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Readers will no doubt be aware of the broad outlines of research into near-death experiences (NDEs), pioneered by Drs Elisabeth Kubler-Ross and Dr Raymond Moody in the 1970s. Since this time, numerous books and studies have appeared by Psychologists, Philosophers, Theologians, Sociologists and Doctors. The most ground-breaking scientific paper was by Dutch cardiologist Dr Pim van Lommel in The Lancet in December 2001. Here he described a prospective study of 344 cardiac arrest survivors from ten hospitals over a two-year period. Of these, 63 had a recognisable NDE and 41 what is technically called a 'core NDE'.

Working with neuroscientist Dr Peter Fenwick at Southampton General Hospital, Dr Parnia had set up a similar but much smaller study, which forms the core of this present book. However, he ranges much more widely, placing the NDE within current neuroscientific knowledge, writing in an accessible style that carries the reader through his story. He begins with a historical overview, summarizing the phenomenon in a cultural context, and moves on to a useful account of current scientific explanations of the NDE, both physiological and psychological. He then describes how he set up the Southampton study and reports on a number of very interesting cases of the kind that will be familiar to researchers in this area, including a couple of experiences reported to senior doctors before they became common.

The scientific paradox of cardiac arrest NDEs is highlighted by Dr Parnia explaining what we know about the physiology of cardiac arrest, especially the effects of lack of oxygen on brain cells. He goes on to describe the physiology of resuscitation procedures, during which the brain blood flow is less than 5% of normal. He expresses the paradox in the following way: "Here we have a group of people who are so severely ill that they have reached the clinical point of death, yet somehow they report having lucid, well-structured thought processes, together with reasoning and memory formation from that time." This highlights the question of the relationship of consciousness to brain processes in a context where the mainstream view is that brain gives rise to consciousness. NDEs are, in my view, a fundamental challenge to this hypothesis, especially where there is verifiable evidence that a patient's NDE perceptions are accurate.

Dr Parnia next considers more general theories of consciousness and brain function, ranging from conventional brain-based theories to non-conventional views from Stuart Hameroff, Sir Roger Penrose and Sir John Eccles. He also analyses some of the limitations of brain-based theories in relation to the nature of subjective experience and the 'binding problem' of how distributed processes give rise to unitary sensations. The last part of the book advances the author's own view of consciousness and the significance of the NDE.

Here I found some of Dr Parnia's assumptions required further analysis. For instance, he claims that consciousness must necessarily be confined within the realms of physics and matter (it manifests within the material universe but need not be confined within it); that he is a collection of billions of cells (assumes that he is identical with his physical body); that consciousness must be made up of subatomic particles since everything else in the universe is so made up (assumes the physical universe = cosmos). Hence, effectively that outer = inner, where outer is form and inner is consciousness. He is right to point out the limitations of the physical senses, but it seems to me that we might also have subtle senses and hence a subtle form or body, which can occasionally be perceived by others as an apparition.

Another way of addressing the issue is Dr Parnia's categorical statement that brain processes undoubtedly mediate the experience. They certainly mediate the recollection of the experience but there are indications that the essence of the NDE – and indeed of mystical experience – is ineffable and not fully expressible in language. So while we may discover more about the molecular mediators and correlates of these experiences, the experiences themselves may transcend such mechanisms. Later in the book, Dr Parnia does acknowledge this point, but he could have made a clearer distinction between epistemology (theories of knowing) and ontology (the nature of reality). And although the NDE is hugely significant in studying what happens when we die, there are other lines of evidence to be considered, as put forward in David Fontana's new book Is there an Afterlife? The NDE is not the last word, but this book is a significant addition to the field.

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