Research
The Pursuit of Happiness at the End of Life: Research on Connection, Care, and Meaning in Hospice Settings
by Hilke Brockmann1
1School of Business, Social & Decision Sciences, Constructor University Bremen, 28759 Bremen, Germany
Cite as: Brockmann, H. (2025). The Pursuit of Happiness at the End of Life: Research on Connection, Care, and Meaning in Hospice Settings. THE MIND Bulletin on Mind-Body Medicine Research, 8, x-x. https://doi.org/10.61936/themind/202506303
Abstract
This paper summarizes the extant research in the search and experience of happiness at the end of life. The present study draws on a range of research disciplines, including palliative care, psychology, sociology and philosophy, in order to examine how the concepts of connection, dignity and meaning coalesce into what might be termed 'happiness at the margins of life'.
Keywords: happiness, connection, well-being, death, end-of-life care
Earlier this year, I was invited by a children's hospice to deliver a speech on the topic of happiness. The invitation was accepted without hesitation. However, as the project progressed, a sense of uncertainty and apprehension began to emerge. The question therefore arises as to how one can discuss the concept of happiness in a context where young lives are characterized by suffering, severe illness and, frequently, the proximity of death. Upon arrival, the initial feelings of uncertainty and anxiety were met with a sense of warmth and clarity. It became evident that the caregivers, parents, and most notably, the children themselves, were eager to explore and articulate the concept of happiness within their respective contexts. During my visit, I personally observed a series of events that led to a significant shift in my perspective. It was observed that children with minimal physical capabilities, many of whom were non-verbal and unable to ambulate, exhibited a palpable sense of contentment. Parents and care professionals were observed to demonstrate an unwavering commitment to fostering connections, capturing moments of aesthetic appeal, and cultivating a sense of contentment among those in their care. This dedication, evident in their actions, serves as a testament to their navigation of grief and the challenges associated with profound exhaustion.
1. Happiness at the End of Life – Beyond Hedonism towards Connectedness
Empirical research in psychology and the social sciences conceptualizes happiness in terms of subjective well-being (Diener et al., 1999, 2018), often measured as a combination of life satisfaction, positive affect, and the absence of negative affect. The emotional part of happiness is a short-lived and changing response to immediate experiences. Life satisfaction refers to a cognitive, longer-term evaluation of one’s life. Both aspects of subjective well-being are not identical but highly correlated (Kuppens et al., 2008). And both aspects rest on the assumption and empirical evidence that the pursuit of happiness is universal and that people are fully aware of their experienced happiness (Veenhoven, 2010). This is why most researchers use questionnaires.
However, surveys fall short in the context of severe illness and dying. Although there is “no consensus nor a gold standard diagnostic marker” (Carr & Luth, 2019, p. 519) for the end of life phase, it is clear that more and more people will no longer be able to answer a questionnaire as they approach death. Data on the wellbeing of the dying often comes from family members or other members from the social support network. This is more than a measurement problem. To connect with the dying demands both new ways to collect information and a new understanding of the importance of connectedness for subjective well-being at the end of life.
2. Three Layers of Connection
End-of-life happiness is associated with different ways to connect with the physical, social, and transcendental environment.
2.1. The Body
Even as illness and physical decline progresses, the body remains a critical medium for connection. Avoiding pain and breathlessness and being kept clean are the most important preferences of patients and caring family members at the end of life. An effective medication and a dignified and careful personal hygiene are at the center of palliative care and strong determinants of end-of-life happiness. Still, these goals are not satisfactory met (Carr & Luth, 2019; Greco et al., 2014; Johansson et al., 2024; WHO, 2023).
The steep decline in happiness at the end of life (Gerstorf et al., 2018) is also reflected in mental
disorders from which many terminally ill patients suffer. 66% of palliative care patients report depressive feelings, and 20% experience severe anxiety, highlighting the need for psychological support and connection (Ann-Yi & Bruera, 2022).
One particularly powerful expression of connection is touch. As Montagu (1986) argued, touch is the first language we learn and one that retains its meaning even when other senses or capacities fade. A Swedish study of palliative care patients revealed that touch and non-verbal communication (e.g., eye contact, rhythmic movements) foster well-being particularly when verbal capacities decline (Håkanson & Öhlén, 2016). Touch is a gesture of recognition and appreciation from others and connects the dying person to their social environment.
2.2. The People
Social connections are inevitable for a happy end of life. Both hospice patients and terminally ill individuals emphasize the importance of relationships and social support over material wealth or achievements (Beng et al., 2022; O’Callaghan et al., 2021).
