What is Nearing Death Awareness in Hospice Patients?


According to Callanan and Kelley in the book “Final Gifts”, nearing death awareness is an attempt by dying people to describe what they are experiencing — the dying process and death. Nearing death awareness occurs in those who are dying slowly, and it is “a communication that is unexpected, and expressed in symbolic language” (1992, pp 13-14). Patients may make symbolic statements such as “the door is closing”, “the curtain is coming down”, “my horse is waiting”, or “the tides are going out”. Generally these are metaphors that symbolize their leaving this life and transitioning to death. These statements often correlate to their life. For example, a patient who was a boater may talk about the tides, or a rancher may describe his horse waiting to take him for a ride.

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Patients may appear confused and disoriented, and they may state that they have spoken to those who have already died or have seen places not presently accessible or visible to family and/or the professional caregivers. They may describe spiritual beings and bright lights. Dying people may make a seemingly “out of character” statement, gesture or request, and they may describe another world of peace and beauty. Dying patients may also tell their family members when they will die.

These behaviors do not indicate confusion, hallucinations, or drug reactions and should not be labeled as such. The patient is possibly beginning to transition from this life and is attempting to describe the dying experience or something they need to achieve for a peaceful death. These messages of the dying may be a symbolic communication to ask for permission to die or address a need — for reconciliation with a family member, a visit from a friend, or knowledge that the survivor will be okay without them. Hospice caregivers and families should not contradict, explain away, belittle or argue with the patient about his, or her, nearing death awareness experiences. Humoring the patient only produces a lack of trust, isolation, and bewilderment for the patient. Hospice professionals attentively and sensitively listen to the patient, affirm the experiences, and attempt to understand these messages of the dying so that unfinished business can be addressed. After these experiences, patients are often more peaceful and their fear of dying lessens. When patients experience nearing death awareness and describe death as peaceful, they are also providing us with a better understanding and acceptance of the death experience. As such, this may be their final gift to family members and hospice caregivers. (Callanan & Kelley, 1992)


Callanan, M., & Kelley, P. (1992). Final Gifts. New York: Bantam Books.

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