Chapter 33
Pastoral Wisdom from the NDE Literature
The room was warm and the curtains were drawn, because the late-afternoon sun on the snow outside had been hurting his eyes. He had stopped opening his eyes anyway. His breathing had taken on the rhythm the nurse had told us to expect — long pauses, then a gentle pull of air, then more silence. His daughter was holding his right hand. I was sitting on the other side of the bed with my Bible closed on my lap. We had stopped talking about an hour before.
He was a retired electrician, eighty-four years old, a widower, a believer. He had been a deacon at the same small Baptist church for forty-one years. The hospice nurse said he would probably die before morning. His daughter had asked me to come. I had been his pastor for eleven years.
I had been at many bedsides by then, but I will tell you honestly that I still did not know quite what to do. Seminary had not taught me. The pastoral-care textbook on my shelf had three pages on dying and twenty-three pages on grief counseling for the bereaved — as if the dying themselves were already gone before they were gone. I had learned at bedsides what I had not been taught in classrooms. I had learned mostly by getting it wrong.1
So I sat. I did not preach. I did not try to fix anything. When his daughter cried, I let her cry. When she wanted to talk, I listened. When she wanted to read his favorite Psalm aloud — the Twenty-Third — I let her read it. I read it again with her when she asked me to.
Around seven in the evening, his eyes opened a little. They did not focus on us. They focused somewhere past us, somewhere over the corner of the room near the window. His mouth moved. His daughter leaned in close. “Dad,” she said. “Dad, what do you see?”
He whispered something I could not hear. She heard it. She told me later: he had said his wife’s name. His wife had been dead for nine years. He smiled. His eyes closed again.
He died about ninety minutes later. He never spoke again. His daughter told me, in the days that followed, that she did not believe she had imagined what he said. She believed her mother had come for him. She believed Christ had been waiting for him in the corner of that little room with the drawn curtains. She wanted to know whether I believed it too.
I told her yes. I told her I had read about thousands of such moments in the research literature, and I had sat with enough dying people in enough rooms to know that what she had witnessed was not an isolated thing. I told her I believed her father had been received by the people he loved and by the Lord he served. I told her she had done the right thing — she had been there, she had spoken her father’s name, she had held his hand, and at the moment her father’s eyes opened on what was waiting for him, she had been a witness to it.
That is what this chapter is about.
It is about what we do at a bedside in February. It is about what the dying need from us, what they are likely experiencing while we sit with them, and how the best contemporary research on near-death experiences sharpens and confirms a pastoral wisdom the church has carried for two thousand years and largely forgotten in the last hundred. It is about a ministry the church can recover — not a clinical specialty, not a credentialed profession, but a plain, embodied, prayerful presence at the threshold. It is a ministry the dying have always needed and that any Christian, with a little training and a great deal of love, can offer.2
For most of Christian history, the church knew how to die and knew how to sit with the dying.3 The dying happened at home. The bed was a familiar bed in a familiar room. The family was there. The neighbors came in shifts. The priest or pastor was sent for, and the priest or pastor came, and the priest or pastor knew — from training, from a tradition, from his own watching at other beds — what to do. There were prayers to say. There were psalms to read. There were words of commendation when the moment came. The dying person was washed and dressed by hands that had known them. The body was laid out in the parlor. The wake was a vigil, not a reception.
The medieval Ars Moriendi tradition I described in the previous chapter on dying well was the formal, written version of this practice. But the practice was older than the manuals and broader than the specifically Christian community that produced them.4 Every village had its women who knew how to sit with the dying. Every parish had its accustomed prayers. Every Christian household, sooner or later, became a deathbed.
Then, over the course of the twentieth century, dying moved.
It moved out of the bedroom and into the hospital. It moved out of the hands of family and into the hands of professionals. It moved from a known event in a known place into a clinical event in a clinical place — surrounded by monitors, attended by strangers, conducted in a language most family members did not speak. By 1980, more than seventy percent of Americans died in hospitals or nursing homes. Today the share who die outside their own homes remains very high, even though the hospice movement has begun to bring some dying back home.5
The pastoral consequences have been heavy. Pastors trained in seminary often have no idea what to do at a deathbed. Lay Christians have rarely seen a person die. Family members panic at signs the older generation would have recognized as ordinary. Hospital chaplains, when they are present at all, are stretched across hundreds of beds. The dying often die without the prayers their tradition had once written for them, surrounded by strangers in a room they do not know.6
Allen Verhey, the late Reformed ethicist, named this loss bluntly: the church has forgotten how to die, and that is in part because the church has forgotten how to sit with the dying. Lydia Dugdale, a physician and bioethicist at Columbia, has made the same case from inside contemporary medicine. The hospice movement, beginning with Cicely Saunders at St. Christopher’s in London in 1967, has tried to recover what was lost. The Christian palliative-care literature is small but growing. None of this changes the basic fact: most pastors, most lay Christians, and most family members today do not know what to do when someone is dying in front of them.7
The good news is that the recovery is possible, and that some of the recovery comes from an unexpected place. The contemporary research on near-death experiences — the dataset I have spent years analyzing — speaks directly to what the dying may be experiencing as we sit beside them. It tells us that the dying may be hearing us when their bodies are not responding. It tells us that the dying may be seeing those gathered around the bed. It tells us that the dying are sometimes already meeting people they love and trust before their breathing has stopped. It tells us, in short, that the bedside is not the empty waiting room our medicalized culture has imagined it to be.8
The historic Christian tradition believed all of this on theological grounds. The dying soul is conscious; the dying soul is met by Christ; the dying soul perceives what is around it. The contemporary research, examined carefully, supports the tradition. What follows in this chapter is what I have learned from twenty years of bedsides, from the dissertation research, from the major NDE studies, and from the wise pastoral writers (Nouwen, Hauerwas, Verhey, Dugdale, Kerr, Anderson) who have been trying to put back together what we lost.9
The eight practices that follow are not a checklist. They are a way of being in the room.
The first practice is the simplest and the hardest. Be there. Not in order to do anything. Not in order to fix anything. Not in order to manage anything. Be there because you are there, and the dying person is there, and your being there is itself the gift.
This is harder than it sounds, because every part of our pastoral and professional formation pulls us toward action. We want to do something. We want to bring comfort. We want to bring the right Bible verse. We want to know what to say. We want to know whether the dying person has “made peace.” We want to ask the family how they are coping. We want, often without realizing it, to manage our own discomfort with what is happening in front of us.
Henri Nouwen, in his last short book on dying and caring, said it as well as it has been said: the greatest gift we can give the dying is the gift of our undefended presence. Not our problem-solving. Not our advice. Our presence. The dying are not problems to be solved. They are persons in the most personal moment of their lives, and what they need is not a manager but a companion.10
What does undefended presence look like? It looks like sitting down rather than standing. It looks like setting your phone on silent and putting it face-down on the windowsill. It looks like noticing the rhythm of the dying person’s breathing rather than glancing at the monitor. It looks like letting silence hold the room rather than filling it. It looks like being willing to stay longer than is comfortable.
The dying perceive presence. We will see this more clearly when we get to the NDE evidence on hearing during clinical death. But even apart from that evidence, the dying who can communicate consistently report that they know who is in the room, they know who is not in the room, and they know whether the people who are there are at peace or anxious. Hospice nurses have observed this for decades. The dying notice. Our being there is registered, even when their bodies do not register that we are there.11
Pastoral
If you take only one thing from this chapter, take this: when in doubt, sit down. The single most common mistake I have made at bedsides is standing — and standing communicates, without words, that you are about to leave. Sitting communicates that you are in no hurry. Sitting changes the room. The dying person feels it. The family feels it. You feel it. Sit down.
