In Death is But a Dream, Christopher Kerr, MD, PhD, the Chief Executive Officer and Chief Medical Officer of Hospice & Palliative Care Buffalo, shares his patients’ end-of-life dreams and visions. The content and intensity of these dreams vary, but often center on patients’ transient meetings with predeceased loved ones, offering a deeply spiritual sense of peace during periods of physical suffering. 

Using patient interviews, Kerr’s book does not fetishize dream events as ghostly commotions or in terms of pseudo-mysticism, or insist on using a religious framework for their interpretation, explaining rather that bearing witness to and legitimizing end-of-life dream experiences constitute a new ethical imperative in the practice of palliative care: “A true holistic approach to patient care must also honor and facilitate patients’ subjective experiences and allow them to transform the dying process from a story of mere physical decline to one of spiritual ascension” (Kerr 28). Case after case, his research documents that because end-of-life dreams provide patients with a singular emotional and psychological comfort that no palliative medication can simulate, hospice professionals need to validate patient dreams by listening carefully and compassionately. 

With this in mind, end-of-life dreams serve as a kind of counter-narrative to dominant cultural understandings and representations of human experiences in hospice, specifically stereotypes of terminally ill individuals as being incapable of meaningful communication, creativity, and understanding. Kerr’s patients’ narratives reveal that end-of-life dreams and visions are not trauma-inducing experiences or instances of religious prophecy, but “help reframe dying in a way that is not about last words and lost love but about strengthened selves and unbreakable bonds across lives” (142). 

Death is But a Dream 
upends medical research, or certain “limitations of science,” that oversimplifies end-of-life dreams by attributing them to neurological deterioration, oxygen deprivation, and the side effects of pain management medication (11). The general lack of rigorous, serious-minded research in end-of-life dream experiences is inseparable, in part, from institutionalized medicine’s “inability to see dying as anything but a failure” which has produced a healthcare system that “reflects a limited view of the totality of the dying experience” (7). The patient accounts that Kerr documents, however, reveal an undeniable dimension of human experience at life’s end whose complexities may be well beyond the reaches of full scientific understanding. End-of-life dreams seem to be part of an elaborate system of compensation (to borrow a term used by Siddhartha Mukherjee), as the mind works overtime to activate and animate certain memories to diminish the physical realities of dying. “There is an adaptation—substantive, spiritual yet cognitively meaningful,” writes Kerr, “a mechanism through which the patient can emerge from the dying process with a positive psychological change” (69). Indeed, the mystery of end-of-life dreams—their visions of loved ones; of seeking forgiveness, healing, and understanding within weeks, sometimes days, of one’s death; of comforting apparitions and visitations—points to a miraculous capacity within the human heart that eases the life-to-death transition.


Kerr’s treatment of a topic that can be (and has been) regarded dismissively due to its potential mysticism and religious dimension is provocative and clear-minded. Among the book’s foremost strengths is its commitment to inclusion in sharing the perspectives and narratives of a full range of racially diverse patients, including terminally ill war veterans, prisoners, persons with disabilities, and children. This heterogenous patient group reveals the true prevalence of end-of-life dreams among individuals of varying ages and different racial, religious, and socioeconomic backgrounds. Kerr’s research findings are grounded in the lived experiences of diverse patients: “Our studies revealed that as patients neared death, dream content shifted from a focus on the living to a focus on the dead. The most important pattern was twofold: As people approached death, their end-of-life experiences increased in frequency, while the content of those experiences featured more predeceased than living loved ones. […] It appears that dreams of the deceased hold prognostic significance based on changes in frequency and content as death draws near” (48). Kerr makes a forceful case for reorienting hospice practices to accommodate end-of-life experiences and to resist discrediting their broader spiritual and emotional significance for the patient in favor of sterile scientific explanations: “[…] we owe it to our patients to support and facilitate their [end-of-life experiences'] capacity for self-healing and self-nurture. Sometimes, that means standing out of the way…” (14). In sharing these compelling patient testimonies, Kerr emphasizes that end-of-life experiences amount to more than biological deterioration, that there is an arcane spiritual aspect to dying that, should it manifest, deserves reverence.



Place Published

New York

Secondary Source