Befriending services enable both patients and their carers to participate socially and significantly improve emotional and psychological wellbeing by reducing feelings of isolation and loneliness (Gardiner & Barnes, 2016).
Social connections in hospice settings are prioritized in ways that are structurally and ethically different from acute medical care and this can be uniquely transformative for patients, but also for carers and volunteers. As a Dutch case study from 2024 shows (Olsman & Versteeg, 2024), sharing wellbeing through joint activities, legacy creation, and purpose enhances wellbeing for all.
To be clear, receiving and providing care is emotionally taxing (Gómez-Urquiza et al., 2020; Kamal et al., 2020). But small pleasures like preparing and eating enjoyable food or shared moments of happiness like organizing social activities are described by the entire ‘caring community’ as enjoyable, meaningful and rewarding.
2.3. Transcendence
Living a meaningful life connects everybody to a transcendent order that is greater than the individual limited existence. This layer of happiness refers to Aristotle’s idea of eudaimonia, the good (“eu”) life and ethical spirit (“daimon”), or what Erik Allardt (1993) called the being of human happiness. “Being stands for the need for integration into society and to live in harmony with nature.” (Allardt, 1993, p. 91).
Numerous studies have confirmed that religious beliefs and particular practices contribute significantly to people’s subjective well-being (Levin et al., 2025; Lewis & Cruise, 2006). This is also true for terminally ill patients and their caring community (Austin et al., 2025).
Spiritual well-being is not confined to religiousness in a narrow sense. Working on one’s life story to affirm legacy and purpose also brings connectedness and happiness (Liefbroer et al., 2025; Potter et al., 2024). Evidence shows that art therapies (Collette et al., 2021) and music interventions (Gillespie et al., 2024) connect to a grander context of beauty and meaning. They also provide a pleasant distraction and moments of shared joy. This is also true for experiencing nature, and animals at the end of life (Fegg et al., 2010; Tomás-Sábado et al., 2015). Other transcendent experiences like moments of awe or deathbed visions seem to reduce stress and anxiety (Claxton-Oldfield, 2024) and comfort (Broadhurst & Harrington, 2016).
These findings are not unexpected. The degree of happiness experienced by an individual throughout their life course is influenced by a number of factors, though these factors exhibit variations in their relative importance over time and between different individuals. The pursuit of happiness is the unifying factor in this concept. The existence of physical limitations is a fundamental factor that creates a clear divide between human beings. This is precisely where future research on end-of-life happiness must commence.
3. Future Connections
Most cited studies are dependent on questionnaire data, the accuracy of which is known to decrease in proportion to the proximity of the patient to death. In order to facilitate ongoing connectivity and the collection of valid and reliable information, it is imperative that future research integrates visual, audio and other data to obtain a comprehensive patient-sensitive picture.
Despite the absence of definitive knowledge regarding the onset of the end-of-life period, the
period leading up to death is commonly characterized by one or more chronic illnesses in contemporary societies (Carr & Luth, 2019). The management of chronic illnesses is predicated on the timely execution of appropriate decisions. The development of enhanced prognostic models, founded on causal designs and derived from precise and extensive data sets, holds the potential to provide patients and their care networks with enhanced information, advanced planning, and, consequently, greater control over their quality of life in the final stages of life.
In accordance with valid models of end-of-life happiness, interventions could become more tailormade, context sensitive and resource-saving. The "low tech high touch" approach to palliative care can be effectively recalibrated with the implementation of smarter technologies (Finucane et al., 2021). It is evident that young patients are trendsetters in the field of digital aids, ranging from chatbots to wearables. These technologies have the potential to enhance well-being by creating new, immersive and entertaining experiences or by enabling patients to remain at home, given that health parameters can be remotely monitored in real-time. The integration of smart technologies
and artificial intelligence has the potential to alleviate concerns associated with overburdening loved ones, protracted waiting times for professional assistance, information insecurity, and the experience of boredom.
This combination of factors has the potential to engender a novel sense of autonomy, efficacy, and interconnectedness among individuals confronted with terminal illness, despite the presence of significant limitations. The visit to the children's hospice revealed a notable absence of fear and presence of curiosity in the young patients, which has led to the formulation of an optimistic hypothesis concerning a shift in perspective on happiness, extending beyond the scope of end-of-life care. The prevailing scientific consensus on happiness requires both research and industry to now deliver both more accurate insights and smart devices and services.
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