The second practice grows out of the first. If you are present, you are also listening — to what the dying person says, to what the family says, and to what the room is telling you.
The dying often speak. Sometimes they speak to people we cannot see. Sometimes they speak in fragments that seem at first not to make sense but that, on reflection, turn out to be perfectly meaningful. Sometimes they speak about things from sixty years ago. Sometimes they speak about the room, about what is happening in the room, about who is in the room. Sometimes they speak about peace. Sometimes they speak about fear. Sometimes they speak the names of people who have already died.
The pastoral discipline is to receive what they say without trying to correct, manage, or interpret it. If the dying woman says that her late husband is in the corner, do not say, “Oh, Mom, that’s just the morphine.” She is telling you something. She may be telling you something you have no instrument to verify, but she is not lying and she is rarely confused in the way her family is afraid she is. The contemporary palliative-care literature on what are now called “end-of-life experiences” or “deathbed visions” has begun to take such reports seriously again, after a long century of dismissing them. Christopher Kerr’s prospective hospice study at Hospice Buffalo, published in The Journal of Palliative Medicine, found that the great majority of the dying patients his team interviewed reported such experiences and reported them as more vivid and meaningful than ordinary dreams. The reports tended to bring comfort, not distress.12
I do not need to settle, at the bedside, the metaphysical question of what exactly the dying woman is seeing. I need to receive what she has told me. I can ask her gently, “What did he say to you?” I can sit with her in the silence after she answers. I can pray with her, when she is ready, and I can leave her in peace when she is not.
Listening to the family is the other half of the practice. The family at a bedside is often dealing with feelings they do not know how to name — old wounds reopening, regret about things never said, fear of what is coming, exhaustion, sometimes relief, sometimes guilt about the relief. The pastor or companion who can simply be a non-anxious presence for the family, willing to sit with whatever they bring, gives them a place to put what they cannot otherwise hold.
This is where the NDE research begins to change pastoral practice in ways the older pastoral writers could not have anticipated.
One of the most consistent findings of the entire NDE research literature is the out-of-body phase — the experience reported by a substantial fraction of NDErs in which they perceive themselves as separated from the body, often viewing the body and the room from a position above or near it, with intact and sometimes enhanced sensory awareness. In the major prospective cardiac-arrest studies, the OBE phase is frequently the first stage of the experience. It can occur during the period when EEG monitoring shows no organized cortical activity. It is consistent across cultures, across decades, and across types of medical crisis.13
What does this mean for the bedside? Two things. The first is that the dying person, even when their body has stopped responding to ordinary stimulus, may be perceiving the room. The second is that what they perceive is not limited to what their body’s eyes and ears can pick up.
The implications are direct and practical. Speak as if the dying person can hear you, because they may be able to. Do not stand at the foot of the bed and discuss the patient’s prognosis as if the patient were not there. Do not, in another room, say things you would not say at the bedside. The pastoral wisdom that has always told us to speak with love at the deathbed turns out to have been, on the empirical evidence, exactly the right wisdom. The dying may indeed be listening.
Case Study
A cardiologist named Michael Sabom, in his 1982 book Recollections of Death, was the first physician to systematically interview cardiac-arrest survivors about their experiences during clinical death. He compared the NDErs’ descriptions of their resuscitations with descriptions given by a control group of cardiac patients who had not had NDEs but were asked to imagine their own resuscitations. The control group made characteristic medical errors in their imagined accounts — about eighty percent of them got something wrong. The NDErs, who claimed to have observed their own resuscitations from outside the body, were essentially error-free. Several of them reported specific details they could not have known from their position on the table, including the actions of staff in the room, conversations between team members, and equipment used. Sabom, who had been a skeptic when he started, concluded that something more than imagination was going on.14
Sabom’s findings have been confirmed in larger prospective studies, including the Dutch Lancet study by van Lommel and the multi-center AWARE studies by Sam Parnia. The cumulative pattern is consistent: a meaningful fraction of cardiac-arrest survivors report awareness of what was said and done in the room during their clinical death, and a smaller but persistent fraction report verifiable details that are difficult to explain on a strict physicalist account.15
For pastoral practice, the takeaway is plain. The dying person whose body has gone unresponsive may still be present in the room. They may be hearing the conversation. They may be seeing the gathered family. They may even be perceiving the love or anxiety of those who are there. We should treat them, in every word we speak in their presence, as a person who is there.
Hospice nurses will tell you, almost universally, that some dying patients seem to be holding on. They are past the point where any natural process should still be going on. The body is exhausted. The signs of imminent death have been there for hours or sometimes days. And yet they breathe. They wait.
Often what they are waiting for is one more visitor. A daughter on a flight from Seattle. A brother who has been estranged for twenty years and is finally on his way. A grandchild who is being driven across the state. The dying seem, in a way our medicine cannot explain, to know who is coming and to wait for them.16
Sometimes, though, what they are waiting for is permission. They are waiting for the family to release them. They are waiting to hear, in some form, that it is all right for them to go.
This is one of the hardest pastoral moments. The family does not want to release the dying person. The family wants the dying person to stay. The pastor can sometimes help by giving the family the words. “You can tell him it’s okay. You can tell him you love him. You can tell him you’ll be all right. You can tell him Christ is waiting for him.”
I have sat with families as they have spoken those words. I have watched a daughter lean down close to her father’s ear and say, “Dad, we love you. We’re going to be okay. You can go now. Mom is waiting. Jesus is waiting. We love you.” I have watched the dying person take three more breaths after that, and stop. I am not saying this is always how it goes. I am saying this is sometimes how it goes, and the pattern is known to every experienced hospice nurse and every experienced pastor I have ever asked about it.17
The pastoral wisdom is not to push the family to give permission before they are ready. The wisdom is to let the family know that giving permission is one of the gifts they can offer the dying person, and that when the time comes — when they are ready — the words are available, and they can speak them.
The dying see things. The literature on this is now large enough that no honest pastoral writer can dismiss it.
Sir William Barrett, a Royal Society fellow and physicist, published the first systematic Western study of deathbed visions in 1926. Karlis Osis and Erlendur Haraldsson followed with a major cross-cultural comparison — American and Indian deathbeds — in 1977. Peter and Elizabeth Fenwick, working in British palliative-care settings, have produced two careful contemporary collections. Christopher Kerr, the medical director of Hospice Buffalo, has published the most rigorous prospective study to date in The Journal of Palliative Medicine, with hundreds of interviews of dying patients about their end-of-life experiences. The findings across all of these studies are remarkably consistent.18
The dying frequently report visions of deceased loved ones — spouses, parents, siblings, sometimes pets — coming to greet them. They report visions of light, of figures present in the room, of a warm and welcoming presence. They sometimes describe travel: they have been to a beautiful place and have come back. They sometimes describe being told it is not yet time. The reports are not, in the great majority of cases, frightening. They are comforting. They are described by the dying as more vivid than dreams, more real than memories, more meaningful than ordinary perception.
The skeptical response — that these are hallucinations produced by a dying brain — has been the standard medical response for most of the past century. I take that response seriously, and the dissertation research engages it carefully in an earlier chapter on the OBE phase and in the chapters on the physicalist alternatives. The short version: many of these visions, taken individually, could be produced by a dying brain. But many of them carry features that the dying brain hypothesis does not predict and cannot explain — verifiable visions of relatives whom the dying person did not know to be deceased, accurate reports of events outside the room, sustained coherent narratives during periods of documented brain shutdown.19
Pastorally, the question of mechanism can wait. What cannot wait is the dying person and the family. The pastoral wisdom is to receive these reports seriously, neither inflating them into doctrine nor dismissing them as nothing. When the dying woman says her late husband is in the corner, the right answer is not, “That’s impossible.” The right answer is something like, “Tell me about him. What did he say to you?” She has been given something. We can receive it with her.
