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Featured Clinical Reviews

Perspectives on Care at the Close of Life: CODA
November 8, 2006

Spiritual Issues in the Care of Dying Patients: “. . . It's Okay Between Me and God”

JAMA. 2006;296(18):2254. doi:10.1001/jama.296.18.2254

On September 20, 2006, Daniel Sulmasy, OMF, MD, PhD, presented the case of Mr W,1 a patient with advanced adenocarcinoma who was admitted to the hospital for resection of a T7 vertebral body lytic lesion. Following surgery, he developed a pleural effusion and a chest tube was placed. Despite drainage, however, the patient's oxygen requirements increased rapidly. The medicine team was aware of Mr W's wishes that he not be intubated or resuscitated and treated for the possible underlying causes for his rapidly worsening respiratory status. During Mr W's interactions with the team, he discussed his strong religious belief in a miraculous cure. Mr W's forthright statement that he believed he would live for many years created a conflict for the team, who were attempting to develop a treatment course and discharge plan to hospice in concert with the weeks-to-months prognosis suggested by Mr W's clinical picture.

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