A hospice nurse has drawn attention to an experience reported by some people approaching death: seeing deceased relatives, friends or even beloved pets. Although these encounters may seem unsettling to those unfamiliar with end-of-life care, patients often describe them as comforting.

Julie McFadden, widely known online as Hospice Nurse Julie, has spoken about these experiences in videos explaining what families may encounter when a loved one is dying. She calls the phenomenon 'visioning' and says she has observed it in more than half of her hospice patients.

According to McFadden, the experiences may begin several weeks before death and can involve seeing loved ones who have already died. However, although researchers have documented similar reports among hospice patients, the reasons behind them remain uncertain.

The phenomenon has prompted scientific interest in how people experience the final stages of life and how healthcare professionals can support patients without dismissing their experiences or assuming they have a supernatural explanation.

What Are End-of-Life Dreams and Visions?

Researchers use the term 'end-of-life dreams and visions' (ELDVs) to describe dreams or waking experiences in which people nearing death report encounters with deceased loved ones or other meaningful figures.

A systematic review published in the American Journal of Hospice and Palliative Medicine in 2024 examined research into these experiences among hospice patients. The paper cites estimates that approximately 50% to 60% of conscious hospice patients report visitation-like experiences while dreaming or awake.

Patients described experiences ranging from seeing deceased relatives to sensing their presence or dreaming about familiar people. Some accounts involved preparing for a journey or feeling reassured by someone who had died.

Researchers noted that these experiences were often meaningful to patients and could provide comfort. However, the findings do not establish that every dying person experiences visions or that these encounters have a single explanation.

Why Some Dying Patients See Deceased Loved Ones

Scientists do not yet fully understand why end-of-life visions occur. The experiences may be influenced by several factors, including dreaming, memory, emotional processing and changes associated with serious illness.

For patients approaching death, familiar people and memories may carry particular emotional significance. Seeing or dreaming about someone who provided comfort during life may help a person process feelings about separation, unfinished relationships or the prospect of dying.

However, researchers cannot conclude that these psychological processes explain every reported experience. Nor does the available evidence establish that visions are proof of an afterlife.

McFadden has said that many patients experiencing visioning remain awake and oriented, challenging the assumption that these experiences are necessarily caused by low oxygen levels in the brain.

Still, the circumstances surrounding these experiences can vary. Serious illness, medication effects, metabolic changes and delirium can also affect perception and awareness, making clinical context important when evaluating what a patient reports.

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When End-of-Life Visions May Need Medical Attention

Not every unusual perception near the end of life indicates a medical emergency. Some patients describe peaceful experiences that do not cause distress, and healthcare professionals may support them by listening without judgment and asking how they feel.

However, hallucinations can also occur alongside delirium, a condition involving an acute change in attention, awareness or thinking. Delirium may develop because of infection, medication effects, dehydration, organ dysfunction or other medical problems.

A sudden change in mental status, new confusion, agitation or a frightening experience should therefore be discussed with the patient's healthcare team. Clinicians can assess whether a treatable cause may be contributing to the symptoms and determine what support is appropriate.

The distinction matters because dismissing every vision as a normal part of dying could mean overlooking a problem that deserves attention. Equally, automatically labelling every end-of-life experience as delirium may disregard something meaningful to the patient.

A sensitive approach recognises the patient's account while considering their comfort, medical condition and wishes.

How Families Can Support a Loved One Experiencing Visioning

For relatives and caregivers, hearing a loved one describe seeing someone who has died can raise questions about what the experience means. Healthcare professionals can help families understand that such reports have been documented in hospice research, even though their causes remain uncertain.

Listening calmly and asking whether the experience feels comforting or frightening can help caregivers understand what the person needs. If a patient finds the encounter reassuring, family members do not need to challenge or dismiss it. They can acknowledge the person's feelings without claiming to know exactly what caused the vision.

If the experience is distressing, a healthcare professional can assess the patient's symptoms and discuss appropriate support. Families should also report sudden changes in awareness or behaviour rather than assuming these are inevitable signs of approaching death.

Ultimately, end-of-life visions remain an area of ongoing research. Evidence suggests they can be significant experiences for some dying patients, but they cannot reliably predict the timing of death or establish what happens after it. Listening with compassion while remaining attentive to medical changes can help patients and families navigate the final stages of life with greater understanding.

Frequently Asked Questions

  • What are end-of-life dreams and visions?
    End-of-life dreams and visions (ELDVs) are experiences reported by people nearing death, involving encounters with deceased loved ones or other meaningful figures.
  • Why do some dying patients see deceased loved ones?
    The reasons are not fully understood, but these experiences may be influenced by dreaming, memory, emotional processing, and changes associated with serious illness.
  • When should end-of-life visions receive medical attention?
    Medical attention is needed if there is a sudden change in mental status, new confusion, agitation, or a frightening experience, as these may indicate delirium or other medical issues.
  • How can families support a loved one experiencing visioning?
    Families can support by listening calmly, acknowledging feelings, consulting healthcare professionals if needed, and reporting sudden changes in awareness or behaviour.
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