End-of-life experiences in patients: a scoping review of types, characteristics, and implications for the mind-brain relationship.

Abstract

Dying patients can experience vivid dreams, visions or unexpected lucid episodes despite declining clinical and mental status. This review examines patient end-of-life experiences (ELEs) and their implications to the mind-brain relationship (MBR). A Scoping Review (ScR) was conducted, searching major academic databases for qualitative, quantitative, or mixed methods studies. Data were synthesized narratively and presented in distribution graphs. Twenty-one papers (20 studies) were included from 1,391 citations, mostly U.S.-based (52%) and descriptive in nature. End-of-life dreams and visions (ELDVs) occur in cognitively intact dying patients, are vividly recalled, often feature deceased loved ones, offering meaning, comfort, and acceptance, suggesting sustained psychological and spiritual activity despite physical decline. Terminal lucidity (TL), though rarer, is a striking phenomenon, marked by the sudden reemergence of clarity, memory, and communication in severely cognitively impaired individuals across various pathologies, challenging the assumption that consciousness is solely a product of brain function. Patient ELEs suggest a possible mind-brain dissociation in the dying process. As research on ELDVs and TL continues to expand, future rigorous studies incorporating clinical controls and neuroimaging will be essential in determining whether these experiences are solely brain-generated or indicative of a broader understanding of consciousness beyond the brain.