A hospice witness: Dr. Christopher Kerr

Dr. Christopher Kerr, author of the 2021 essay “Experiences of the Dying: Evidence of Survival of Human Consciousness” written for the Bigelow Institute for Consciousness, writes:

When I became a hospice doctor 23 years ago, neither my medical training nor my doctoral degree in neurobiology could have prepared me for what I would witness at bedside of patients nearing death. I used to believe that my job was caring for life pre-death. Instead, I came to realize that there is more to dying than death.

My observations at bedside have led me to the counterintuitive claim that the survival of human consciousness after death may be nowhere more evident than in what happens to the dying before death. These are moments of transition when the mind’s elevation transcends the body and brain’s deterioration. Put another way, we can’t look into the continuity of consciousness past death by having an exclusive focus on the after. Doing so would assume a before/after division that the dying experience itself renders irrelevant. The dying process is a continuum within which our patients experience a heightening of consciousness and an acute awareness of their past and present existence. This experience includes a consciousness that is most often shared with others who died before them and but who are now fully present to them. The dying process reveals a connectivity between and across lives, both living and dead. This continuity of connectivity persists regardless of time or bodily existence and supports the hypothesis that consciousness survives beyond bodily death.

I used to believe that end of life includes processes that understandably draw us inward towards introspection and reflection, processes that distill life into what truly counts and in so doing, validate having lived and mattered. That the dying process would alter the patient’s perception made sense. What was unexpected if not jarring was that the process entails so much more than just a changed outlook in patients. Shortly before death, the dying have dreams and visions of their predeceased loved ones, scenes of vivid and meaningful reunions that testify to an inexplicably rich and transformative inner life. The phenomenon includes a lived, felt, often lucid experiential reality whereby those loved and “lost” return to the dying in ways that cannot be explained by memory alone. Children and parents sometimes lost decades earlier come back to put patients back together and help them transition peacefully. At the precise moment we associate with darkness, loss, physical decline, and sadness, their presence helps the dying achieve peace, comfort, and forgiveness, which suggests an existence beyond our bodily form. A failing brain does not imply a failing mind, and biological decline does not diminish the soul. In fact, in our final days, our physical form does not follow function: patients are spiritually and perceptually alive and vibrant despite a failing body. This is the paradox of dying.

A remarkable body of work on Near-Death Experiences (NDE) has been cited as evidence that consciousness is more than a byproduct of our brain and survives our mortal form (1-5). Skeptics offer physiologic explanations and argue that the memories or sensations of NDE-like experiences are actually triggered by the brain as it shuts down or reboots; they attribute the phenomena to causes including oxygen shortage, anesthesia, neurochemical responses to trauma and “post-resuscitation syndrome” (6-8). Critics of NDE study protocols also suggest that this research does not “exclude that the reported memories were based on retrospective imaginative (re)constructions built up from memories, prior knowledge, and/or expectations about the world” (9). Others explain NDEs based on spiritual or psychological interpretations, ranging from the theories of Expectancy to Dissociation (6, 9, 10).

Proving consciousness beyond death must not only account for neurobiological changes associated with “clinical death” but also address factors that define and inform consciousness, such as changes in awareness, wakefulness, and connectedness. At Hospice, we routinely care for dying patients who are not only neurologically intact but fully aware and awake. Whereas physical death is a circumscribed event, dying for most is a prolonged process that inherently alters consciousness. The dying processes we witness are anticipated, non-acute and physically irreversible. Yet, instead of exhibiting a waning consciousness, many of our patients display a heightened acuity and a rich inner life which includes changes in perception as well as an awareness of both their internal and external existence. Not surprisingly, such experiences of consciousness are qualitatively distinct from those events described in traumatic or acute death, alterations in brain function from anesthesia or recovery from recusation. The studies conducted at Hospice Buffalo for over a decade further corroborate that the dying are paradoxically often emotionally and spiritually alive, even enlightened, despite their terminal physical decline, not just in the minutes or hours before physical death, but in the days and weeks. In other words, these extraordinary inner experiences that have been attributed to a failing brain with NDEs occur during the dying process on a continuum that goes from intact cognition to the fluctuating states of consciousness and failing organs that define the immediate hours before death.

We hypothesize that only those who are actively dying have the vantage point and the language to define their changing and enlightened existence, the keyhole through which to see what’s beyond. Our work focuses not only on the dying process but specifically, on the experiencing of it, the subjective or conscious dimensions of dying. The tragic physical process of dying often obscures the experiential, inner or subjective dimensions of dying which represent a heightened form of consciousness, an awakening of feelings, wonderous perceptual experiences, insights into one’s present and future existence as well as a feeling of connectivity, wholeness and belonging. Our patients exhibit changes in awareness of thought, memories, feelings, sensations, and environments. Not only are such experiences near universal, but they are remarkably similar. This is why to find evidence of the survival of human consciousness after death, we need to look at what happens before death, in these moments of transition when the before and after merge to the point of irrelevance and the enlightened mind transcends the body and brain’s deterioration.

