Religion, spirituality, and end of life care
Christina M. Puchalski, MD, MS
Rabbi Elliot Dorff, PhD
Balaji N Hebbar, PhD
Iman Yahya Hendi, MA
Kusala Bhikshu, BA
Edward O'Donnell, MA
INTRODUCTION — Spiritual, religious, and cultural beliefs and practices play a significant role in the lives of patients who are seriously ill and dying. In addition to providing an ethical foundation for clinical decision making, spiritual and religious traditions provide a conceptual framework for understanding the human experience of death and dying, and the meaning of illness and suffering [1].
The importance of spiritual and religious beliefs in coping with illness, suffering, and dying is supported by clinical studies as well as individual narrative descriptions [1-9]. Most patients derive comfort from their religious/spiritual beliefs as they face the end of life, and some find reassurance through a belief in continued existence after physical death [10]. However, religious concerns can also be a source of pain and spiritual distress, for example, if a patient feels punished or abandoned by God [11].
A common goal for the dying patient, family members, and the health care professional is for a meaningful dying experience, in which loss is framed in the context of a life legacy [12]. Such an experience includes support for the patient's suffering, the avoidance of undesired artificial prolongation of life, involvement of family and/or close friends, resolution of remaining life conflicts, and attention to spiritual issues that surround the meaning of illness and death [13].
Clinicians can and should help dying patients find meaning and hope through recognition of the spiritual dimension of their experience [6]. Although they may lack the expertise to address spiritual concerns in depth, healthcare professionals should be able to discuss spirituality with their patients and identify those in spiritual distress so that appropriate referral may be made to spiritual care providers [11]. These include chaplains, community-based clergy, spiritual directors, pastoral counselors, and culturally based healers.
Here we will provide an overview of religion, spirituality, and spiritual care in patients who are terminally ill. This is followed by a brief summary of the major religious faiths and how their beliefs impact decision making and coping as patients approach the end of life.
RELIGION AND SPIRITUALITY — The terms religion and spirituality are not interchangeable. The term "religion" usually refers to an organized faith system of beliefs, practices, rituals, and language that characterize a community searching for transcendent meaning in a particular way, generally based upon belief in a divine being [14]. Religion represents only one of many forms of spiritual expression.
Broadly defined, spirituality is that which gives ultimate meaning and purpose in an individual's life. Although spirituality can be expressed in religious beliefs and practices, it can also more broadly include a relationship with God/Divine or a higher power, or with family, or with cultural communities. People may be in touch with their spirituality through formal religious rituals or sacraments, or through interaction with nature, humanity, or the arts [15].
Spirituality is a continuous process that changes over a person's lifetime, and is affected by illness and dying. Terminally ill patients generally acknowledge a greater spiritual perspective or orientation than either nonterminally ill or healthy patients [16].
CLINICAL ASSESSMENT AND MANAGEMENT OF SPIRITUAL ISSUES — Many clinicians find it difficult to initiate a discussion with patients about spirituality. Clinicians are often reluctant to talk about spiritual issues with their patients because they believe it is not their role to do so, or that patients might consider such discussion intrusive or evangelical. Furthermore, physicians may feel overwhelmed and unsure of how to respond if a patient turns to them in spiritual distress [17-19]. Yet, most studies indicate that patients want their health care professionals to ask about spiritual concerns, and that they benefit from discussions of these issues with their physicians [20-23].
The interdisciplinary nature of spiritual care — Spiritual care requires an interdisciplinary focus, with participation of all members of the healthcare team. This includes the clinician, nurse, chaplains, social worker, counselors, dietitians, housekeeping staff, and other allied health care workers. In addition, members of the community (clergy, parish nurses, others) may also interact with all or some members of the healthcare team, with the patient, and/or with the patient's family.
In the collaborative interdisciplinary team model of patient care, each member of the team has an area of expertise. Although all members may discuss overlapping issues such as diet, physical symptoms, spiritual issues, and social concerns, the trained professionals in each of these areas will usually pursue certain issues in greater depth (show figure 1). For example, a chaplain may discover that a patient is bothered by pain or nausea, and then relay these concerns to the doctor or nurse so that they can make appropriate recommendations for treatment. Any member of the team may discuss spiritual issues with the patient. However, it is usually the chaplain or other spiritual care professional who can address these issues in depth, and make treatment and/or follow-up recommendations.
**Spiritual care providers — Spiritual care providers may be chaplains who work in healthcare settings such as hospitals, hospices, and long term care facilities, or members of the community (eg, clergy, parish nurses, spiritual directors). All are trained to address the spiritual and existential issues faced by patients in the context of serious illness and death. However, there are some differences in the focus and capabilities of different types of spiritual care providers: Chaplains, who may be ordained clergy or lay persons, are certified by one of five organizations after they complete a two-year training program called Clinical Pastoral Education (CPE) [24]. Chaplains are qualified to work with patients of any religious denomination, as well as with those who are not religious or who don't identify themselves as spiritual. Non-chaplain clergy typically provide more religiously oriented care, usually with a patient of the same religious denomination. Pastoral counselors are mental health counselors with an advanced-degree (masters, PhD) who have additional training in spiritual, existential and religious issues. Spiritual directors work with patients to deepen their relationship with the divine power/higher being/transcendent, however the individual patient understands that concept.
Assessment — Routine inquiry about spirituality should be incorporated into the initial or interim history [18,25,26]. A spiritual history tool with the acronym FICA (which stands for Faith/beliefs, Importance/Influence, Community, Address in care) can be a helpful starting point to open a conversation with patients about the importance of their beliefs, faith community, and their intersection with health care (show figure 2) [29]. Other clinically useful assessment tools include HOPE [36] and SPIRIT [38]. Another potentially useful tool is the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) instrument [30], although this tool is used mainly for research studies.
