Near-death experiences (NDEs) during cardiac arrest likely occur when the patient is unresponsive and the brain is severely compromised, not in early arrest or after resuscitation. There is no evidence that cortical electrical activity recorded during dying or CPR is linked to NDEs; such recordings may be artifacts. Cardiac arrest halts blood flow to the brain, causing loss of cortical electrical activity within 10–30 seconds. During CPR, brain activity may remain absent or severely disturbed. Because NDEs appear at the moment the brain is severely compromised, this may support the idea that consciousness can persist beyond the brain.
Near death, end-of-life dreams and visions (ELDVs) and delirium often overlap, making them hard to tell apart. This case report describes an elderly Brazilian woman with metastatic cancer who experienced both. ELDVs involved vivid encounters with deceased relatives and biographical themes, but many were distressing and occurred alongside fluctuating attention typical of delirium. The Confusion Assessment Method (CAM) identified delirium but could not distinguish ELDVs within delirious states. ELDVs often emerged during lucid windows with preserved recall and insight. Distress alone did not differentiate the two. Supplementing CAM with qualitative criteria—content, vividness, biographical meaning, insight, cultural fit, and recall—may prevent misclassification and support holistic palliative care.