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Meaningful Visions or Delirium?

Dr. Saul Ebema

Throughout my years of working in Hospice, I have heard lots of stories about dreams and visions from hospice patients. One area that has confused the hospice team more is that of visions. Let me explain for clarity.

Some years ago, I did a joint visit with the nurse to a patient in a nursing home. He was in his bed, having a conversation with people that we couldn’t see. He was mentioning names that his daughter later confirmed were of dead family relatives.

As we gave him a little space to continue with his conversation, the facility nurse came in and told us that the patient was having a moment of delirium and recommended medication.

Recent research however indicates that these visions are not a result of delirium but that they are comforting, real and often meaningful for the dying patient.

“End-of-life dreams and visions have been documented through the ages, but there has often been a lack of understanding on the part of health care workers about their significance,” said Dr. Christopher Kerr, chief medical officer at Hospice Buffalo.

A study by Dr. Christopher Kerr, James P. Donnelly, PhD, and colleagues found that end-of-life dreams and visions are an intrinsic and comforting part of the dying process.

Kerr tells the story of one dying woman who talked and acted as if she were holding an infant in her arms. She called him by name: Danny.

Her four children, who surrounded her bedside, were puzzled. They had no idea who “Danny” was. Then the patient’s sister arrived. She explained that the patient’s first child, Danny, had been stillborn. None of Danny’s siblings ever knew he existed.

The study found that “the most common dreams and visions were of deceased relatives or friends.”

This kind of End-of-Life Dreams and Visions become more frequent as the patient approaches death.

The study demonstrates that End-of-Life Dreams and Visions are commonly experienced and are characterized by a consistent pattern of realism and emotional significance.

The researchers noted that some medical professionals tend to discount pre-death dreams and visions. “If they are seen as delusions or hallucinations, they are treated as problems to be controlled.”

According to Kerr, there is an important distinction between End-of-Life Dreams and Visions and Delirium. The study concluded: “During a delirium state, the person has lost their connection to reality and ability to communicate rationally. Delirium is distressing and dangerous and must be treated medically. In contrast, our study shows that End of Life Dreams and Visions are typically comforting, realistic, and often very meaningful, highlighting a critical difference.”


Reference:

  1. Christopher W. Kerr, James P. Donnelly, Scott T. Wright, Sarah M. Kuszczak, Anne Banas, Pei C. Grant, Debra L. Luczkiewicz. End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients’ ExperiencesJournal of Palliative Medicine, 2014; 17 (3): 296 DOI: 10.1089/jpm.2013.0371

Hospice Chaplaincy is a nonprofit organization committed to promoting excellence in spiritual care at the end of life. We are committed to the belief that people from all backgrounds, cultures and faith traditions should experience the end of life in a way that matches their own spiritual/religious values and goals. The task of dying is complicated and often confronts us with lots of spiritual, emotional and physical suffering. Hospice Chaplaincy is dedicated to providing support and professional development resources for hospice chaplains, patient advocacy, and education services to the public, to create a cultural shift to inform and transform our thinking around the psychosocial and psychospiritual issues at the end of life .

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