At the hospital where I did my residency in internal medicine, there was a ward designated for terminally ill patients who had recently transitioned to hospice care. When a nurse there paged me to say that so-and-so had died, it was never really a surprise. I could walk to the bedside instead of running. I offered my condolences to any nearby family members before shining a light into the patient’s fixed pupils and holding my stethoscope for a while against their quiet chest. Then, for the sake of the death certificate, I looked at the wall clock and noted the time.
Regular monitoring of vital signs fell away in those cases, which meant that I was usually confirming the absence of a pulse long after the heart had stopped beating. My job as the on-call doctor was closer to formality than ceremony. The semantics could feel a little uncanny, especially when I was underslept: a body wasn’t technically dead until I pronounced it so.
Such arbitrary definitions bother Sam Parnia, an associate professor and critical care physician at New York University whose recent book, Lucid Dying, draws from years of research on clinical resuscitation and consciousness. In his telling, the primary mistake lies in thinking about life and death in binary terms. Instead he sees death as a continuum, a “grey zone” that has widened since the advent of modern CPR in the mid-twentieth century. Cutting-edge resuscitative technologies—for instance, a recently formulated chemical solution that can restore cellular activity in a pig’s brain several hours after its decapitation—are poised to expand it even further.
These innovations have increased the two-way traffic through this gray zone: everyone eventually enters, but more and more of us are returning. Estimates of how many people have had near-death experiences hover around 10 percent of the general population, though questionnaires on the subject can be generous in their definitions, considering “a true life-threatening event” to be just as notable as “an event that just felt so.” (Some investigators prefer the term “recalled experiences of death” to avoid the question of death’s proximity.) Among survivors of cardiac arrest, the figure is closer to 20 percent. Across this collective testimony, specific narrative elements—weightless hovering, cinematic retrospection, lights and tunnels—recur often enough that, for Parnia, they constitute another challenge to death’s presumed finality: the mind (or soul, or self, or psyche, depending on the storyteller’s preference) appears to survive beyond the dying body’s ability to sustain it.
Parnia is not the only academic with an interest in the afterlife. The field is large enough to support a professional society, the International Association for Near-Death Studies, with an associated journal that publishes three times per year. Compared with the average scholarly article on the subject, though, Parnia’s popular writing, which includes his earlier books What Happens When We Die (2005) and Erasing Death (2013), is bolder in its arguments about what it all means.
Most contemporary theories of consciousness begin with the materialist assumption that our brains generate our conscious selves; death of the former implies death of the latter. Scientific attempts to pin down the neural origin of consciousness, however, have thus far come up short. Functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) have been used to compare the brain in conscious and unconscious states under experimental conditions like anesthesia, magnetic stimulation, and the rapid presentation of competing words or images. But showing how conscious experience moves through the brain fails to clarify why that information coalesces into subjectivity. This failure exemplifies what the philosopher David Chalmers has called “the hard problem of consciousness,” a stubborn distance between the phenomenon’s experience and its measurability. While adherents to biological models of consciousness believe that laboratory observation may yet catch up with their theoretical work, detractors contend that the premise of such experiments is incorrect.
Parnia is one such detractor. He is a dualist in the Cartesian sense; for him, the body, particularly the brain, is a medium for the mind rather than its source. “When we place our hand in a glove, the two become intricately linked together,” he writes, borrowing an analogy from the surgeon Bahram Elahi. The mind is separate from the brain, dualists argue, just as the hand is separate from the glove. Some dualists grant that the mind might still have a material basis (perhaps as a fundamental property of the physical universe akin to mass, gravity, or electromagnetic fields), but if so it exists outside the body, which it is “tethered to” in life and “liberated from” thereafter. Parnia believes that this alternative to the scientific consensus is supported by mounting clinical evidence, which the rest of us, caught up in our narrow preconceptions of death, are unwilling to take at face value.
