Why more doctors are validating near-death experiences

According to an influential study published by The Lancet in 2001, one out of 10 patients who go into cardiac arrest will come back with a new core memory. This “near-death experience” (or NDE) is so vivid and convincing that it often reshapes the patient’s view of the world, the afterlife and their own identity.

Unlike fragmented or disorganized experiences seen in hallucinations or delirium, NDE narratives are characterized by a high degree of clarity and persistence. When researchers have asked, many patients have identified the NDE as the most important moment of their life.

Despite decades of academic research on these experiences, little about NDEs has permeated into the curriculum of medical schools. NDE researchers Marieta Pehlivanova and Bruce Greyson conducted a survey of 215 University of Virginia physicians in 2024. While very few of them had pathologizing or dismissive views about NDEs, this survey showed that the main barrier to accepting them was knowledge. Consequently, most of the consulted physicians expressed their wish to learn more about them.

This challenge was not unfamiliar. In many ways, it echoed experiences working in the field of psychedelics, another domain involving profound and often transformative experiences that remain poorly understood within mainstream health care.

Despite widespread use and growing scientific interest in psychedelics, the Healthy Ecologies and Lifestyles Lab (HEAL) at Simon Fraser University found a lack of clear, evidence-based guidance for both the public and health-care professionals. In response, the HEAL Lab developed a community-based public health guide for lower-risk psilocybin use, and is currently developing evidence-based guidance for psychedelic-assisted therapy of mental health and substance use disorders.

To address a similar gap in evidence-based guidance in the field of NDEs, there was a need to bring together the available scientific literature and provide practical steps for clinicians and others seeking to better understand these experiences.

My article “Five things to know about: Near-death experiences,” published in the Canadian Medical Association Journal, provides succinct guidance about what NDEs are and what to do about them. Perhaps the most salient point of the article is that these experiences should not be viewed as an impairment or mental disturbance, as they often result in positive changes to mental health.

I also acknowledged the elephant in the room: NDEs often feature narratives of what the patients perceive as an afterlife. They also can describe out-of-body experiences, which may or may not be verifiable. Yet, patient-centred, evidence-informed frameworks suggest health-care providers should validate and explore these experiences using openness and nonjudgmental tones.

What is a near-death experience?

The main feature of the NDE is a strong feeling of belonging or being “back home,” which often translates to a profound sensation of merging with everything. Researchers refer to this phenomenon as ego dissolution.

A specific chronology of NDEs is difficult because people often cannot feel the passing of time. They would say time stopped or there was no time. It is in this context that vivid imagery of memories occurs. These are not regular memories but enhanced versions, as they evoke not only the patient’s feelings but those of other people who shared each moment with them. Many reach a point of no return, like a tunnel or a bridge. The AWAreness during REsuscitation II (AWARE II) Study includes a comprehensive thematic description of NDEs in its supplementary material.

NDEs are often evaluated through the Greyson NDE scale, or a similar instrument that evaluates the strength of these different aspects. Using this method, researchers have identified an affinity between NDEs and other altered states of consciousness, particularly those produced by psychedelics such as dimethyltryptamine (DMT). Understanding this affinity is useful because subsequent studies suggest that experiences with psychedelics can significantly alter psychological traits, which are considered the constituent parts of our personality.

Thinking of NDEs as a psychedelic experience is helpful to understand why doctors need to be prepared to “contain” a patient who comes back from the brink of death. In other words, to ensure the patient’s psychological safety and the appropriate integration of the NDE. Clinical studies consistently show that the lasting positive effects of psychedelics (on depression, PTSD, anxiety and personality traits like openness) are strongly associated with what happens before, during and after the session. In this context, dismissive attitudes can be traumatizing for patients.

Moreover, NDEs often result in overall positive changes, with patients often finding an increased sense of meaning, a reduced fear of death and enhanced prosociality. These characteristics place near-death experiences outside of the profile of psychiatric disturbances.

Verifying anomalous perception

Out-of-body experiences are sometimes reported during NDEs, when people describe feeling as though they are outside their own body and able to observe what is happening around them. A subset of out-of-body experiences involve verifiable perceptions. In other words, the patient recalls perceiving something they should not have while unconscious (beyond simple memory reconstruction).

The International Association of Near Death Studies published a compilation of more than 100 cases in the second edition of The Self Does Not Die in 2023. These include descriptions of objects in places that were out of reach to those in the room, even if they were trying to look. For example, “a 1985 quarter lying on the right-hand corner of the eight-foot-high cardiac monitor,” which a physician found upon climbing a ladder. Another example is a 12-digit serial number on top of a seven-foot respirator, referred to by a patient with obsessive-compulsive disorder. In this case, the serial number was confirmed by a technician.

I discussed my favourite report in a podcast episode produced by CMAJ. In this case, the patient seems to have gone above the ceiling to an adjacent room.

Most of the examples in the book come from individual health-care workers who wrote or talked about them, as the case definition required a third-person testimony. While the accuracy of this type of reports is often contested, prospective clinical studies have also found a few cases of veridical perception, meaning the patient was able to provide verifiably accurate observations while unconscious. The authors of the AWAreness during Resuscitation (AWARE) study, for example, wrote:

“our verified case of visual awareness when cerebral function is ordinarily absent or at best severely impaired is perplexing… our findings do not suggest that visual awareness in cardiac arrest is likely to be hallucinatory or illusory since the recollections corresponded with actual verified events.”

Studying veridical perception in NDEs poses methodological challenges for researchers. Researchers in the AWARE study, for example, placed over 1,000 signs across five hospitals at overhead heights, facing the ceiling (a vantage point only visible from near the ceiling). Despite following over 2,000 cardiac arrest patients, only a very small number survived and were interviewed. Out of them, two included out-of-body reports, and neither occurred where researchers had placed signs.

A recent innovation in the area involves the creation of a veridical NDE scale that physicians can apply to quantify the accuracy of the perceptions and the patient’s perceptual capacity at the moment. This enables a crowd-sourced approach to data collection that is more likely to yield cumulative results in the long term.

While studying the veracity of out-of-body reports is scientifically compelling, physicians should prioritize caring for the patient. Rather than shutting down the conversation, they should normalize it by asking if they remember something from the time they were gone. If a near-death experience is reported, they should let the patient know this is a common occurrence and allow them to make sense of their own experience. In addition, they can connect the patient to support groups that have developed appropriate resources to help them process their experience.

Ultimately, fostering a strong therapeutic alliance is essential both for supporting patients who find the experience distressing and for facilitating meaningful scientific inquiry.