TERMINAL LUCIDITY

By Masooma Hyder Baig

The human brain consists of many unknowns that the scientific community are still trying to uncover. One of which is terminal lucidity: a stage of mental clarity and awareness occurring in a larger number of palliative care patients with neurodegenerative and psychiatric diseases minutes, hours or days before dying (Lim et al., 2018). This article aims to discuss the background and prevalence of terminal lucidity and the roles of healthcare professionals in sensitively approaching this condition. 

WHAT IS TERMINAL LUCIDITY? 

Terminal lucidity is characterised by an often weak and severely ill patient who displays decreasing cognitive and functional ability (Lim et al., 2018) having a period where they experience increased alertness, increased energy and better memory function before dying (Nahm et al., 2012). Although heavily underresearched, anecdotal cases of terminal lucidity have been reported since the 19th century in patients (Ijaopo et al., 2023).  The journey to understand this phenomenon is still ongoing with many different proposed reasonings and mechanisms being suggested.

THEORIES AND EXPLANATIONS 

There is no consensus as to why terminal lucidity occurs however some have suggested its mechanisms revolve around an increase in certain neurotransmitters or the brain’s natural response to failing physiological systems (Kinard, 2023). The exact neurotransmitters remain unclear however dopamine and adrenaline are both known to be heavily involved in aiding movement (Gepshtein et al., 2014) and increasing energy levels (Cafasso, 2018) along with serotonin being responsible for mood regulation (Guy-Evans, 2022). This could potentially highlight how a combination of all three chemicals may be involved in altering signalling pathways when terminal lucidity takes place. However, it is imperative to consider that the specifics remain uncertain largely due to ethical considerations involved in the research of terminal lucidity where patients may not have the capacity to consent. 

 An additional reason includes the possibility of a person’s soul sensing an impending feeling of death where proposed understandings imply that the body and soul are two different entities. It can then be inferred that the soul as it slowly departs may sometimes still strive to form some sort of connection before completely departing – where we see that mental clarity is spiritual rather than neurobiological (Christopher, 2022). This comes with its drawbacks as the concept of the soul and consciousness within the sciences is still not fully understood (SUCHSCIENCE, 2023).   

ROLE OF HEALTHCARE PROFESSIONALS

The unexpected return of awareness and change in mood undoubtedly may bring peace and a sense of closure for the loved ones of patients. It may also bring a sense of false hope, however, if families and friends are unaware of terminal lucidity. Thus, healthcare professionals must manage the concerns and expectations (Main et al., 2010) regarding this sudden urge of energy the patient experiences so that loved ones are prepared for end-of-life circumstances. Managing these expectations and concerns also involves various considerations that include what symptomatic treatment or relief can be given to ensure the betterment of quality of life is upheld and suitable for each patient. This would include multidisciplinary meetings with loved ones involved in shared-decision making (Kuosmanen et al., 2021) to thoroughly discuss options and changes to care plans.

CONCLUSION 

To conclude, terminal lucidity remains a complex and enigmatic occurrence, sought to be understood by scientific and philosophical communities alike. The potential theories and explanations regarding this phenomenon include justifications from both of these communities whether it be the involvement of neurotransmitters or understanding the spiritual realm: opening multiple avenues for further research as per ethical guidelines. For patients and their kin, its prevalence may allow for closure and a final connection before the patient passes away. Healthcare professionals, however, have a duty to approach these circumstances with compassion, in a manner to both manage expectations and prevent false hope. We can thus comprehend how terminal lucidity is not simply just a scientific unknown to be researched. Rather it is also a very human endeavour where all communities approach analysis and evaluation intending to improve palliative care: a means to honour the mysteries of life even at the times of death.

REFERENCES 

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Christopher, T.C. (2022). Dualism 101: Terminal Lucidity and an Explanation. Open Journal of Philosophy, 12(04), pp.687–700. doi:https://doi.org/10.4236/ojpp.2022.124047.

Gepshtein, S., Li, X., Snider, J., Plank, M., Lee, D. and Poizner, H. (2014). Dopamine Function and the Efficiency of Human Movement. Journal of cognitive neuroscience, [online] 26(3), pp.645–657. doi:https://doi.org/10.1162/jocn_a_00503.

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Ijaopo, E.O., Zaw, K.M., Ijaopo, R.O. and Khawand-Azoulai, M. (2023). A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness. Gerontology & Geriatric Medicine, [online] 9, p.23337214231183243. doi:https://doi.org/10.1177/23337214231183243.

Kinard, J. (2023). Why Dying People Often Experience a Burst of Lucidity. [online] Scientific American. Available at: https://www.scientificamerican.com/article/why-dying-people-often-experience-a-burst-of-lucidity/ [Accessed 14 Mar. 2024].

Kuosmanen, L., Hupli, M., Ahtiluoto, S. and Haavisto, E. (2021). Patient participation in shared decision‐making in palliative care – an integrative review. Journal of Clinical Nursing, [online] 30(23-24), pp.3415–3428. doi:https://doi.org/10.1111/jocn.15866.

Lim, C.-Y., Park, J.Y., Kim, D.Y., Yoo, K.D., Kim, H.J., Kim, Y. and Shin, S.J. (2018). Terminal lucidity in the teaching hospital setting. Death Studies, [online] pp.1–7. doi:https://doi.org/10.1080/07481187.2018.1541943.

Main, C.J., Buchbinder, R., Porcheret, M. and Foster, N. (2010). Addressing patient beliefs and expectations in the consultation. Best Practice & Research Clinical Rheumatology, [online] 24(2), pp.219–225. doi:https://doi.org/10.1016/j.berh.2009.12.013.

Nahm, M., Greyson, B., Kelly, E.W. and Haraldsson, E. (2012). Terminal lucidity: A review and a case collection. Archives of Gerontology and Geriatrics, [online] 55(1), pp.138–142. doi:https://doi.org/10.1016/j.archger.2011.06.031.

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