Parnia’s clinical research has combined physiological data from the gray zone of death with survivors’ firsthand reports. In an ambitious 2023 study called AWARE-II (AWAreness during REsuscitation), which Lucid Dying cites often, Parnia and several colleagues analyzed, over seven years and twenty-five sites, 567 patients who experienced in-hospital cardiac arrest, obtaining formal consent from the survivors and waivers for the deceased. Monitoring EEG tracings along with intracranial blood levels during CPR showed that organized electrical activity persisted despite the brain being starved of oxygen, a paradox difficult to square with basic neurobiology. Materialist attempts to explain these patterns are plausible but complicated—maybe an amplified signal circulates through a depleted network of surviving brain regions just before the whole system collapses. Dualists like Parnia, by contrast, read these patterns as evidence of the distinction between consciousness and the body, glimpses of the proverbial hand leaving its glove.
Studies from other laboratories have yielded similarly circumstantial conclusions. In critically ill patients whose life support is actively withdrawn, EEG tracings have repeatedly revealed surges of organized electrical activity that resemble conscious mental states. Comparable signals have been seen in rats dying by suffocation, lethal injection, and terminal sedation, which some see as hinting at the decoupling of mind and brain. While this pattern is notable, such signals are also reliably extinguished before the final heartbeat, lending support to the opposing interpretation that conscious experience arises from the body it inhabits. A Canadian study from 2022 recorded the brain waves of eight patients, for example, none of whom demonstrated EEG activity after circulatory arrest. Other investigators have noted that these end-of-life electrical phenomena may be more common in patients with epilepsy and thus tantamount to seizures, which activate parts of the brain similar to those activated by conscious experience.
The AWARE-II study also aimed to corroborate the “out of body” element that recurs across many recalled experiences of death, in which survivors report floating above their own bodies and in some cases remember specific details of their resuscitation. In a remarkably literal test of extracorporeal perception, the investigators placed a tablet above patients undergoing CPR and projected one of ten images for their disembodied consciousnesses to apprehend. The tablet was deliberately turned away from the direction of chest compressions so that it would be visible only from above. The investigators also played an audio recording of the names of three fruits through a pair of headphones (allowing for the possibility of consciousness lingering between a dead body’s ears rather than drifting immediately toward the ceiling). Of the hundreds of cardiac arrest patients included in the study, only twenty-eight survivors were healthy enough to complete a post-resuscitation interview, the results of which didn’t prove much: no respondents could recall their visual cue, and only one correctly identified the fruits as “apple,” “pear,” and “banana.”
Perhaps the convergent details of survivors’ testimonies remain the most convincing evidence for the existence of near-death experiences. The first AWARE study, published in 2014 and also led by Parnia, included structured interviews with over one hundred cardiac arrest survivors across fifteen different hospitals. As in the later study, only one patient had verifiable sensory recollections of the arrest itself, and none remembered any of the visual stimuli planted by the study team. But half of all interviewees endorsed some subjective recollection of their period of unconsciousness, and 9 percent of those reports were consistent with an archetypal near-death experience.
That archetype is at least a half-century old. In his influential 1975 book Life After Life, the philosopher and then medical student Raymond Moody popularized the phrase “near-death experience” by analyzing roughly fifty accounts of such experiences and their aftereffects, outlining fifteen shared narrative elements including “feelings of peace and quiet,” “the border or limit,” “coming back,” and “new views of death.” One of Moody’s colleagues, the psychiatrist Bruce Greyson, integrated these themes eight years later into the Near-Death Experience Scale, which many scholars, including the AWARE study team, still use as a standardized metric for near-death phenomena.
Individual accounts in Moody’s collection rarely included all fifteen themes, but they suggested a common trajectory. One central feature is what Moody calls “the review,” in which spiritual escorts—who are typically described as radiantly bright but variable in number and form, ranging from anonymous angels to bygone relatives—replay episodes from the dying individual’s life in what feels like an impossibly detailed recording. The point of the exercise, as multiple survivors remember it, is to judge the morality of their own behavior from the perspective of an ethereal witness. The effects on survivors’ earthly priorities that Moody describes are likewise predictable, shifting away from self-interest and toward acts of love, service, and growth.
