What Happens When We Die?

1. Near-Death Experiences are a consistent phenomenon across history and cultures.

Examining the medical literature, it became clear to me that these questions were in fact those that had occupied researchers in the 1970s and 1980s, and some of the answers were already available.

Ancient accounts. Reports of experiences near death are not new; they date back to antiquity. Plato described a soldier named Er who had a journey from darkness to light, judgment, and visions after a near-fatal injury. Hieronymus Bosch's 15th-century painting "Ascent into the Empyrean" depicts a tunnel and light, resembling modern NDE accounts. An 18th-century British admiral described a panoramic life review after nearly drowning.

Cross-cultural presence. NDE-like experiences have been reported across diverse cultures and religions, including:

• Bolivian, Argentinean, and North American Indians
• Buddhist texts and Islamic works
• Accounts from China, Siberia, and Finland
  While interpretations may vary based on background (e.g., seeing a specific religious figure), core features like out-of-body sensations, peace, light, and meeting deceased relatives are consistently present.

Not personality-dependent. Studies in the 1980s found no significant correlation between having an NDE and personality traits like IQ, extroversion, neuroticism, anxiety, hysterical tendencies, death anxiety, danger-seeking, or psychotic personality. This suggests NDEs are not simply a product of specific psychological profiles.

2. Early scientific studies characterized NDEs and their common features.

At the beginning of the book, Moody had provided an “ideal” or “complete” near-death experience based upon all the common NDE features.

Moody's pioneering work. Dr. Raymond Moody's 1975 book Life After Life brought NDEs into scientific discussion by documenting similar experiences among 150 survivors of near-death encounters. He identified a composite NDE featuring peace, body separation, a tunnel, bright light, meeting deceased relatives or a being of light, a life review, and a border.

Common features identified:

• Feelings of peace and well-being
• Sense of detachment from the physical body (out-of-body experience)
• Moving through darkness or a tunnel
• Encountering a bright, warm, welcoming light
• Meeting deceased relatives or a being of light
• Having a panoramic life review
• Reaching a border or point of no return
• Feeling intense joy, love, and peace

Measuring NDEs. Researchers developed scales like the Weighted Core Experience Index (Ring) and the Greyson Scale to standardize and quantify NDEs. The Greyson Scale, with 16 features, assigns scores to differentiate NDEs from other experiences and measure their depth, providing a basic tool for research comparison.

3. Objectively studying NDEs requires investigating experiences during clinical death.

So a method was needed to identify a group of people who were objectively on the brink of death.

Limitations of past research. A major challenge in early NDE studies was the inability to objectively verify how close to death individuals actually were, as accounts were often collected years later without access to medical records. Subjective reports of being "near death" were not medically precise.

Cardiac arrest as a model. The author proposed studying experiences during cardiac arrest as an objective model of clinical death. This state meets the criteria of clinical death (no heartbeat, no breathing, loss of brain stem reflexes) and mimics the initial, potentially reversible, phase of dying.

Why cardiac arrest is ideal:

• Objective biological state: Heart and breathing stop, leading to rapid loss of brain function.
• Reversible: Allows for survival and reporting of experiences.
• Universal mechanism: The final biological pathway for death, regardless of cause.
• Differentiates from illness hallucinations: Focuses on experiences during actual cessation of vital signs.

Study design challenges. Setting up a prospective study during cardiac arrest faced significant hurdles, including finding time for research, gaining hospital staff support for a controversial topic, ensuring confidentiality, and managing unexpected publicity and staff curiosity about study methods like hidden targets.

4. Anecdotal accounts suggest verifiable out-of-body experiences occur during cardiac arrest.

When I saw him later, he told me that he had watched everything from above and described all that had happened in detail.

Reports from medical staff. Experienced medical professionals, including cardiologists and pediatricians, shared compelling anecdotes of patients who, after surviving cardiac arrest, reported observing and accurately describing events that occurred during their resuscitation. These details were often impossible for the patient to have known through normal senses.

Examples of verifiable details:

• Describing specific actions of doctors and nurses during CPR.
• Recalling conversations held by medical staff while the patient was clinically dead.
• Identifying objects or procedures used during resuscitation.
• Describing the layout of the room or the appearance of staff members.

The paradox in practice. These accounts are particularly striking because they come from patients who were in a state of clinical death, with no pulse, no breathing, and presumed absence of brain function. The ability to recall specific, verifiable details from this period challenges conventional understanding of consciousness.

Beyond the immediate vicinity. Some anecdotal reports even describe patients observing events outside the resuscitation room, such as family reactions or scenes outside the hospital, further complicating conventional explanations based on limited sensory input or brain activity.

5. NDEs during cardiac arrest present a scientific paradox: lucid consciousness despite brain inactivity.

How can there be such clear and lucid thought processes when the brain is at best severely disrupted, and as far as we can measure, not functioning?

Brain function ceases. Scientific studies using electroencephalograms (EEGs) consistently show that within 10-20 seconds of cardiac arrest, electrical activity in the brain ceases, resulting in a "flatline" EEG. This indicates a severe lack of blood flow and oxygen, incompatible with normal brain function.

The NDE contradiction. Despite this cessation of measurable brain activity, a significant minority (10-20%) of cardiac arrest survivors report having lucid, well-structured thought processes, reasoning, memory formation, and conscious awareness during this period. This is the core scientific paradox.

Why it's paradoxical:

• Normal brain insult: Illness or injury typically causes confusion and memory loss, not heightened awareness.
• Memory formation: The brain state during cardiac arrest should prevent memory encoding.
• Lucid thought: Complex cognitive processes should not be possible without electrical activity.

Challenging assumptions. This discrepancy between reported conscious experience and measured brain inactivity forces a re-evaluation of the fundamental assumption that consciousness is solely a product of brain-cell electrical activity.

6. Conventional brain theories struggle to explain subjective consciousness and the NDE paradox.

Consciousness poses the most baffling problems in the science of the mind.

The "hard problem". Conventional neuroscience theories, while explaining how the brain processes information (the "easy problems"), fail to account for how physical processes in the brain give rise to subjective conscious experience – the feeling of seeing red, the taste of coffee, the sense of self.

Limitations of current models:

• Subjective experience: No plausible mechanism explains the transition from electrical/chemical signals to felt experience.
• Binding problem: How do distributed brain activities combine into a single, unified conscious perception?
• Consciousness emergence: How does pre-conscious activity become conscious at a critical point?
• Free will: Brain-as-computer models struggle to accommodate the concept of personal agency and accountability.

Correlation vs. Causation. Brain scanning techniques show which areas are active during conscious experiences, but this correlation doesn't prove the brain produces consciousness. It could be that consciousness uses the brain, or a third factor influences both.

Hallucination argument insufficient. While brain stimulation can induce OOBE-like sensations, this doesn't prove all NDEs are hallucinations. Brain areas involved in hallucinations also mediate "real" experiences, and brain activity correlation doesn't determine external reality.

7. Nonconventional theories propose consciousness may be a separate, subtle entity.

His view was that the mind itself played an active role in selecting and integrating brain-cell activity and molded it into a unified whole.

Beyond brain activity. Some scientists and philosophers argue that consciousness cannot be fully explained by current understanding of brain processes. They propose alternative models that look beyond conventional neuroscience.

Alternative perspectives:

• Quantum processes: Theories like Orchestrated Objective Reduction (Orch OR) suggest consciousness arises from subatomic quantum events in brain microtubules, not just electrical signaling.
• Irreducible entity: Consciousness may be a fundamental, irreducible scientific entity, like mass or gravity, not derivable from other physical properties.
• Dualism: The mind/consciousness may be a separate entity that interacts with the brain, as proposed by Nobel laureate Sir John Eccles.

Consciousness as subtle matter. Professor Bahram Elahi suggests consciousness is a subtle type of matter, currently undetectable by our instruments, similar to how electromagnetic waves were once invisible but are now understood and utilized.

Implications for NDEs. If consciousness can exist independently of conventional brain activity or is a separate entity, this could potentially explain how lucid awareness and memory formation occur during the brain "flatline" of cardiac arrest.

8. Our perception of reality is limited by senses, brain, and social context.

Reality, as we know it, is not neurologically determined, but is rather determined socially and our understanding of it is necessarily limited by the limitations of our body and in particular our brain.

Multiple realities exist. There is a "true" reality independent of human perception (like electromagnetic waves before their discovery) and a "perceived" reality shaped by our senses, brain, and social context. Our understanding of the former is limited by the latter.

Social construction of reality. Society, including scientific communities, collectively determines what is considered "real" by assigning meaning to experiences and phenomena. This definition can change over time, often with resistance, as new information or perspectives gain acceptance (e.g., Earth revolving around the sun).

Limitations of human perception:

• Senses: Our five senses detect only a narrow range of the physical world (e.g., visible light spectrum).
• Brain: The brain's computational abilities are limited, sometimes misinterpreting sensory input (e.g., visual illusions) or struggling to comprehend concepts beyond three dimensions.
• Instruments: While instruments extend our senses, they still don't reveal the entirety of "true" reality (e.g., individual atoms).

NDEs and reality. Applying this to NDEs, the fact that they are mediated by brain changes doesn't make them "unreal" hallucinations. Brain activity correlates with all experiences, real or not. Whether an NDE corresponds to an external reality cannot be determined solely by studying brain function; it's a question beyond current neuroscience's scope.

9. Testing verifiable out-of-body claims is key to understanding NDE reality.

The only aspect of the near-death experience that can be objectively tested, validated, and studied in the context of whether it is real or not is in fact the out-of-body component.

The testable element. While many NDE features (peace, light, meeting beings) are subjective and difficult to verify externally, the out-of-body experience (OOBE) component, where individuals report observing physical events, offers a potential avenue for objective scientific testing.

The hidden target method. The author's study design included placing hidden visual targets in hospital rooms that are only visible from a high vantage point (e.g., near the ceiling). If patients reporting OOBEs can accurately describe these targets, it would provide objective evidence supporting their claims of perceiving the environment from outside their body.

Potential outcomes:

• No one reports targets: Suggests OOBEs are likely illusions or false memories.
• Patients report targets visible from below (eyes open): Suggests perception occurred through normal senses.
• Patients report targets visible only from above: Provides strong evidence for perception from an OOBE perspective, challenging conventional models.

Addressing alternative explanations. This method helps differentiate true OOBE perception from possibilities like:

• False memories formed after recovery.
• Limited perception through normal senses during partial consciousness.
• Hallucinations unrelated to the actual environment.

10. Large-scale, prospective studies are essential to resolve the NDE paradox.

However, as many thousands of people, including small children, have reported a fully functioning mind and consciousness and have been able to relate specific events that happened during their cardiac arrest, the possibility is raised that mind and consciousness can exist separately from the brain and also during and at least for some time after death.

Need for robust data. Despite intriguing anecdotal reports and smaller studies, definitive conclusions about consciousness during cardiac arrest require large-scale, prospective research with sufficient statistical power. Previous studies, while significant, were limited by sample size.

The AWARE study. The author's ongoing multi-center AWARE (AWAreness during REsuscitation) study aims to address this by recruiting over a thousand cardiac arrest survivors across multiple hospitals. It combines interviews about experiences with objective medical data collection.

Key objectives of AWARE:

• Determine the true incidence of NDEs and OOBEs during cardiac arrest.
• Correlate experiences with biological markers (oxygen, CO2, drugs).
• Test the validity of OOBE claims using hidden visual targets.
• Monitor brain function during cardiac arrest to correlate with reported consciousness.

Addressing alternative theories. The study is designed to test conventional explanations (lack of oxygen, drugs, false memories) against the possibility of consciousness continuing during brain inactivity.

11. Studying death offers a unique window into the fundamental nature of consciousness.

If we take up this challenge, then we can potentially answer the last completely unsolved mystery in biological sciences.

Death as a laboratory. The state of clinical death during cardiac arrest provides a unique, albeit brief, opportunity to study human consciousness when the brain is not functioning according to current scientific understanding. It's a natural experiment that cannot be replicated ethically.

Challenging the status quo. If consciousness is proven to exist and function lucidly during brain inactivity, it would fundamentally challenge the prevailing scientific view that mind is solely a product of brain activity. This would necessitate a paradigm shift in neuroscience and our understanding of life.

Profound implications. Unraveling the mystery of consciousness at the end of life could have far-reaching implications for:

• Our understanding of the mind-brain relationship.
• The nature of consciousness itself.
• The possibility of consciousness surviving bodily death.
• Philosophical and societal views on life, death, and the self.

An open scientific frontier. The study of consciousness during death is a new, objective scientific field with the potential to answer one of humanity's oldest and most profound questions, pushing the boundaries of biological science.

Last updated: June 12, 2025