Simon Boas, who wrote a candid account of living with cancer, passed away on July 15 at the age of 47. In a recent BBC interview, the former aid worker expressed a surprising sentiment: “My pain is under control and I’m terribly happy – it sounds weird to say, but I’m as happy as I’ve ever been in my life.”

While it might seem unusual for someone to find happiness as the end of life approaches, this perspective is not uncommon. As a clinical psychologist working with people nearing the end of their lives, I have often observed similar attitudes.

Research suggests that fear of death lies at the unconscious core of the human experience. William James, an American philosopher, described the awareness of mortality as “the worm at the core” of the human condition. However, a study published in Psychological Science reveals that individuals nearing death use more positive language to describe their experiences than those merely imagining death. This indicates that the actual experience of dying can be more pleasant, or at least less unpleasant, than we might expect.

In his BBC interview, Boas shared insights that helped him accept his situation. He emphasized the importance of enjoying life and prioritizing meaningful experiences, suggesting that acknowledging death can deepen our appreciation for life. Despite his pain and challenges, Boas remained cheerful, hoping his positive attitude would support his wife and parents through the difficult times ahead.

Boas’s reflections echo the wisdom of the Roman philosopher Seneca, who advised that living a fulfilling life depends more on the quality of our minds than on the quantity of our years. Similarly, psychiatrist Viktor Frankl, a Holocaust survivor, articulated in his seminal work “Man’s Search for Meaning” (1946) the importance of finding meaning in all circumstances. Frankl’s ideas laid the groundwork for existential psychotherapy, and its modern adaptation, meaning-centered psychotherapy, offers cancer patients a way to enhance their sense of meaning.

The relationship between happiness and meaning is complex. Recent studies published in Palliative and Supportive Care and the American Journal of Hospice and Palliative Care asked people nearing death what constituted happiness for them. Common themes included social connections, enjoying simple pleasures like being in nature, maintaining a positive mindset, and shifting focus from seeking pleasure to finding meaning and fulfillment as their illness progressed.

In my work, I often encounter individuals who arrive at a similar outlook on life as Boas. One person who stands out is Johan.

When I first met Johan, he came to the clinic alone, with a slight limp. We talked about his life, interests, relationships, and the meaning he found in them. Johan was lucid, clear, and articulate.

At our second meeting, he used crutches, as one foot had begun to lag and he couldn’t trust his balance. Though frustrated by his physical decline, he still hoped to cycle around Mont Blanc.

When I asked about his concerns, Johan burst into tears. “That I won’t get to celebrate my birthday next month,” he said. It wasn’t the moment of death itself that weighed on him, but the things he wouldn’t be able to do again.

At our third meeting, Johan arrived with a friend’s support, no longer able to grip the crutches. He told me he had been watching videos of himself cycling with friends and decided to watch YouTube videos of others cycling around Mont Blanc. He even ordered a new, expensive mountain bike. “I may not be able to ride it, but thought it would be cool to have in the living room,” he said.

For our fourth and final visit, Johan arrived in a wheelchair. He had the bike next to his couch. He expressed one last wish: “If by some miracle I were to get out of this alive, I would like to volunteer in domestic care services – one or two shifts a week. They work hard and it gets crazy sometimes, but they make such an incredible contribution. I wouldn’t have been able to get out of the apartment without them.”

My experience with patients facing life-threatening diseases is that it’s possible to feel happiness alongside sadness and other seemingly conflicting emotions. Patients can experience gratitude, remorse, longing, anger, guilt, and relief – sometimes all in one day. Confronting the limits of existence can provide perspective and help a person appreciate life more deeply than ever.