In Lucid Dying, Parnia elaborates this taxonomy further, increasing Moody’s fifteen elements to around fifty. The exercise sometimes feels like hairsplitting: for example, from Moody’s initial observation of the out-of-body experience, Parnia derives subthemes that include “shedding the body,” “becoming detached from events and the body,” and “separation from the body with external visual awareness.” Regardless, emphasizing a standard template for recalled experiences of death makes it harder to dismiss individual accounts as synaptic accidents or faith-based delusions. Resurrection memoirs published by survivors tend to skew pulpy and denominational, and they are usually marketed for the spirituality shelves rather than popular science. But by considering them in aggregate, Parnia asks a provocative question: How is it that so many people across ages, religions, time periods, geographies, and professions “might dream the same dream”?
Parnia generally sidesteps the possibility of a cultural explanation for these similarities. However unorthodox the near-death experience may be as a subject of clinical research, it remains a broadly familiar convention. Cartoon characters’ souls have been leaving their bodies for decades, from Tom and Jerry to All Dogs Go to Heaven. Social media speculation that Donald Trump’s personality might have transformed after he narrowly escaped assassination led him to clarify to campaign donors three weeks later, “I’m not nicer.” In Lucid Dying, Parnia dwells on a sixteenth-century oil painting by Hieronymus Bosch called Ascent of the Blessed, which features angels carrying humans through a tunnellike passage from darkness in the foreground toward light in the distance. Parnia regards the painting as historical validation of an unchanging narrative, overlooking the possibility that the inheritance of such images might contribute to that narrative’s repetition.
Recollections of death are also less uniform than Parnia allows: less than one tenth of survivors in the first AWARE study had a typical near-death experience, which means nine tenths did not. Other memories retained from the unconscious period were harder to categorize, including visions of plants and wild animals, experiences of torture and persecution, and a sense of déjà vu. One survivor remembered “being dragged through deep water,” for example, while another recalled being forced through a ceremonial immolation. Other researchers have found that up to 14 percent of recollections of death are distressing, involving monstrous creatures, noxious smells and sounds, vast emptiness, and horrible pain. Despite these varied data, Lucid Dying describes the emotional valence of near-death experiences as consistently positive, except for attempted suicides, whose gloomy recollections—depressing landscapes, aimless wandering—Parnia chalks up to “a hell of their own making.”
To demonstrate the distinctiveness of recalled experiences of death, Parnia reports conducting a machine learning study that compared over a thousand survivors’ testimonies to similar numbers of recounted dreams and drug trips, yielding statistically significant differences among all three groups. Other investigators, however, using Greyson’s validated Near-Death Experience Scale, have found striking similarities between near-death experiences and drug-induced alterations of consciousness, enough to suggest the latter (particularly via dissociative compounds like ketamine) as a laboratory model for further study of the former. Mind-altering substances are relevant to near-death experiences not only because they represent a similarly hyperaware yet disconnected mental state, but also because scientists have observed, in a cohort of asphyxiated rats, that death corresponds with a potent outflow of psychedelic neurochemicals generated within the brain.
To Moody’s credit, Life After Life leaves open the possibility that drug use and near-death experiences might be two paths “among many leading to the achievement of enlightenment and to the discovery of other realms of existence.” He opens his book with a regretful note about his unfamiliarity “with the vast literature on paranormal and occult phenomena,” confident that such background reading would have enhanced his understanding of near-death experiences. Parnia, on the other hand, derides journalists who refer to recalled experiences of death as hallucinations but does not hesitate to label drug-induced visions the same way, lumping them together with dreams as “imaginary,” whereas recalled experiences of death are “real.”
Parnia accuses fellow scientists of bias more than once in Lucid Dying but offers comparatively little reflection on the limits of his own open-mindedness. He acknowledges that the notion of an everlasting soul has personal appeal: “What would be the point of experiencing a flash of existence, only to be annihilated and disappear forever afterward?” Elsewhere, recalling the timeworn arguments against natural selection, he cites the genius of Mozart and Einstein as reason to doubt the “happenstance” emergence of the human mind.
I find the premise of this work charming, even if its conclusions aren’t necessarily convincing. It invokes an older and more capacious definition of science, conversant with rather than siloed away from religion, philosophy, and culture. In Lucid Dying, Parnia frames the study of recalled experiences of death as a way of learning “how to live.” Moody completed his psychiatry residency at the University of Virginia School of Medicine, where the Division of Perceptual Studies has been researching not only near-death experiences but after-death communication and children’s recollections of past lives since 1967. Such earnest attempts at solving existential problems through experimental means convey admirable confidence in the scientific enterprise.
