Author Affiliations: Program in Medical Ethics, Division of General Internal Medicine, University of California, San Francisco (Drs Lo, Ruston, Pantilat, and Rabow and Ms Kates); Division of General Internal Medicine, Center for Bioethics and Health Law, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Arnold); Kennedy Institute of Ethics, Georgetown University, Washington, DC (Dr Cohen); Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse (Dr Faber-Langendoen); Division of Aging Studies, Institute for Spirituality and Health, George Washington University School of Medicine, St Louis, Mo (Dr Puchalski); Program for Biopsychosocial Studies, Department of Medicine, University of Rochester School of Medicine, Rochester, NY (Dr Quill); Hackensack University Medical Center, Hackensack, NJ (Rabbi Schreiber); John J. Conley Department of Ethics, Saint Vincent's Manhattan, The Bioethics Institute of New York Medical College, New York, NY (Dr Sulmasy); and Program on the Medical Encounter and Palliative Care, Department of Medicine, Duke University, Durham, NC (Dr Tulsky).
As patients near the end of life, their spiritual and religious concerns
may be awakened or intensified. Many physicians, however, feel unskilled and
uncomfortable discussing these concerns. This article suggests how physicians
might respond when patients or families raise such concerns. First, some patients
may explicitly base decisions about life-sustaining interventions on their
spiritual or religious beliefs. Physicians need to explore those beliefs to
help patients think through their preferences regarding specific interventions.
Second, other patients may not bring up spiritual or religious concerns but
are troubled by them. Physicians should identify such concerns and listen
to them empathetically, without trying to alleviate the patient's spiritual
suffering or offering premature reassurance. Third, some patients or families
may have religious reasons for insisting on life-sustaining interventions
that physicians advise against. The physician should listen and try to understand
the patient's viewpoint. Listening respectfully does not require the physician
to agree with the patient or misrepresent his or her own views. Patients and
families who feel that the physician understands them and cares about them
may be more willing to consider the physician's views on prognosis and treatment.
By responding to patients' spiritual and religious concerns and needs, physicians
may help them find comfort and closure near the end of life.
Lo B, Ruston D, Kates LW, Arnold RM, Cohen CB, Faber-Langendoen K, Pantilat SZ, Puchalski CM, Quill TR, Rabow MW, Schreiber S, Sulmasy DP, Tulsky JA, for the Working Group on Religious and Spiritual Issues at the End
of Life . Discussing Religious and Spiritual Issues at the End of LifeA Practical Guide for Physicians. JAMA. 2002;287(6):749–754. doi:10.1001/jama.287.6.749