Flourishing at the End of Life
- Tyler VanderWeele
- Aug 25, 2025
- 5 min read
Updated: 6 hours ago
How to find meaning and growth when time is short.
By Tyler J. VanderWeele Ph.D.
Key points
Flourishing is multi-dimensional.
While health will be declining at the end of life, a person might flourish in other ways.
Meaning, relationships, and character can be realized in unique ways even as death approaches.
Receive Tyler's monthly insight and research updates from the Human Flourishing Program team.
The definition of flourishing we have used at the Human Flourishing Program at Harvard is “the relative attainment of a state in which all aspects of a person’s life are good, including the contexts in which that person lives.” Understood thus, flourishing is an ideal. It is not something we ever attain perfectly in this life.
Flourishing is also multi-dimensional. We may be flourishing in certain ways, but not in others. These aspects of this conceptualization of flourishing are especially important if we are to consider the notion of flourishing at the end of life.
In many ways, the notion may seem paradoxical. The very etymology of the word “flourishing” is related to blossoming or flowering – it presupposes life, and suggests a state of abundant health. At the end of life, health is in decline, and death is approaching. Certainly, not all aspects of a person’s life are good. However, even if there are certain things that are not good at the end of life, there may well be others that are. In a recent paper in Theoretical Medicine and Bioethics, we argue that a person can in fact flourish in certain unique ways, even at the end of life.
Unique Features of Flourishing at the End of Life
Unlike a tree or a flower, a person also has mental capacities, is involved in human relationships, and finds meaning within the narrative of his or her life. These are important aspects of the human person and of human flourishing.
These are aspects of human life that can perhaps find some degree of fulfillment even when health is in decline. As health declines and as death approaches, one will certainly not be flourishing in a perfect sense, but one can arguably flourish in a qualified or conditional sense, conditional on that end-of-life context.
We should perhaps pay more attention to these other aspects of flourishing in end-of-life settings. Flourishing is multi-dimensional, and we will be neglecting opportunities to flourish if we consider only health as the end of life approaches.
In fact, we would argue that in certain respects flourishing can be realized in unique ways at the end of life. The meaning of one’s life gradually unfolds over time; events take place that can alter not only one’s future trajectory but also one’s understanding of the past. At the end of life, it is perhaps more possible to make sense of the entire trajectory of one’s life, to find meaning in it, and to try to make sense of it as a coherent whole, with all its twists and turns.
The end of life can also be an important time for relationships. It can be a time when relationships are themselves brought to a satisfactory conclusion; or where there may be unique opportunities for reconciliation or forgiveness in instances in which relationships have been broken. One’s marital vows are, in some sense, brought to their fulfillment at the time of death. No doubt, with death approaching, there can also be pain, loneliness, and fear in the context of relationships as well, but also opportunities for growth and fulfillment.
Given the struggles, fear, pain, and suffering that may be present as death approaches, such settings can again perhaps paradoxically also be opportunities for growth and for the strengthening of character. Working through the challenges one confronts can help bring about greater fortitude. Trying to make sense of suffering and struggles can perhaps help deepen one’s spirituality. Working through pain and suffering may increase one’s compassion and love for others. There can be unique opportunities for growth at the end of life as well.
None of this should be glamorized, and the struggles at the end of life can often be excruciating. We should certainly seek to alleviate pain and suffering, and the causes of that suffering, but when we cannot fully address these matters, we should arguably also seek opportunities for growth within suffering.
Indeed, our work in the Global Flourishing Study sometimes suggests some surprising relationships between adversity and subsequent growth or resilience. This is not an excuse to not address suffering, but rather an invitation to try sometimes to find meaning and growth in the midst of it.
End-of-Life Flourishing Assessments and Future Directions
To facilitate reflection on these matters, and also to advance research on flourishing at the end of life, we have introduced a modification of our flourishing assessment, adapted to end-of-life contexts. This new end-of-life flourishing assessment takes our prior flourishing measure but alters a number of the questions to be more appropriate for the end of life: from health to questions of pain; from purposes to meaning; from delayed gratification to growth; from satisfaction in relationships to their conclusion.
We also propose that in the context of the end of life, particular priority be given to the flourishing domains of meaning, character, and relationships over those of health, happiness, and financial security. While all of these are important in life as a whole, when death is approaching, meaning, character, and relationships are arguably especially salient.
We are currently piloting the use of this measure in a number of settings. The assessment is not intended to be a replacement for more traditional quality-of-life assessments, more tailored to symptoms of specific conditions, but rather a supplement. We think both assessments, and others, can and should be used to help try to understand patient experience, and to provide appropriate care. The flourishing assessment helps address broader questions of meaning, relationships, and growth, even at the end of life. We hope that these assessments, as tools for understanding and reflection, might in some sense assist with the “art of dying” (Ars moriendi), bringing about a good death in the midst of real challenges.
We hope that this work might also help us reevaluate how we think about human experience at the end of life as well, perhaps even influencing discussions of physician aid in dying. When our entire focus is placed on the domains of health, happiness, and financial considerations, an early termination of life may seem, to some, like the best option.
But this is to miss the broader context of flourishing, and a flourishing life. It is to neglect those aspects of flourishing that arguably matter most at the end of life. When we think also about meaning, relationships, and character, the considerations change. Some degree of flourishing can be attained—and even attained in unique ways—even at the end of life.
Receive Tyler's monthly insight and research updates from the Human Flourishing Program team.
References
Symons, X. Rhee, J.Y., Tanous, A., Balboni, T. and VanderWeele, T.J. (2024). Flourishing at the end of life. Theoretical Medicine and Bioethics, 45:401-425.
