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November 15, 2000

Placing Religion and Spirituality in End-of-Life Care

Author Affiliations

Author Affiliations: Departments of Family Medicine and History & Philosophy of Medicine, Center on Aging, University of Kansas Medical Center, Kansas City (Dr Daaleman); and The Healthcare Chaplaincy, New York, NY (Dr VandeCreek).

JAMA. 2000;284(19):2514-2517. doi:10.1001/jama.284.19.2514

In 1995, the SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) trial stimulated a reexamination of systems of care for seriously ill and dying patients.1 This study has accelerated efforts to improve end-of-life care and has indirectly promoted a rapprochement among religion, spirituality, medicine, and health care.2 The goal of a quality comfortable death is achieved by meeting a patient's physical needs and by attending to the social, psychological, and the now recognized spiritual and religious dimensions of care.3,4 This perspective is highlighted in a recent consensus statement that includes the assessment and support of spiritual and religious well-being and management of spiritual and religious problems as core principles of professional practice and care at the end of life.5 Yet multiple ethical and pragmatic issues arise. For example, should physicians identify patients' spiritual and religious needs and intervene in clinical settings? The roles and responsibilities of patients and physicians in this scenario are unclear. An understanding of religion and spirituality within the context of end-of-life care, quality of life, and patient-clinician interactions may illuminate the problems and potentialities for both patients and clinicians.