The dying often respond to touch when they no longer respond to words. Holding a hand is ministry. Stroking a forehead is ministry. A daughter resting her head against her father’s shoulder is ministry.
Touch reaches the body when language has stopped reaching the body. The dying brain may not be processing speech. The dying body still feels the warmth of another body. Hospice nurses know that a hand on a shoulder, a kiss on a forehead, calms a restless dying patient when nothing else will. The skin remembers love when the words have become too hard to follow.20
Pastoral touch should be gentle, appropriate, and offered — not imposed. Ask the family. Ask the patient when they can answer. Take cues from how the patient is being touched by those who know them best. A pastor who places a hand on a dying parishioner’s hand, who keeps it there during a prayer, who lets the gesture be itself the prayer, has communicated something words cannot communicate. The Christian tradition has always known this. The laying on of hands at ordination, at healing, at confirmation, at commendation of the dying — all of it speaks the same theological grammar. The body matters. The hand matters. The presence is mediated through the flesh.21
Pray with the dying, and pray for the dying, and pray when there is nothing else to do.
The historic prayers of the church for the dying are wiser than anything I am going to come up with in the moment. The Lord’s Prayer is one of the few things some dying patients can still say along with you. The Twenty-Third Psalm is another. “The Lord is my shepherd; I shall not want.” I have heard dying men and women, who have not spoken intelligibly in three days, mouth those words along with the prayer at their bedside. The neural pathways that hold the deepest words of a person’s life are sometimes the last to fail.22
Beloved hymns work the same way. “Amazing Grace.” “Great Is Thy Faithfulness.” “It Is Well with My Soul.” A daughter quietly singing a hymn her mother used to sing to her can reach a dying mother whose body has gone past speech. The Apostles’ Creed, recited slowly, is a kind of prayer; it gathers the dying person’s confession into the church’s confession across centuries. The prayers of commendation that the older liturgies preserved — “Go forth, Christian soul, from this world” — are rich with the church’s memory of how to send the dying on their way.23
The pastor or companion who has memorized a few of these prayers, hymns, and psalms is never empty-handed at a bedside. When the room becomes hard, when the family is exhausted, when the words run out, you can begin: “The Lord is my shepherd…” The room finds itself again. The dying person, if they can hear at all, hears something they have heard a thousand times. The family hears the cadence that holds them.
The last practice is the one that is hardest for most of us. Be willing to say nothing.
The dying do not need to be entertained. They do not need to be distracted. They do not need our running commentary. They sometimes need quiet — quiet for what is approaching, quiet for what is happening inside them, quiet for whatever encounter is beginning.
The standard hospital room is loud. Monitors beep. Carts rattle in the hall. A television hangs from a corner bracket and someone has left it on. Family members talk through their nervousness. The pastor, feeling the awkwardness, fills it with words. None of this serves the dying.
A good pastoral practice at the bedside, when it is possible, is to lower the volume of the room. Turn off the television. Pull the curtain across the door if the hallway is loud. Keep voices soft. Let the room find a stillness. Then sit in it.
I have learned, slowly, that I do not have to say anything for my presence to count. I can sit. I can hold a hand. I can let the family cry. I can listen to the breathing change. I can pray silently. The dying person knows I am there. The family knows I am there. That is enough.
Pastoral
The eight practices — presence, listening, attending to the OBE phase, permission to die, attending to deathbed visions, touch, prayer, silence — are not techniques. They are not steps you check off. They are the shape of love at a bedside. Any one of them, offered well, is ministry. All eight, woven together over the hours and days of an unfolding death, can be the most important thing you ever do for another human being. You will get it wrong sometimes. The dying are gracious; they generally do not notice your failures the way you do. Keep going.
I have been weaving NDE research findings into the practices throughout. I want now to gather the most important findings together, because the implications for pastoral practice deserve a moment of focused attention.
Five findings from the contemporary research, taken together, change how we should be in the room with the dying.
The first is that the dying may be hearing us during periods when their bodies appear unconscious. Cardiac-arrest survivors who have had NDEs frequently report having heard specific things said in the room while their hearts were stopped and their EEGs were flat. They describe the conversations of the staff, the words spoken by a family member who came in during the resuscitation, sometimes even words spoken in a corridor or a waiting room.24 Whether one accepts the dualist reading or holds out for some yet-unidentified neural mechanism, the empirical pattern is clear enough that it should change practice. Speak as if the dying person hears you. Avoid speaking about them as if they were absent. Let your voice carry love and faith into a room that may be more occupied by their awareness than the bedside monitors suggest.
The second is that the dying may be seeing those gathered around the bed. The OBE phase, when it occurs, often gives the experiencer a perspective from above the bed or near the ceiling. NDErs report seeing who came into the room, who left, who was holding their hand, who looked anxious, who looked at peace. The implication is not just that we should speak well in the room; we should also be well in the room. Posture matters. The energy we carry matters. A family member at peace, even a family member quietly crying, gives the dying person something different than a family member furious or panicked.
The third is that some dying patients enter and leave NDE-like states multiple times before final death. Hospice clinicians have long observed brief periods of unexpected lucidity in the final days of dying. The phenomenon called terminal lucidity has been documented in a small but careful research literature, particularly the work of Michael Nahm and Bruce Greyson; patients with advanced dementia, severe psychiatric illness, or near-total loss of cognition sometimes return, in the final hours or days, to startling clarity — recognizing family members, speaking in full sentences, sometimes asking forgiveness or expressing love. The biological mechanism remains contested. The pastoral implication does not. These brief returns are often precious openings for words of love, blessings, and goodbyes. Do not waste them. If you have something to say to your father, and your father is suddenly clear, say it.25
Note on Terminal Lucidity
Terminal lucidity is the unexpected return of clarity in patients near death whose cognitive function has been severely impaired by dementia, psychiatric illness, or other conditions. It has been reported in the medical literature for centuries and has been documented in contemporary studies, but no satisfactory neurological explanation has been offered. Some researchers in the dualist tradition take it as further evidence that the soul is more than the brain’s function and is sometimes able to express itself through a failing body in the final approach to death. Whatever the mechanism, the phenomenon is well attested and pastorally significant. Stay attentive to a patient with dementia in the final days. Clarity may return.
The fourth is that the deceased frequently appear to welcome the dying. The pattern of so-called “Peak in Darien” cases — cases in which the dying person reports being met by a relative whom no one in the room knew to be deceased, with the death subsequently confirmed — is well attested across the research literature. These cases cannot be explained as projection or wish-fulfillment. They are difficult for the dying-brain hypothesis. Pastorally, they confirm what the older Christian tradition always said: those who have gone before in Christ are still real, still present, and may indeed greet the soul at its passage.26
The pastoral application is gentle. We can speak, in the right moments, of those who have already gone. “Your mother is with the Lord. She loved you. She is waiting for you.” This is not sentimentality. It is, on the evidence, very probably true. We do not invent the welcome; Christ has been preparing it. The communion of saints is not just a phrase in the creed.
