book reviews

‘Suddenly she looked eagerly towards part of the room, a radiant smile illuminating her whole countenance. “Oh, lovely, lovely” she said. When asked what it was that she saw, she replied, “Lovely brightness, wonderful beings”. A moment later she exclaimed: “Why it's Father! Oh, he's so glad I'm coming; he is so glad. It would be perfect if only W [her husband] would come too.” ‘

This account, by his obstetrician wife of a young woman dying in childbirth, prompted Sir William Barrett to research such occurrences for Deathbed visions (1926), the first book devoted to the topic. Since then scores of other examples have been recorded. When neuropsychiatrist Peter Fenwick and his wife Elizabeth decided to publish on their own professional interest, they received several hundred replies from the public about what they have called end-of-life experiences. These experiences form the substance of the enigmatically named The art of dying: do they mean a good death or the possibility that in death art eclipses science?

What the authors are considering can be divided into three categories: deathbed visions, deathbed coincidences, and near-death experiences; circumstances vary but each have features in common. Probably no more than 10–20% of people experience these phenomena, but evidence gathered by the Fenwicks from staff in nursing homes, hospices and coronary care units leaves little doubt as to their authenticity: hard-headed professionals and people who insist they are naturally sceptical accept these extraordinary events without being able to explain them. Some people are so overwhelmed that they keep the incident private, because they are ‘too embarrassed to tell anyone in case they think [they] are mad’. Existing pathology, toxic confusional states, medications, cultural and religious leanings have repeatedly been ruled out as causes.

Deathbed visions are quite unexpected: a bright light often accompanies the visitor, a close relative or friend in the prime of life – ‘How nice of you to come!’ – and the atmosphere is warm and comforting. Pain and suffering vanish, there is no fear, and death is welcomed as a journey to a beautiful garden. Onlookers have frequently emphasised the lucidity of the dying – ‘She seemed to come alive’ (note the irony) – and even sufferers from years of Alzheimer's disease will regain the ability to talk rationally. Witnesses declare that the impact is such that they no longer have any fear of death.

Deathbed coincidences are, if anything, even more bizarre. They are the occasions when a close friend or relative suddenly becomes aware in dreams or on waking at night that a loved one, who they may not have seen for years or who may live miles away, is dying. They note the time and immediately fall asleep as though the message was expected. They may even forget the episode until they are contacted to say that death occurred at the very time they recorded. Human beings are not alone: stories abound of inanimate objects and birds and animals being sensitised by death. Clocks, especially for some reason grandfather clocks, stop, bells ring, electric systems fail; birds, like crows and owls, and animals, in particular cats and dogs, seem especially susceptible. A cat called Oscar from a nursing home in Providence, Rhode Island, made the pages of the New England Journal of Medicine because of his habit of hopping on the bed of those about to die.

How can we explain these fascinating encounters? Telepathy, clairvoyance, psychokinesis, Jung's synchronicity have not passed the test of evidence: The roots of coincidence (1972) a lively enquiry by polymath and euthanasiast Arthur Koestler could have been written today. Science may recognise the brain's part in consciousness of the world around us but has little to say about the origin of our thoughts, feelings and beliefs. The Fenwicks may have hit on a clue in their study of near-death experiences. These happen during a cardiac arrest when the individual characteristically looks down on their body as it enters a tunnel on a journey, from which it is turned back. At this time there is no brain activity, no ‘consciousness’, as judged by the electroencephalogram. The tantalising thought occurs that such experiences are driven by something else that we lamely call ‘soul’ or ‘mind’. Tim Bayne, one of the editors of the forthcoming Oxford companion to consciousness has written:

… the pressing problem of consciousness research concerns our inability to grasp, even in the faintest outlines, how conscious states of any kind emerge from the grey porridge found between the ears.

• © 2009 Royal College of Physicians