Spiritual issues should be periodically readdressed over the course of the illness because of their dynamic nature [27]. Clinicians should be particularly sensitive to comments that might indicate spiritual need or distress. Often, patients express spiritual need with discernible cues such as fear, despair, desire for a hastened death, hopelessness, feeling useless or isolated, loss of meaning or dignity, or death anxiety [13,28]. These cues should be followed up with further discussion, support and appropriate referral.
Management of spiritual issues — A practical guide for discussing and managing spiritual and religious issues that arise during end of life care is available from a working group on religious and spiritual issues at the end of life [19]. It details active listening and supportive dialogue to help patients work through existential issues and find peace. Important goals for the clinician are to listen carefully and empathetically, clarify the patient's concerns, beliefs and spiritual needs, be sensitive to comments that may indicate spiritual distress, and to mobilize supportive resources such as spiritual care providers, when necessary (see above).
**Importance of symptom control — Physical symptoms are common at the end of life, and if severe or uncontrolled, may impact psychological well-being and quality of life. Many terminally ill patients report that physical discomfort is one of their greatest concerns as they face the prospect of death. Effective management of physical symptoms (particularly pain) can help allay patient's fears, and is essential in addition to addressing issues related to spiritual distress.
Pain is typically multifactorial, with physical, emotional, social, and spiritual components. Each dimension must be addressed. A patient may appear to suffer from unrelenting physical pain and, even though appropriate medication is given for the physical pain, the patient continues to be in distress. Emotional, social or spiritual pain or distress may be contributing to the expression of pain. It is therefore important to address all dimensions of pain and other symptoms, including the spiritual dimension, in order to provide the patient with optimal symptom management.
The clinician-patient relationship — An important component of spiritual care has to do with the relational aspect of the healthcare professional-patient partnership [19,32]. All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. Compassion means "to suffer with", and to render compassionate care requires a commitment on the part of the healthcare professional to be a partner with the patient in the midst of their suffering. This means: Being fully present and attentive to the patient during the time that the healthcare professional has with that patient. Creating an atmosphere of trust where patients and their family members can share their deepest concerns. Instead of focusing on agenda-driven conversations about treatments and outcomes, being more open to the patient and listening to his or her concerns, beliefs, hopes, fears, and dreams. The focus of care should be on the whole person, including the physical, emotional, social and spiritual aspects of the individual. Treatment plans should be formulated that incorporate what is important to the patient.
An important component of this exchange is listening fully to the patient's story: who they are, what they value, how they make decisions, who is important in their lives, what gives their lives meaning, and how they understand illness and dying. Giving voice to patients who cannot speak for themselves. This comes from either knowing the patient from previous clinical encounters, or learning enough about him or her from family, friends, and/or their spiritual or religious communities to be able to defend what is important to them, even if it conflicts with what may be the recommended evidence-based course of action. Focusing on the inherent dignity of all people regardless of their physical condition. Providing the patient and his or her family with opportunities for closure, forgiveness, and the best quality of life that can be achieved.
PRAYING WITH PATIENTS — Some patients may request that the healthcare professional pray with him or her. The extent to which this is possible depends on the clinical setting and circumstance and the individual beliefs of the patient and healthcare professional. Clinicians or other healthcare professionals should never feel obliged to pray with patients; some clinicians and healthcare professionals may feel comfortable with the requests, while others may not. A clinician or healthcare professional should never coerce a patient into praying or into accepting the prayers of the clinician. That could potentially violate the trust a patient places in the clinician and be outside the boundaries of legitimate medical practice [33,34].
Christianity — Especially with dying patients, a request for the helath care professional to pray with him or her is usually very profound for the patient. A clinician or healthcare professional can sit by in silence as the patient prays in the patient's own language or tradition. Alternatively, the clinician or healthcare professional can suggest that a chaplain be invited to lead the prayer.
Islam — Doctors may pray for patients, and they are encouraged to. Patients may also pray either for themselves or for other fellow patients or family mebers as it is believed that the prayers of suffering patients are especially welcomed by God because of their suffering. Praying may either be performed individually or in a group.
Hinduism — The Hindu religion does not have specific guides on issues of physicians praying together with patients.
PRACTICES OF MAJOR WORLD RELIGIONS — As noted above, most patients express their spirituality in the form of religious beliefs and practices. What follows is a brief description of the major world religions, and individual issues within each faith that impact on healthcare decision making, and how patients respond to serious illness and dying [6,35].
Buddhism — Buddhism is a non-theistic world religion that exists in several basic forms and many ethnic variations. The Buddha is not worshipped as a God; instead, his life and teachings are seen as a model to follow.
The Four Noble Truths, the primary teachings of the Buddha, are as follows: Life is ultimately unsatisfactory because of birth, sickness, old age, and death. The desire to cling to and hold on to the pleasant, and push away the unpleasant is a cause for suffering. Nirvana is the end of desire, craving, clinging, and suffering. The Noble Eightfold Path is the way leading to the end of suffering. The path consists of right view, right intention, right speech, right action, right livelihood, right effort, right mindfulness, and right concentration. This path combines personal discipline, mental purification, and wisdom to achieve ultimate happiness and a skillful way of living.
**Meaning of suffering — Buddhists believe that life is filled with pain and suffering, but that suffering can be overcome. Suffering originates from the mistaken belief that one can somehow hold on to all the good, and push away all the bad. