Intended for healthcare professionals

Clinical Review

Care of the dying patient: the last hours or days of lifeCommentary: a “good death” is possible in the NHS

BMJ 2003; 326 doi: (Published 04 January 2003) Cite this as: BMJ 2003;326:30

Recognising the phenomena of premonitions of death

We agree with Ellershaw and Ward that recognising the key signs and
symptoms is an important clinical skill in diagnosing dying.1 We further
believe that a recognition of the phenomena of premonitions of death is at
least as helpful in this context.2,3

For example, the phenomenon of Hui
Guang Fan Zhao, recently termed as Lazarus premonition or Witzel-Ngeh
phenomenon refers to a state of transient revival of the dying person
shortly before death.2 Failure to recognise this phenomenon as a
premonition of death may create a false hope that the dying patient is
starting to get better, thereby posing a risk to reintroduce futile
treatment and investigation. However, in paediatric palliative care
setting, Lazarus syndrome is said to occur when a child suffering from a
terminal illness is expected to die and then unexpectedly goes into
remission.4,5 Some patients, who may or may not be dying, may experience
and express to others premonitions of their imminent death.2,3 This
premonition is not the same as a simple ‘death wish’ and should be taken
seriously.3 Unless the patient is dying, a more vigilant nursing and
medical care may avert a sudden cardiopulmonary arrest and death.

Otherwise, a high quality palliative care should be assured. Recognition
of these intriguing phenomena as normal variants of the dying process in
terminally ill patients may allow a last window of opportunity to resolve
any social, psychological and spiritual issues.2,3

Joseph K T Ngeh
specialist registrar in geriatric and general
internal medicine

Department of Clinical Geratology

Vivien K L Toh
specialist registrar in endocrinology, diabetes and
general internal medicine

Oxford Centre for Diabetes, Endocrinology and Metabolism
Radcliffe Infirmary, Oxford OX2 6HE

1 Ellershaw J, Ward C. Care of the dying patient: the last hours or
days of life. BMJ 2003;326:30-4.

2 Ngeh JKT. Observations of the phenomenon of Hui Guang Fan Zhao- Lazarus
premonition. Age Ageing 2002;31:434.

3 Ngeh JKT. The phenomenon of premonition of death in older patient. J Am
Geriatr Soc 2003 (in press).

4 Ngeh JKT, Toh VKL. The Lazarus phenomenon. J R Coll Physicians Edinb
2002; 32:143.

5 Stevens MM. Paediatric palliative care. In: Doyle D, Hanke G, MacDonald
N. Oxford textbook of palliative medicine. 2nd ed. Oxford: Oxford
University Press; 1997; 714.

Competing interests:  
None declared

Competing interests: No competing interests

18 January 2003
Joseph K T Ngeh
Specialist Registrar in Geriatric and General Internal Medicine
Vivien K L Toh
Department of Clinical Geratology, Radcliffe Infirmary, Oxford OX2 6HE