by Drew A Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD and published in August 2004. Re-copy-edited in April 2009; web-sites updated.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Marchand L. Near Death Awareness. Fast Facts and Concepts. August 2004; 118. Available at: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_118.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

 ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Non-Pain Symptoms and Syndromes, Psychosocial and Spiritual Experience: Patients, Families, and Clinicians