Final Gifts

Final Gifts: Understanding the Special Awareness, Needs and Communications of the Dying is a work on the psychology of death by hospice nurses Maggie Callanan and Patricia Kelley. Drawing on their decades of intimate experience caring for the dying, the authors set out to provide a comprehensive survey of the physical, psychological, and metaphysical aspects of the end-of-life process. They call this distinct period of life “Nearing Death Awareness,” and advocate a greater understanding of this transitional period of life, as well as more empathy towards terminally ill people. The book received praise for shining a light on a difficult subject that is too often ignored or repressed in medical literature and other ways of representing illness and death.

Callanan and Kelley first define Nearing Death Awareness. It is a capacious, yet only murkily understood, aspect of the human experience, encompassing the facts of the body’s death (such as a weakening heartbeat, or a decline in brain activity) but also cognition about death. They note that terminally ill patients are highly reflective in their final weeks and days, focusing their energy on metaphysical questions over the bodily evidence of impending death. They contend that Nearing Death Awareness has some similarities to Near Death Experiences, or NDEs.

Callanan and Kelley break down Nearing Death Awareness into four main behaviors. Not all four are common to everyone, but many terminal patients exhibit at least one. The first is that a patient will seem to prepare for a journey, even if he or she can no longer physically move. In the second, a patient will start seeing beings that have no ordinary physical form. In the third, a patient will start to perceive a destination outside of ordinary time and space. In the fourth, a patient exhibits knowledge about the date and time when their death will happen. Callanan and Kelley claim that they have observed these four behaviors in people of all different races, cultures, genders, social backgrounds, and religions.



Callanan and Kelley also look back on the experience they gained in the healthcare field, managing the dying process, as well as communicating with the families of the dying. They argue that both birth and death are essential to the human life cycle, and should be seen in a positive light. They also validate the unique emotions and experiences of the dying, believing that they only enrich the human life. Most of these feelings and experiences are not captured in medical literature, and likely never will be, since they aren’t amenable to scientific analysis.

The last part of Final Gifts reviews several aspects of living and dying that frequently become uncomfortable to patients once they realize they are going to die. Most of the aspects are related to the regret of leaving some task incomplete: from declining to convey an important message to someone out of fear, to forgoing one’s dreams to pursue money or prestige in their place. Callanan and Kelley exhort their readers to help the dying complete the tasks, even if they are mostly imaginary, so that they can die peacefully. They suggest some tools for communicating to the dying, showing that it is possible to relieve a lot of their emotional suffering by helping them surmount any lingering obstacles.

Final Gifts describes a new way of thinking about dying. Rather than rely on medicalized definitions of death and near-death care, Callanan and Kelley’s creation of Near Death Awareness opens up this universal moment in human life to philosophical, emotional, and metaphysical discussion. The authors humanize death in a way that, they believe, the medical sciences have failed, and place healthcare professionals who are normally thought of as auxiliary in the center of the care process.