The fifth finding is that the transition is, for most of those who have prepared for it, not terrifying. Both the NDE literature and the deathbed-vision literature concur. The dying who have lived in faith and prepared for death tend to die with a peace that surprises observers who do not share the faith. The dying who have not prepared, or who carry unresolved fear, sometimes die harder. But the encounter, when it comes — when the person crosses from the body into whatever lies beyond — is consistently described, by those who returned to tell us, as marked by light, peace, and love. The fear was on this side. The light was on the other.27
I am not in a position to claim that NDE evidence settles every theological question about what happens at death. The evidence describes the early phase of the transition, not the long-term postmortem state. Every NDEr came back. We do not have direct empirical witness to the full intermediate state, much less to the final judgment. What we do have is a remarkably consistent picture of the threshold. And the threshold is not what the dying-brain hypothesis predicts. It is, instead, what the historic Christian tradition has always taught the threshold to be: an encounter with light, an encounter with love, an encounter with persons.28
Pastoral wisdom has to bend toward particular cases. The general practices apply at every bedside, but the bedside of a dying child is not the bedside of a dying ninety-year-old, and the bedside of a believer is not the bedside of a person who has spent their life refusing the gospel. Six common situations deserve specific attention.
The relatively straightforward case. A Christian who has lived in the faith and knows they are dying. The pastoral task here is to stand in the historic tradition of the church and offer what the church has always offered: confession, prayer, communion where appropriate, the reading of beloved Scriptures, the words of commendation when the moment comes, the loving presence of family and church, and the assurance that Christ will be the one who meets them on the other side.
This is not, in the experience of those who do it, a heavy ministry. It is a beautiful one. The dying believer who has prepared for death often dies with a peace that surprises everyone in the room. They are not afraid. They sometimes seem to be looking past us toward something we cannot see. The historic prayers and psalms hold them and us. The family is supported in their grief by the larger reality the dying person is entering. The Christian tradition was built for this moment, and when the moment comes and the tradition is allowed to do what it was built to do, it does it well.29
This is the harder case — in some ways the hardest case. It is the case I have wrestled with most, both pastorally and theologically. I will write more fully about it in the next chapter. Here I want to say only what is needed for present pastoral practice.
I hold to conditional immortality with postmortem opportunity. I believe, on biblical and theological grounds developed at length elsewhere in my writing, that Christ continues to pursue the unsaved after death — not in a way that erases human responsibility, but in a way that ensures every soul will face Christ Himself, in unmediated personal love, before any final judgment is made. I believe the encounter at death, of which NDEs give us the leading edge, is part of that pursuit. I do not believe the dying unbeliever is necessarily lost the moment their heart stops. I believe Christ meets them. I believe they have an encounter with the same Person every NDEr describes. What that encounter does in them, what they choose, what comes of it — these are matters in which I do not claim certainty.30
I want to be careful here. The NDE evidence does not by itself settle the question between conditional immortality, evangelical universalism, or eternal conscious torment. The evidence supports a conscious encounter at the threshold; it does not tell us what happens after. The pastoral hope I am describing rests primarily on biblical and theological grounds, with the empirical evidence as confirmation of the threshold encounter, not as proof of any particular eschatology.
Pastoral
What this means at the deathbed of an unbeliever: do not write them off. Pray for their meeting with Christ. Speak of God’s love for them, not of their last chance to escape damnation. Trust Christ to be Christ. The historic tradition has always known that the deepest evangelism is finally not your work but His. You are a witness, not a savior. Be a faithful witness; pray for the meeting; trust the Lord. And if the family asks you, after the death, whether their loved one is “in heaven” — do not lie either way. Tell them honestly: I do not know what came of the encounter, but I know there was one. Christ met them. We pray and we hope. We are not the judge.
I have buried three children in twenty years of ministry. Each was the worst day of that year. There is no pastoral wisdom that makes the dying of a child anything other than what it is.
What I will say is what I have said to those families. The historic Christian tradition has held, with broad consensus across most of its history, that the death of a child is met by the mercy of God in a special way. Various theological accounts have been offered — the age of accountability, the Reformed reading of covenantal mercy, the patristic intuition that the unbaptized infant is received in the love of Christ. I am not going to settle the disputes here. What I will say is that the dying child — whether the four-year-old who drowned, the fifteen-year-old with leukemia, or the ninety-minute-old who never opened her eyes — is met by Jesus. The Jesus who said let the little children come to Him, who held them on His knees and blessed them, who rebuked His own disciples for trying to keep children away — that Jesus does not change.31
The pediatric NDE literature, which I treat in earlier chapters on the OBE phase and the encounter with the being of light, is striking and precious here. Children who have come close to death and returned describe encounters with Jesus, with deceased grandparents, with light and warmth and love, in language that — given how young some of them are, three or four years old — cannot plausibly be cultural conditioning. The evidence comforts grieving parents in a way nothing else does. We are not making it up. The encounter at death is real. The child you love is met.32
The pastoral task at the bedside of a dying child is the task of bearing witness to a love stronger than the death you are watching, and of holding the parents through the worst hours of their lives. There are no words that fix this. There is only the presence of one who is not afraid to enter the room.
Sometimes there is no deathbed at all. The phone call comes. The car accident, the heart attack on the racquetball court, the suicide, the overdose, the workplace fatality. The family did not get to be there. There was no goodbye.
Pastoral ministry in these cases is ministry to the bereaved, not to the dying. The dying have already gone. What the family carries is the absence of the goodbye, the absence of the last words, sometimes the absence of any spiritual conversation in the days before. They carry the agony of not knowing what their loved one experienced in the final moments. And sometimes they carry the weight of last interactions that were not what they would have wanted them to be.
Two pastoral things to say here. The first is that the encounter at death does not depend on the bedside. The dying person who collapsed alone in the parking lot was met as surely as the dying person whose family held their hand in hospice for ten days. Christ does not require our being there in order to be there Himself. The NDE literature on cardiac arrest, where the experiencer was often alone or surrounded only by strangers, makes this evident: the encounter happens regardless of who else is in the room.33
The second is that grief in sudden death is not less than grief in slow death; it is shaped differently. The bereaved family needs space to live with the absence of the goodbye. The pastoral task is sustained presence over weeks and months — presence at the funeral, presence at the table after, presence months later when others have moved on, presence at the first anniversary of the death. The companioning of the dying becomes the companioning of those left behind. The ministry continues.
The patient in coma, in deep sedation, on a ventilator, after a major stroke. The patient whose body is alive but whose responsiveness has been gone for hours, days, sometimes weeks.
The temptation here, both for medical staff and for family, is to treat the patient as already gone. They are, in many cases, not gone. The cumulative NDE evidence on the OBE phase suggests that consciousness during clinical “unconsciousness” is real, at least in many cases, at least intermittently, at least during certain phases. Sam Parnia’s recent work has been moving toward what he calls a “lucid dying” framework — the recognition that a substantial fraction of dying patients are conscious during clinical death in ways that the standard physicalist account cannot easily accommodate.34
For pastoral practice, the rule is the same as for any dying patient: act as if they hear you. Speak love. Read Scripture they have loved. Play music they have loved, if it is welcome in the room. Pray. Hold a hand. Tell them what you would tell them if you knew they were listening. They may be.
I want to add a particular note for families who are facing the decision about life-sustaining treatment for an unconscious or minimally responsive loved one. The decision belongs to the family in conversation with their physicians and, where appropriate, their pastor. The NDE evidence does not tell families what to choose. What it does tell them is that whatever they choose, they have not chosen against the soul of the person they love. The soul is held by Christ, not by the ventilator. The withdrawal of medical interventions that are extending the dying process rather than restoring life is not, on the historic Christian view, abandonment of the patient. It is the recognition that medicine has reached the limit of what medicine can do, and the dying person is being given back to the God who made them. The pastoral companion can help the family see this clearly without pressuring the decision in either direction.
