Alexandre da Silva Faco,; Jonatas Lima; Léo Peruzzo

doi:10.19080/PMCIJ.2019.03.555601

Mini Review

“Terminal Lucidity”: How to Discuss a Topic So Barely Studied?

Alexandre da Silva Faco, Jonatas Lima* and Léo Peruzzo

Dra. Ana Carolina Ossowsky Rebolho, Brazil

Submission: September 09, 2019; Published: September 13, 2019

*Corresponding author: Jonatas Lima, Dra. Ana Carolina Ossowsky Rebolho, Brazil

How to cite this article: Alexandre da Silva Faco, Jonatas Lima, Léo Peruzzo. Terminal Lucidity: How to Discuss a Topic So Barely Studied?. Palliat Med 002 Care Int J. 2019; 3(1): 555601. 10.19080/PMCIJ.2019.03.555601

Abstract

This scientific article discusses a topic that has not been the target of many studies: the so-called “terminal lucidity”. Although it was only in 2009 that this term has been used scientifically to refer to cases in which patients near to death attained a spontaneous remission of their symptoms, it is possible to see references dating back more than 250 years. Over time, the theme has been debated within two visions: the first under the philosophical/spiritual prism and the second under the medical/scientific view. The second has been gaining more and more area, once it has been noticed that the cases of terminal lucidity are manifested in patients with psychiatric and/or neurological diseases. Certainly there still are big gaps to be filled and only with the increase of research on the subject by the scientific community is that explanations and definitive answers shall be stablished about such phenomenon

Keywords: Terminal lucidity; Mental clarity; Symptom remission; Degeneration; Disturbance; Death

Introduction

Daily, in the clinical practice, we come across cases where terminally ill patients suddenly improve their clinical condition and then pass away. Despite its relative frequency, the concept of “death lucidity”, “health’s visit”, “pre-death improvement”, “pre-death remission”, among other tems, is rarely addressed in the bibliography. Beyond the importance of this phenomenon understanding is a big step towards the human’s mind comprehension, its impact on the family of the individual experiencing this event is to be considered, which can sometimes be misunderstood due to both lack of knowledge and negligence of medical staff.

Objective

The purpose of this paper is to discuss the limit of the scientific knowledge about “Death Lucidity”.

Methods

Bibliography review based on PubMed and Google Scholar databases searching for articles that somehow tried to explain and/or exemplify the “Death Lucidity” phenomenon. The topic was also researched in a textbook dealing with the discussion of death and its nuances.

Discussion

Palliative care and its knowledge are becoming increasingly present in brazilian hospitals. Because it is a recent specialty and still with little professional qualification, the care focused on the terminal patient makes the heath professional face situations in which scientific knowledge alone cannot explain. The recognition of the death process is considered one of the most difficult tasks in the medical field. Although this concept is not accurate in the literature, it is defined as a moment in the patient’s evolution from which the irreversibility of the disease makes any treatment aimed at prolonging life, prolonging suffering. Typically, during the final phase (last 48 hours), anorexia and no fluid intake, immobility, cognitive impairment, myoclonus, pain, peripheral collapse, functional failure and final snoring are often observed

Despite the least attention in the recent decades, the unexpected mental clarity and memory recovery shortly before death is a curious phenomenon at least and it has been reported in the medical literature over the last 250 years. The scientific term used by the very first time in 2009 and already widespread by Dr. Michael Nahm, one of the leading researches in the field, is known as terminal lucidity. In one of the views on death lucidity and its process, we have the following description: When each one of the cells realizes that their time here is ending, they strive to show, for one last time, their best state of functioning. Then, you leaver cells will be exemplary hepatocytes, those in your lungs incredibly adept at gas exchange, your brains cells awaken, and those unsed neurons all wake up and curiously look at the scene and say ‘Let me see what is going on.’ Suddenly, your whole body works well [1].

There are numerous reports of its presentation. The fact that a patient suddenly recover his consciousness, say goodbye to his family, remember their names and events after a long period of inability to learn, with progressive short- and long-term memory loss, is a complete mystery. However, it is undeniable that in some cases the spontaneous remission of symptoms occur.

After the first half of the nineteenth century, however, the scenario showed a significant drop in the academic interest in the area. The cases came to be published by authors more interested in the philosophy of mind and brain, and not necessarily by doctors. It was not until 1975 that another detailed article on death lucidity was published in a medical journal, thus becoming the only publication on the subject in the twentieth century

According to Brayne [2], in his study of end-of-life-experiences with caregivers in a hospice, it was observed that seventy per cent of the individuals confirmed the frequent occurrence of this phenomenon in patients with dementia. Thais is, near death, these individuals became more lucid. The most well-known cases involve patients whose brains degenerated from diseases such as Alzheimer’s but recovered with an intact memory shortly before their died. However, reports of terminal lucidity are not restricted to this “disease class” alone. Its appearance has already been reported in patients with schizophrenia, mood disorders, meningitis, central nervous system tumors and stroke.

In the early nineteenth century, Burdach [3] noted that there are two ways in which terminal lucidity manifests itself. At first, the severity of the mental disorder may slowly decrease, as opposed to the decline of the body’s vitality. And in the second, total mental clarity may come abruptly and unexpectedly moments before death. The phenomenon may have a wide range of levels and varieties, but it is always characterized by the unexpected return of long-lost mental faculties. Still, there are only preliminary data on its prevalence and no data on the assessment of the psychological and physiological conditions that may favor it [4-6].

Despite the potential to initiate the development of new forms of therapy and contribute to an advanced knowledge of the cognition, memory process and nature of the human mind, terminal lucidity has been and still largely ignored by professionals and family members involved. In addition, it comes as a complete surprise to those who watch death, so it is possible to miss the last opportunity to relate better to a loved one who was previously unresponsive for a long time and sometimes, for years [7].

It is currently thought that it is not possible to affirm the definite mechanism of death lucidity. It can result of different processes depending on the etiology of the underlying diseases. For example, cachexia in chronic patients can cause considerable shrinkage of brain tissue, relieving the pressure exerted by intracranial lesions and thus allowing the fleeting return of some brain functions. However, it is unclear whether this would explain the complete remission of cognitive deficits reported during terminal lucidity. Some patients who have their life support removed may experience an unexplained transient onset of electroencephalographic activity as blood pressure drops moments before death. There is also no clarity about how severely mentally affected patients can sometimes recognize their family members and recall their lives shortly before death, suggesting that the memories in these cases became only inaccessible and were not erased at all. These findings suggest that the neuroscience of terminally ill patients is far more complex than commonly thought [8].

Conclusion

Although there is a “common sense” about its real existence, the rare articles that address the issue usually involve cases of psychiatric and neurological patients whose underlying pathologies would theoretically prevent an abrupt improvement from occurring. In confronting the stranger, even if we have no perception, we have our actions molded from this interaction. The “I” particular to each one, and the “other”, the beyond me, is what we call alterity. Based on this assumption, one way of looking at this phenomenon would be to credit the health team itself with the biased analysis of certain end-of-life event.

But on the other hand, although scarce, the literature brings reports that occurred all over the globe, which allow us, in a way, to realize that regardless of the culture in which the heath professional was created, the phenomenon is described. Because it is a subject beyond technical knowledge, difficult to prove effectively, controversial and even subjective, it is of paramount importance that the subject be addressed more often.