There’s admirable generosity, too, in the treatment of paranormal phenomena as a legitimate subject of clinical inquiry. In Life After Life, Moody cites biomedicine’s prioritization of objective data over subjective reports as a reason why the ubiquity of near-death experiences in the hospital tends to hide in plain sight. “In the course of their training,” he writes, “it is constantly pounded into M.D.s-to-be that they must beware of what the patient says about the way he feels.” Given the field’s track record of undervaluing patients’ accounts (from the long, fraught history of so-called female hysteria to present-day contested illnesses like multiple chemical sensitivity or chronic Lyme disease), popular opinion often favors clinicians who remain open to potential explanations beyond fabrication or psychopathology.
Yet Parnia’s work turns out to be less interdisciplinary than it initially appears: science takes priority over religion and philosophy, successfully clarifying life’s meaning where other modes of inquiry have failed. He characterizes his findings on mortality as the resolution of a stalemate, arriving at what he calls “authentic spirituality, in an impartial manner.” For a researcher who repeatedly critiques his opponents in the debate about consciousness as narrow-minded, it’s an impressively reductive judgment, saying less about the limits of other forms of knowledge than about the limits of how a scientist understands them.
While careful to avoid the language of divinity in his analysis of near-death experiences, Parnia clearly alludes to a divinely ordained purpose behind them. Every action taken in our lives, large or small, is measured in death against “a universal moral and ethical code.” The code itself is vaguely defined, a utilitarian scaffold that resembles the Golden Rule. Parnia dubs it “a curriculum of humanity,” retrieved from death to guide us in our earthly lives. He offers multiple supporting anecdotes, including one from a poet named Rachel whose near-death experience entailed revisiting an encounter with a pet guinea pig when she was eight years old:
One day, while I was holding this guinea pig, I stood up, and he suddenly bit me…. I threw him onto the sofa right beside me and that was it. My finger was fine, and the guinea pig was fine, and I didn’t think any more of that incident. Now, during this review,…I experienced how the guinea pig had felt when he had bitten me. He had become afraid….
That is where I learnt an awful lot about what I now consider is important to being human and the purpose and relationships that we share, which was very educational for me.
Most of the moral instruction attributed to near-death experiences is in this vein. No one recalls being forced to reckon with their reliance on exploitative labor practices, factory farming, or fossil fuels. Dignifying the psychological trauma of a single guinea pig does not lead Parnia to wonder about the ethics of killing however many lab rats to document their dying brain waves. After coming back to life, survivors are described as becoming more compassionate and less judgmental, not politically active or vegan.
The notion of a species-wide lesson plan doesn’t resolve one’s curiosity about the soul so much as introduce further questions about the nature of our putative teacher. Parnia considers his bucking of the materialist paradigm revolutionary, but the dualist alternative leads him to echo a much older idea: that scientific inquiry can yield a clearer vision of God. “I am thinking Thy thoughts after Thee,” goes an apocryphal line attributed to Johannes Kepler, the seventeenth-century German astronomer who discovered the laws of planetary motion. “The God of the Bible is also the God of the genome,” wrote Francis Collins, the director of the National Institutes of Health from 2009 to 2021. “He can be worshiped in the cathedral or in the laboratory.” Parnia resists making any firm theological commitments, but the upshot of his research is similar credence in a cosmic plan.
Why should that plan be revealed selectively to the dying? According to Parnia, death is when the need arises for “access to the totality of our consciousness.” Now, as more people come back from the gray zone, the privilege of acting on that revelation seems to favor those with access to high-end hospitals. Perhaps intensive care ought to be considered a form of worship, too. Surveys suggest that almost three quarters of American physicians believe in God, as opposed to roughly one third of American scientists. No doubt some of those doctors have felt called by their faith to clinical work. Regular encounters with death might strengthen that faith, each an occasion to imagine our proximity to higher powers. Maybe it’s also the daily work of modern medicine that promotes not just religion but a specifically interventionist view of heaven, populated by supreme beings with an abiding interest in our getting better.
English (US) · 