Life’s Last Rally: Terminal Lucidity
A mystery at the deathbed.
Posted Oct 10, 2018
To paraphrase Shakespeare, there are more things in heaven and earth than we can ever imagine or understand. This certainly applies to the many unusual and mysterious happenings that can occur around the deathbed. Today, most people have heard of deathbed visions in which the dying have visions of deceased relatives, religious figures, pets, or friends, and near death experiences in which someone is close to death or has died, left their body, experiences the afterlife and returns to life. There are, however, other exceptional end of life experiences that are less well known but equally intriguing. One of these phenomena goes by many different names. It is called “the last hurrah,” “the final good bye,” or “the end of life rally.” More recently, it has been given the name of “terminal lucidity” by Michael Nahm, a German researcher and biologist. Terminal lucidity is not to be confused with terminal agitation, which is characterized by delirium, anxiety, agitation, and cognitive decline. Indeed, it is quite the opposite: Terminal lucidity applies to someone who is close to death and has been unresponsive, yet will suddenly show a marked improvement in their energy and mental functioning. They will engage in meaningful conversation with others and even ask for food or drink. They appear to be their old selves. Families feel that a miraculous healing has taken place and that their loved one will now be alright, only to have them die minutes or hours later.
There has been relatively little scientific research into the phenomenon of terminal lucidity. It has only been named since 2009, although, according to Nahm, there are anecdotal reports of people experiencing end of life rallies in the medical literature dating back at least 250 years. Those who work with the dying, such as hospice nurses, are certainly familiar with it. There are many questions surrounding the phenomenon: Why and how does it happen? What is the mechanism involved? Why do some experience it while others do not? Terminal lucidity has been found in individuals with dementia, brain tumors, strokes, and mental illnesses such as schizophrenia. These are the people one would think would be least likely to have this experience, and yet they do.
A small group of researchers is currently investigating terminal lucidity. In addition to Nahm, Alexander Betthyany of Vienna  has been attempting to gather data about it. So far the response rate to the questionnaire he has distributed has been limited. While the results are in no way definitive, out of 227 dementia patients tracked, approximately 10 percent exhibited terminal lucidity. From his literature review, Nahm has reported that approximately 84 percent of people who experience terminal lucidity will die within a week, with 42 percent dying the same day. These findings suggest that normal cognition can occur in spite of a severely damaged brain. How is it possible for someone’s brain to be destroyed by a disease, and yet the person can become lucid and engaging close to death? Nahm gives the example of a 91-year-old woman who suffered from Alzheimer’s disease for 15 years:
“The woman had long been unresponsive and showed no signs of recognizing her daughter or anyone for the previous five years. One evening, she started a normal conversation with her daughter. She talked about her fear of death, difficulties she had with the church and family members, and then died a few hours later.”
There is as yet no logical scientific answer to this medical mystery. There is just not enough information to postulate a definitive mechanism for terminal lucidity. The fact that it occurs in people with different diseases suggest that there may be different processes occurring. Some speculate that this could be a spiritual experience or divine gift. It certainly is a gift for family members attending the death to have one last opportunity to be with their loved one and to say their last goodbyes. Both family members and caregivers who have been witness to this state that they feel changed by the experience.
Exceptional experiences such as terminal lucidity, deathbed visions, and near-death experiences have raised questions about whether the mind is actually a product of the brain. Some philosophers and theologians have theorized that consciousness is outside of the brain. This idea has been suggested as an explanation for near-death experiences. Hopefully, there will come a day when we can have the answers to these unusual experiences. Until then, if you are with your loved one at the end of their life and you are lucky enough to be around them when they are having such an experience, consider it a final gift and savor those moments. The dying who have these experiences appear to have a more calm and peaceful death, while family members who are with them say that they will always cherish the special last moments with their loved one.
Dr. Betthany is continuing to conduct research on terminal lucidity. If you have witnessed this phenomenon, he requests that you fill out the survey at this link.
 Nahm, M. (2009). Terminal Lucidity in People with Mental Illness and other Mental Disability: An Overview and Implications for Possible Explanatory Models. Journal of Near-Death Studies, 28(2), Winter 2009, 87-106.
 Nahm, M., Greyson, B. Kelly, E. and Harroldsson, E. (2011)Terminal Lucidity: A Review and a Case Collection. Archives of Gerontology and Geriatrics. 55,138-142.