The following is a video of our patient Florence, six days before death. She is free of neurologic disease and has not taken any psychoactive medication. Although dying, Florence is physically unburdened and cognitively intact while describing the closing of her life. To her, dying is a conscious experience that is vibrant as well as self-fulfilling. Her consciousness is lucid: she is fully awake, aware and connected. Through this keyhole, Florence doesn’t dream, analyze or simply remember, but instead feels the familiar and comforting presence of those she has loved and lost. Unlike the epiphanies or revelations often associated with NDEs, there are no great insights or messages. In fact, language is near absent and not needed. Florence is instead at her family’s kitchen table in the company of her deceased husband and daughter; she has been put back together and is truly home. Her awareness is acute, complete and secured in the certainty of what has always defined who she is: her relationships. She is now restored in a promise of what lies ahead. Florence doesn’t have any feeling of being out of her body or any perception that she is dead: her existence, as defined by love, is understood and sustained. These experiences are not only validating but remove any fear of physical death. Florence is already on her journey, her consciousness continuing where her body can no longer go (Link to: Florence Interview Video).

These moments of life-affirming enlightenment at the time of death have been acknowledged across cultures and throughout history. Indeed, while modern medicine has been resolutely silent on the topic of dying, often reducing it to mere “medical failure”, the humanities, the realm of culture and religion, have long testified to its significance to humanity. From writers, poets and philosophers as far back as ancient Greece, from Buddhist and Islamic texts to accounts from China, Siberia, Bolivia, Argentina, India and Finland, from the religious and sacred traditions of Native Americans and other indigenous peoples around the world, meaningful pre-death dreams and visions have been widely recognized and celebrated. They are mentioned in the Bible, Plato’s Republic, and in medieval writings such as the 14th century mystic Julian of Norwich’s The Revelations of Divine Love. They show up in Renaissance paintings and in Shakespeare’s King Lear. They appear in 19th-century American and British novels, in T.S. Eliot’s poetry, and last but not least, in the Dalai Lama’s meditations on death. If anything, the medicalization of death has obscured a language that has always been available to make sense of our finitude and that has been integral to humanity’s need to maintain connection with the departed. This awareness that we remain intertwined beyond death is central to the story of our shared humanity.

Starting in the twentieth century, reports on pre-death experiences began to be collected systematically through eyewitness accounts (11-16). More recently, a research team at Hospice Buffalo, has conducted studies on over 1,500 patients and families. The process of dying is a reality that only the dying could tell us about, from a vantage point that the living do not share. It was the testimonies of these patients as well as our subsequent systematic studies of their inner experiences that helped us reframe dying and our notion of a before and an after death and of consciousness itself. The data confirmed that the vast majority of dying patients, shortly before death, have these comforting dreams and visions that most commonly summon predeceased loved ones. After witnessing how these bonds of love re-emerge as unbreakable at life’s end, the question we were left pondering was “are the deceased ever really gone?” Indeed, those who returned were not just random appearances; they were most commonly, as with Florence, people who best loved and secured the dying in life and were reuniting at a depth that suggests they were never gone. One ninety-five-year-old gentleman claimed to smell his mother’s perfume as she whispered “I love you” in his ear. His mother had passed ninety years earlier when he was five years old, yet his vision of her was as crisp as if she had just left him. Such experiences return at life’s end in ways that transcend mere recollection and are instead tangible, material, and lived. With full lucidity, these patients claim such experiences are “more real than real” and rich in detail not previously recalled but now vividly summoned.

“Transcendence” is typically the concept used to denote an existence or experience beyond the normal or physical level. The word literally means “going beyond.” It is also a state that is associated with the afterlife and that best represents the work that pre-death experiences do in helping patients transition to death. In fact, the power of the spiritual transformation and “transcendence” they occasion in patients’ lives cannot be overstated. Near death, the boundaries between the experiential and the spiritual, body and mind, present and past, conscious and unconscious impulses dissolve to provide comfort through a process of connectivity across the living, the dying, and the dead. The process brings about a form of spiritual and emotional solace that is rooted in lived experience rather than just dreams or memories. Recognizing people’s experience of dying as the gateway to continued consciousness beyond life and death is crucial if we are to become more literate on what constitutes our mortality.

 

Christopher Kerr, “Experiences of the Dying: Evidence of Survival of Human Consciousness,” an essay written for the 2021 Bigelow Institute for Consciousness Studies in response to the question: “What is the best evidence for survival of consciousness after bodily death?” Dr. Kerr, MD, PhD, is the Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo.