Right before dying, many people experience vivid and meaningful dreams and visions, according to accounts across cultures and throughout history. Yet little scientific research has investigated the phenomenon. A new study in the American Journal of Hospice & Palliative Care, the first study to focus primarily on the patient's perspective, found that most of these dreams are a source of personal comfort. They bring about a sense of peace, a change in perspective or an acceptance of death, suggesting that medical professionals should recognize dreams and visions as a positive part of the dying process.

Researchers at Daemen College and at Hospice Buffalo, an agency of the Center for Hospice & Palliative Care, studied 63 patients admitted to the hospice over a period of 18 months. Investigators interviewed patients daily, asking them about any dreams and visions and taking down detailed descriptions of them. Most participants reported experiencing at least one dream or vision, memorable in much more clarity than other dreams or delirious episodes and characterized by an impression of realism and emotional significance. The researchers' analysis revealed six categories that encompassed all the dreams—often participants saw deceased loved ones waiting for them, for example. As patients approached death, they tended to transition from dreaming about living people to dreaming about the dead, which the patients described as more comforting.

The overarching theme that emerged from the study was that end-of-life dreams and visions are a source of comfort. Previous studies have come to similar conclusions: a survey of hospice nurses in 2013 found that 89 percent believed these experiences were associated with calm and peaceful deaths. Yet medical professionals tend to discount predeath dreams and visions, according to physician Christopher W. Kerr, one of the study's co-authors. He says that most doctors offhandedly attribute these incidents to delirium or the side effects of medication.

The researchers believe that such a dismissive attitude toward dying patients' experiences can be detrimental to their mental health. “We need to treat the patient, not only the disease; overall quality of life at the end of life is important,” says Pei C. Grant, director of research at Hospice Buffalo. She and her colleagues suggest that families and practitioners talk about dreams with patients—who are often excited to share their dreams when asked about them. Doing so allows patients to review their life, process feelings about death and come to terms with past experiences. “Just being there and listening—that's really what the patient wants,” Grant says. Acknowledging the personal significance of these end-of-life experiences may help patients and families through the difficult transition from dying to death.

Visions of Lost Loved Ones

As patients approach death, they often have realistic and memorable dreams in one or more of these six categories, according to the new study:

  • 1. Comforting presence: A loved one—often deceased but sometimes living—offers solace.
  • 2. Preparing to go: Patients ready themselves for a journey. In one patient's dream, she boarded a plane with her (living) son and felt comforted.
  • 3. Watching or engaging with the dead: Deceased friends and relatives play a significant role, which patients overwhelmingly reported as being comforting.
  • 4. Loved ones waiting: Deceased friends often seem to be “waiting.” Three days before her death, one woman reported both visions and dreams of being at the top of a staircase with her (predeceased) husband waiting for her at the bottom.
  • 5. Distressing life experiences: Patients may revisit traumatic life experiences, such as war, childhood abuse, or difficult situations or relationships.
  • 6. Unfinished business: A few patients report distressing dreams that center on fears of being unable to accomplish important tasks. Two young mothers recount dreaming about caring for their children. —E.B.