The dementia patient is in a specific category of pastoral difficulty, because the family has often already done much of their grieving long before the patient’s body dies. The mother who no longer recognizes her children, the father who cannot find his way out of his own room, the spouse who has forgotten the marriage of fifty years — the family is already mourning the person they used to know. The body lingers in the absence of the person.
Two things matter pastorally here. The first is that the soul is more present than the dementia suggests. The body’s instrument has been damaged severely; the cognitive expression of the soul has been impaired; but the soul itself, on the historic Christian view, is not the brain’s function. The soul is using a damaged instrument. What the soul is undergoing — what the dementia patient is experiencing inside the silent face — we do not fully know. We should not assume the worst.
The second is that terminal lucidity is real. In the final days, sometimes the final hours, dementia patients sometimes return, suddenly and unmistakably, to clarity. They recognize their children. They speak in full sentences. They ask for forgiveness; they offer love; they pray. Do not be far from the bedside in the final week of a dementia patient’s life. The opening may come. When it comes, it usually does not last long. Be there for it.35
Four pastoral questions come up at almost every deathbed I have attended. Brief answers, with the caveat that every situation has its own contour and what follows is general counsel rather than rigid rule.
“Should I tell the dying person they are dying?” Generally yes, with honesty and love. The dying often know already — the body has been telling them for weeks — and being treated as if they do not know isolates them from the people who should be closest to them in the most important moment of their lives. Truthfulness is itself love. There is no virtue in pretending the situation is other than it is. The exception is when a dying person actively refuses the topic and signals they do not want to discuss it. Some people genuinely prefer to leave the conversation unspoken; respect that. But do not protect them from a truth they have already grasped.36
“Should I read the Bible to the dying?” If the dying person has loved Scripture, yes — very much yes. The beloved psalms (23, 27, 46, 90, 91, 121, 130), the Sermon on the Mount, John 14, Romans 8, 1 Corinthians 15, Revelation 21–22. Read them slowly. Let the cadences hold the room. Read the version the dying person has loved most; the King James Version is still the version many older believers have memorized in their bones. If the dying person has not been a Scripture reader, do not impose readings; you may still read quietly, for yourself and the family, but do not turn the deathbed into the religious encounter the patient never sought in life. Christ meets them on His terms; we do not need to manufacture His arrival.
“Should I share my own grief with the dying?” Carefully. The dying do not need to be burdened with our anticipatory grief, our regret, our unfinished business with them. But they should not be forced into the cruelty of pretending they are not dying for our sake. Some honest expression of love and sorrow is part of what they need to hear from us. “Dad, I am going to miss you. I love you.” That is grief in the room, and it is also love, and the dying receive it as love. The pathology is the unbridled lament that asks the dying person to comfort us. Save the breaking-down for after.
“What do I say at the moment of death?” Often very little. Some words are good ones: “It is okay to go. We love you. Christ is waiting.” Or simply, “Into your hands, Lord, we commend our father.” Or simply silent presence. The Christian tradition has preserved beautiful words of commendation that you can learn and have ready: “Go forth, Christian soul, from this world, in the name of God…” The exact words matter less than the love and faith carried by the voice that says them. The dying often go in the silence right after such a prayer, as if they had been waiting for the church to release them.37
The recovery of deathbed companioning will not happen at the level of a few unusually attentive pastors. It needs to happen at the level of institutions and congregations.
The hospice movement is a gift. Cicely Saunders, the British physician who founded St. Christopher’s Hospice in London in 1967, brought modern medicine, theological seriousness, and pastoral wisdom together in a single institutional form that has transformed end-of-life care wherever it has spread. The hospice philosophy — that dying persons deserve aggressive comfort care, holistic attention, and a setting that honors the dying as persons rather than as failing bodies — is, at its best, deeply Christian, even when its institutional form is now broadly secular. Christians should know about local hospice options, should support hospice workers, should encourage families to seek hospice services early rather than late, and should — where God leads — consider hospice ministry as a vocation.38
One specific pastoral counsel is worth pausing over. Many families wait too long to call hospice. They wait because they hear “hospice” as a kind of giving up; they wait because the doctor has not pushed it; they wait because they are afraid that admitting their loved one is dying will somehow hasten the death. The empirical pattern is the opposite. Patients who enter hospice care earlier in their dying trajectory typically have better symptom control, fewer hospitalizations in the final months, and report greater dignity in the dying process; their families report better bereavement outcomes. The pastor who can gently encourage a family to seek hospice when the medical signs are clear, who can frame hospice not as defeat but as faithful attention to the dying, gives that family a real gift. Hospice is the closest thing modern medicine has produced to the old home deathbed.
The chaplaincy ministry is another part of the institutional picture. Hospital and hospice chaplains, when they are well trained and faithful, do work that no parish pastor can do alone. They are present at deaths the local pastor never hears about. They sit with families the local church may not know exist. They are often the only Christian voice in a clinical environment that has been thoroughly secularized. Christian chaplaincy is a serious vocation, and the church should be sending its best people into it, supporting their training, and praying for their ministries. The Christian chaplain in a secular hospital faces particular pressures — pressures to be vaguely “spiritual” rather than specifically Christian, pressures to perform brief comfort rather than offer substantive ministry, pressures of caseload that strain the kind of presence I have been describing as central. They need our prayer, our financial support, and our recognition that what they do is real ministry of the church even when it does not look like the parish ministry we are more familiar with.
The local church is the part of the picture most easily overlooked. The local congregation has been, historically, the primary unit of dying-well ministry. Neighbors took shifts. Older women who had attended many deaths trained younger ones. The pastor came when called and stayed as long as needed. The casseroles arrived after the death without anyone organizing them. The community held the bereaved.
Most of this has weakened. Many congregations no longer know how to do it. The recovery is possible but it takes intention. A local church that is serious about deathbed ministry trains a small core of mature lay companions who are willing to sit with the dying when the family needs relief. It writes a brief booklet of beloved psalms, hymns, prayers, and commendations, and gives it to families when illness becomes serious. It teaches its members to stay present after a death, not to disappear once the funeral is over. It treats the bedside as a primary site of pastoral ministry, not a footnote.39
I have seen this work in small congregations and large ones. A church I served in the Midwest had what they called the Comfort Team — eight or ten older members, mostly retired, several of them widowed, who took shifts at the bedsides of dying parishioners when the family needed a break. They had a binder with the prayers and psalms. They had a phone tree. They knew not to talk too much, knew when to leave, knew how to make the kind of coffee that families could actually drink at three in the morning. They were not licensed, not credentialed, not paid. They were the church doing what the church does. The dying parishioners they sat with died as well as anyone I have ever attended.
Pastoral training is the linchpin. Most seminaries devote almost no curriculum time to deathbed ministry. They should devote a great deal. A pastor in his or her first decade of ministry will sit with twenty to fifty dying people. The pastor who has been taught how to do it, taught what the dying may be experiencing, taught what to say and what not to say, taught the historic prayers and the psalms, taught the wisdom from the NDE literature on hearing during clinical death and on deathbed visions — that pastor will give to grieving families gifts they will remember for the rest of their lives. The pastor who has been taught nothing will fumble, will improvise, will sometimes do well and sometimes do harm, and will eventually figure it out by trial and error at the cost of the families who came first.40
I want to close with a theological question I have come back to many times over the years. What are we doing, exactly, when we sit at the bedside of a dying person?
We are not the agents of their salvation. Christ is the savior; we are not. We do not, by our presence, accomplish their redemption. We do not, by our prayers, force God’s hand. We do not, by our reading of Scripture, bring the dying person to Christ; the dying person is being met by Christ in a way our reading of Scripture cannot duplicate.
What we are doing, I have come to believe, is participating in Christ’s own ministry to the dying. Christ is the one who descends. Christ is the one who meets the dying soul at the threshold. Christ is the one who carries them across. We are, at the bedside, doing on the visible side of that encounter what He is doing on the other side. We are being His witnesses, His hands, His voice in the room. We do for our brothers and sisters what Christ Himself is also doing for them, only in the way that humans can do it — with a held hand, a quiet word, a beloved psalm, a soft song, a long silence, a tear we are not ashamed of.41
The historic tradition called this commendation — the act of giving the dying person back to the God who made them, with the church’s prayers attending. Commendation is the precise theological word. We commend the dying soul to Christ. We do not save it; we hand it over. We hand it over with love, with prayer, with the words of Scripture, with the rhythms of the psalms, with the company of the church across centuries gathered into our small voice in the small room. Christ takes the soul we have commended. The encounter at the threshold, which the NDE evidence has begun to describe with new precision, is the other side of our commendation. We hand the soul over; Christ receives.42
This frame, I think, is what makes the ministry sustainable. If I were the agent of the dying person’s salvation, every bedside would be unbearable, because every bedside would be the moment my work either succeeded or failed. But I am not the agent. I am a witness. The work is Christ’s. My presence is a sign of what is happening in a place I cannot see. My prayers join a much larger prayer. My hand holding their hand mirrors a hand far stronger than mine that is also holding them.
That changes the room. It changes me when I walk into the room. It changes what I am willing to sit with. I do not have to manage what is happening; what is happening is being managed by the one who descended into death, who carries the keys of death and Hades, who has gone before every dying person who has ever lived.43
I think back to the bedside in February with which this chapter began. The retired electrician, eighty-four years old, breathing his Cheyne-Stokes breathing, his daughter holding his hand. His wife’s name on his lips at the moment his eyes opened on something we could not see. His peaceful death an hour and a half later.
What were we doing in that room? We were sitting with the dying. We were reading the Twenty-Third Psalm. We were holding a hand. We were keeping silence when silence was right. We were, in our small ordinary way, attending the threshold — the threshold across which our brother in Christ was being carried by hands stronger than ours.
I believed it then. I have come, in the years since, to believe it more. The ministry of companioning the dying is not optional. It is not for specialists. It is not even, in the deepest sense, difficult. It requires only what the saints have always brought to it: presence, love, prayer, and faith that the One who meets the dying at the threshold is doing the work we cannot do.
When my own time comes, I hope someone will sit with me. I hope they will read me the Twenty-Third Psalm. I hope they will hold my hand. I hope they will tell me, when the moment comes, that it is okay to go. I hope they will say my wife’s name when she comes for me, as I believe she will. I hope they will commend me, with old words the church has carried for centuries, into the hands of the Lord who has been waiting.
That is the ministry. It is older than we are, and larger than we are, and more beautiful than the medicalized death our age has settled for. It can be recovered. The dying are waiting. Christ is already in the room. We have only to walk in and sit down.44
— — —
The pastoral wisdom developed in this chapter applies most cleanly to the deathbed of a believer, the bedside of one whose faith has shaped their dying as it shaped their living. The harder pastoral case — the case of the dying unbeliever, the one whose life has not been visibly oriented toward Christ — deserves its own chapter. The next chapter takes it up directly, integrating the conditional-immortality and postmortem-opportunity framework with bedside ministry, addressing the heavy pastoral guilt that strict-restrictivist evangelical frameworks have produced, and asking what genuine hope can be offered when the dying person has not, in any way visible to us, made peace with God in life.
↑ 1. The pastoral undertraining of contemporary Protestant clergy in deathbed ministry is widely documented; see Allen Verhey, The Christian Art of Dying: Learning from Jesus (Grand Rapids: Eerdmans, 2011), 1–30, on the post-Enlightenment medicalization that pushed pastors out of the dying room; Lydia S. Dugdale, The Lost Art of Dying: Reviving Forgotten Wisdom (San Francisco: HarperOne, 2020), introduction and ch. 1, on the same phenomenon from a physician’s side. The opening vignette in this chapter is a composite drawn from several actual deathbeds I have attended, with names and identifying details altered.
↑ 2. The argument that deathbed ministry is recoverable as a normal Christian practice (rather than a clinical specialty) is central to Verhey, Christian Art of Dying, ch. 7; cf. Stanley Hauerwas, Naming the Silences: God, Medicine, and the Problem of Suffering (Grand Rapids: Eerdmans, 1990), and the broader Hauerwas corpus on the church’s ministry at the bedside.
↑ 3. For the historic tradition, see ch. 3 of this volume on Christianity’s long teaching about dying, and chapter 32 (Dying Well) for the theology of the dying believer. The fullest scholarly treatment remains Philippe Ariès, The Hour of Our Death, trans. Helen Weaver (New York: Knopf, 1981), especially Part 1 (“The Tame Death”) on the pre-modern Western pattern.
↑ 4. On the late-medieval Ars Moriendi tradition, see the long Tractatus artis bene moriendi and the shorter illustrated version, available in Eric Daniel Jubin’s recent translations; for analysis, Verhey, Christian Art of Dying, ch. 3, and Dugdale, Lost Art of Dying, ch. 2. The earlier monastic and patristic sources for Christian dying are surveyed in Frederick S. Paxton, Christianizing Death: The Creation of a Ritual Process in Early Medieval Europe (Ithaca: Cornell University Press, 1990).
↑ 5. The shift of dying out of the home is documented in Atul Gawande, Being Mortal: Medicine and What Matters in the End (New York: Metropolitan, 2014), chs. 1–3; and Sherwin B. Nuland, How We Die: Reflections on Life’s Final Chapter (New York: Knopf, 1994). Recent CDC data show that approximately one-third of U.S. deaths now occur at home, with hospital deaths declining and hospice-supported home deaths rising; see CDC National Center for Health Statistics reports on place of death. The trend toward home death is real but uneven.
↑ 6. For the cultural-pastoral consequences, see Verhey, Christian Art of Dying, 19–46; Dugdale, Lost Art of Dying, ch. 1; Joel Shuman and Brian Volck, Reclaiming the Body: Christians and the Faithful Use of Modern Medicine (Grand Rapids: Brazos, 2006), ch. 6.
↑ 7. Cicely Saunders’s founding of St. Christopher’s Hospice in London in 1967 is the standard origin point of the modern hospice movement; see her collected essays, David Clark, ed., Cicely Saunders: Selected Writings 1958–2004 (Oxford: Oxford University Press, 2006). For Christian engagement with the contemporary recovery, see Verhey, Christian Art of Dying; Dugdale, Lost Art of Dying; Hauerwas, Naming the Silences; Kathryn Greene-McCreight, I Am with You: A Study Guide to the Christian Practice of Visiting the Sick.
↑ 8. The dissertation underlying this book analyzed 5,278 NDE cases (832 from peer-reviewed scholarly sources, 4,446 from the NDERF and IANDS online databases). See Matthew Friend, Near-Death Experiences as Evidence for Substance Dualism within the Conditional Immortality Debate (Th.D. diss., Trinity College of the Bible and Trinity Theological Seminary, 2025), chs. 4–5, for the data analysis discussed throughout this volume.
↑ 9. The principal contemporary writers on Christian deathbed ministry I have leaned on include Henri J. M. Nouwen, Our Greatest Gift: A Meditation on Dying and Caring (San Francisco: HarperSanFrancisco, 1994); Stanley Hauerwas, Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church (Notre Dame: University of Notre Dame Press, 1986); Verhey, Christian Art of Dying; Dugdale, Lost Art of Dying; Megory Anderson, Sacred Dying: Creating Rituals for Embracing the End of Life (New York: Marlowe, 2003); and Christopher Kerr with Carine Mardorossian, Death Is But a Dream: Finding Hope and Meaning at Life’s End (New York: Avery, 2020).
↑ 10. Nouwen, Our Greatest Gift, esp. ch. 2 (“You Are a Child of God”) and ch. 3 (“You Are a Brother or Sister of All People”). Nouwen’s broader reflection on undefended presence pervades his pastoral writings; see also The Wounded Healer: Ministry in Contemporary Society (Garden City, NY: Doubleday, 1972).
↑ 11. The hospice-clinical observation that the dying perceive presence even when not visibly responsive is widely reported in the palliative-care literature; see Kerr, Death Is But a Dream, esp. chs. 4–5; and Maggie Callanan and Patricia Kelley, Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying (New York: Bantam, 1992), a foundational hospice-nurse account.
↑ 12. Christopher W. Kerr et al., “End-of-Life Dreams and Visions: A Longitudinal Study of Hospice Patients’ Experiences,” Journal of Palliative Medicine 17, no. 3 (2014): 296–303; Anne L. Grant et al., “The Significance, Frequency, and Phenomenology of End-of-Life Dreams and Visions,” Journal of Palliative Medicine (subsequent reports). The core finding: end-of-life experiences are common among the dying, are reported as more vivid and meaningful than ordinary dreams, and are typically comforting rather than distressing.
↑ 13. The OBE phase is treated at length in chapter 18 of this volume. The major studies establishing the phenomenology and prevalence include Michael B. Sabom, Recollections of Death: A Medical Investigation (New York: Harper & Row, 1982); Pim van Lommel et al., “Near-Death Experience in Survivors of Cardiac Arrest: A Prospective Study in the Netherlands,” The Lancet 358 (2001): 2039–45; Sam Parnia et al., “AWARE—AWAreness during REsuscitation—A Prospective Study,” Resuscitation 85 (2014): 1799–1805; and Sam Parnia et al., “AWAREness during Resuscitation II: A Multi-Center Study of Consciousness and Awareness in Cardiac Arrest,” Resuscitation 191 (2023).
↑ 14. Sabom, Recollections of Death, esp. chs. 4–6, on the comparison between NDEr accounts and the imagined-resuscitation control group; further developed in Michael B. Sabom, Light and Death: One Doctor’s Fascinating Account of Near-Death Experiences (Grand Rapids: Zondervan, 1998), with the Pam Reynolds case.
↑ 15. Van Lommel, “Near-Death Experience in Survivors of Cardiac Arrest”; Parnia, AWARE I and AWARE II. The cumulative evidence is treated at length in chapters 10–14 of this volume.
↑ 16. The phenomenon of dying patients waiting for an arriving family member is documented in Callanan and Kelley, Final Gifts, ch. 8 (“Choosing a Time”); Kerr, Death Is But a Dream, ch. 5; and the broader hospice-clinical literature. The phenomenon is observational rather than experimentally controlled but is reported with high consistency by experienced hospice clinicians.
↑ 17. Callanan and Kelley, Final Gifts, ch. 8, is the standard hospice-nursing account of the “permission to die” pattern. Cf. Anderson, Sacred Dying, on the rituals of release.
↑ 18. William Barrett, Death-Bed Visions: The Psychical Experiences of the Dying (London: Methuen, 1926); Karlis Osis and Erlendur Haraldsson, At the Hour of Death (New York: Avon, 1977); Peter Fenwick and Elizabeth Fenwick, The Art of Dying: A Journey to Elsewhere (London: Continuum, 2008); Kerr, Death Is But a Dream; and the Kerr et al. Journal of Palliative Medicine series cited above. The cross-cultural and cross-temporal consistency of deathbed visions is the most striking feature of this literature, and is hard to reconcile with the standard physicalist reading.
↑ 19. The features of NDEs and deathbed visions that the dying-brain hypothesis has trouble explaining — veridical encounters with deceased relatives unknown to be deceased, accurate distant observation, sustained coherence during documented brain shutdown — are the focus of chapters 10–14 of this volume. See especially the “Peak in Darien” cases discussed in chapter 13.
↑ 20. The clinical observation that touch reaches dying patients when language no longer does is reported throughout the hospice nursing literature; see Callanan and Kelley, Final Gifts; Anderson, Sacred Dying, ch. 6, on physical presence; and the broader palliative-care textbooks (Doyle et al., Oxford Textbook of Palliative Medicine).
↑ 21. The theological grammar of laying-on-of-hands is rooted in the Old Testament priestly tradition (Lev. 1:4; Num. 27:18–23), continued in apostolic practice (Acts 6:6; 13:3; 1 Tim. 4:14; 2 Tim. 1:6), and extended into the historic ordinances of the church for healing, blessing, and commendation of the dying. See James B. Torrance, Worship, Community and the Triune God of Grace (Downers Grove, IL: InterVarsity, 1996), on embodied participation in Christ’s priestly ministry.
↑ 22. The neurological basis for the persistence of well-rehearsed verbal material in advanced dementia and dying is partly understood; deeply consolidated language is held in distributed networks more resistant to neurodegeneration than later-acquired or weakly consolidated language. The pastoral implication does not depend on the mechanism: well-loved Scripture and prayer are often the last verbal forms a dying believer can join. See, for clinical context, Linda Clare, Neuropsychological Rehabilitation and People with Dementia (Hove: Psychology Press, 2008).
↑ 23. The classical commendation prayer (Proficiscere, anima Christiana: “Go forth, Christian soul, from this world…”) is preserved in the Roman Catholic Order of Christian Funerals and in adapted forms in the Book of Common Prayer (1979 BCP, “Ministration at the Time of Death,” 462–67). For Protestant adaptations, see The Worship Sourcebook, 2nd ed. (Grand Rapids: Faith Alive, 2013), section on services at the time of death.
↑ 24. The auditory-perception findings during cardiac arrest are documented in Sabom, Recollections of Death; van Lommel, “Near-Death Experience in Survivors of Cardiac Arrest”; Parnia, AWARE I and AWARE II. See further chapter 12 of this volume on cardiac-arrest NDEs and the EEG problem.
↑ 25. On terminal lucidity, see Michael Nahm and Bruce Greyson, “Terminal Lucidity in Patients with Chronic Schizophrenia and Dementia: A Survey of the Literature,” Journal of Nervous and Mental Disease 197, no. 12 (2009): 942–44; Michael Nahm et al., “Terminal Lucidity: A Review and a Case Collection,” Archives of Gerontology and Geriatrics 55, no. 1 (2012): 138–42; and Alexander Batthyány, “Paradoxical Lucidity: A Potential Paradigm Shift for the Neurobiology and Treatment of Severe Dementias,” Alzheimer’s & Dementia 15, no. 8 (2019): 1107–14.
↑ 26. The “Peak in Darien” class of NDE cases — encounters with deceased relatives whom the experiencer did not know to be deceased — is treated at length in chapter 13 of this volume. The classic discussion is Bruce Greyson, “Seeing Dead People Not Known to Have Died: ‘Peak in Darien’ Experiences,” Anthropology and Humanism 35, no. 2 (2010): 159–71.
↑ 27. The peaceful character of the NDE encounter is one of the most consistently reported features in the literature; see Raymond A. Moody Jr., Life After Life, rev. ed. (San Francisco: HarperOne, 2001 [1975]); Kenneth Ring, Life at Death: A Scientific Investigation of the Near-Death Experience (New York: Coward, McCann & Geoghegan, 1980); Jeffrey Long with Paul Perry, Evidence of the Afterlife: The Science of Near-Death Experiences (New York: HarperOne, 2010); and the dissertation analysis in Friend, Near-Death Experiences as Evidence for Substance Dualism, ch. 4.
↑ 28. The evidential limit — that NDEs describe the threshold rather than the long-term postmortem state — is discussed in chapter 24 of this volume on the conscious intermediate state. Every NDEr returned; the evidence covers minutes to perhaps an hour of postmortem experience, not the full intermediate state and certainly not final judgment.
↑ 29. The pastoral wisdom for the dying believer is the focus of chapter 32 of this volume (Dying Well); the present chapter is companioning, not preparation. For the historic prayers and rites, see the Book of Common Prayer 1979, “Ministration at the Time of Death” (462–67); the Roman Catholic Pastoral Care of the Sick; the various Protestant orders for ministry at the time of death.
↑ 30. My CI + PO position is developed at greater length in my earlier volumes Beyond the Grave and Death Is Not the Deadline; for the underlying biblical and theological argument see Stephen Jonathan, Grace Beyond the Grave: Is Salvation Possible in the Afterlife? A Biblical, Theological, and Pastoral Evaluation (Eugene, OR: Wipf and Stock, 2014); James Beilby, Postmortem Opportunity: A Biblical and Theological Assessment of Salvation After Death (Downers Grove, IL: IVP Academic, 2021); Gabriel Fackre, “Divine Perseverance,” in What About Those Who Have Never Heard? Three Views on the Destiny of the Unevangelized, ed. John Sanders (Downers Grove, IL: InterVarsity, 1995); for the universalist edge of the spectrum I remain open to, see Gregory MacDonald [Robin A. Parry], The Evangelical Universalist, 2nd ed. (Eugene, OR: Cascade, 2012); Thomas Talbott, The Inescapable Love of God, 2nd ed. (Eugene, OR: Cascade, 2014); Andrew Hronich, Once Loved, Always Loved: The Logic of Apokatastasis (Eugene, OR: Wipf and Stock, 2023). Chapter 34 of this volume engages the specific bedside application.
↑ 31. The biblical material on Jesus and children is concentrated in Matt. 18:1–6, 19:13–15; Mark 9:36–37, 10:13–16; Luke 18:15–17. The historic Christian theological accounts of the death of children are surveyed in Ronald H. Nash, When a Baby Dies: Answers to Comfort Grieving Parents (Grand Rapids: Zondervan, 1999), ch. 4; cf. John Sanders, No Other Name: An Investigation into the Destiny of the Unevangelized (Grand Rapids: Eerdmans, 1992), ch. 7.
↑ 32. Children’s NDEs are treated in chapter 31 of this volume. The major case-collection studies include Melvin Morse with Paul Perry, Closer to the Light: Learning from the Near-Death Experiences of Children (New York: Villard, 1990); P. M. H. Atwater, The New Children and Near-Death Experiences (Rochester, VT: Bear, 2003); and the relevant peer-reviewed papers in the Journal of Near-Death Studies.
↑ 33. The cardiac-arrest NDE literature includes many cases in which the experiencer was alone or surrounded by strangers at the moment of arrest; see van Lommel, “Near-Death Experience in Survivors of Cardiac Arrest”; Parnia, AWARE I and II. The encounter at the threshold occurs regardless of the social context of the bedside.
↑ 34. Sam Parnia, Lucid Dying: The New Science Revolutionizing How We Understand Life and Death (New York: Hachette Go, 2024); Parnia’s framework develops the idea that a substantial fraction of dying patients are conscious during clinical death in ways the standard physicalist account cannot accommodate. See further the AWARE-II findings on EEG patterns during CPR.
↑ 35. Nahm and Greyson, “Terminal Lucidity in Patients with Chronic Schizophrenia and Dementia”; Nahm et al., “Terminal Lucidity: A Review and a Case Collection”; Batthyány, “Paradoxical Lucidity.”
↑ 36. The pastoral-medical question of truth-telling at the end of life is treated thoughtfully in Gawande, Being Mortal, chs. 5–7; Verhey, Christian Art of Dying, ch. 7; and Hauerwas, Naming the Silences. The contemporary palliative-care literature has largely abandoned the older convention of withholding terminal diagnoses from patients; for the empirical and ethical case, see Elizabeth K. Vig and Robert A. Pearlman, “Quality of Life While Dying,” Journal of Pain and Symptom Management 25 (2003): 218–22.
↑ 37. The classical commendation prayer is the Proficiscere, anima Christiana; see fn. 23 above. For pastoral practice at the moment of death see Anderson, Sacred Dying, ch. 9; Verhey, Christian Art of Dying, ch. 7; and the Episcopal “Litany at the Time of Death” (BCP 1979, 462–67).
↑ 38. Cicely Saunders’s collected writings (Clark, ed., Cicely Saunders: Selected Writings) document the explicitly Christian motivation of the early hospice movement. For Christian engagement with the institutional form, see Daniel Sulmasy, The Healer’s Calling: A Spirituality for Physicians and Other Health Care Professionals (Mahwah, NJ: Paulist, 1997), and the various essays in Joel Shuman and Keith Meador, Heal Thyself: Spirituality, Medicine, and the Distortion of Christianity (New York: Oxford University Press, 2003).
↑ 39. For practical congregational resources, see Anderson, Sacred Dying; the various denominational handbooks (e.g., the PC(USA) Book of Common Worship on services at the time of death); and the Stephen Ministry training materials, which have produced thousands of trained lay companions over the past four decades.
↑ 40. The deficiency of seminary training in deathbed ministry is widely acknowledged; for analysis see Hauerwas, Naming the Silences; Verhey, Christian Art of Dying, ch. 7; and Daniel Schipani and Leah Dawn Bueckert, eds., Interfaith Spiritual Care: Understandings and Practices (Kitchener, ON: Pandora, 2009).
↑ 41. The theological frame of human ministry as participation in Christ’s ministry is rooted in the Pauline language of being “in Christ” (e.g., 2 Cor. 5:17–20) and developed christologically in T. F. Torrance, The Mediation of Christ, rev. ed. (Colorado Springs: Helmers & Howard, 1992); cf. James B. Torrance, Worship, Community and the Triune God of Grace, on the priestly continuation of Christ’s ministry through the church.
↑ 42. The technical theological term commendation describes the church’s act of giving the dying person back to God in trust; see the patristic and medieval sources in Paxton, Christianizing Death; the BCP “Ministration at the Time of Death”; and the Roman Catholic Order of Christian Funerals. For the link between commendation and the encounter at the threshold, see chapter 21 of this volume on the encounter with the being of light.
↑ 43. “I am the living one. I died, and behold I am alive forevermore, and I have the keys of Death and Hades” (Rev. 1:18 ESV). The patristic doctrine of Christ’s descent and its bearing on the dying soul is developed in chapter 25 of this volume; the standard study is Hans Urs von Balthasar, Mysterium Paschale, trans. Aidan Nichols (Edinburgh: T & T Clark, 1990); for an evangelical engagement, Matthew Y. Emerson, “He Descended to the Dead”: An Evangelical Theology of Holy Saturday (Downers Grove, IL: IVP Academic, 2019).
↑ 44. The closing image — that Christ is already in the room and we have only to walk in and sit down — is a deliberate echo of the Emmaus pattern (Luke 24:13–35), in which Christ is the unrecognized companion of those who are walking through the worst day of their lives. The deathbed is, in this frame, an Emmaus road; we are joining a journey already underway with One who has already been walking.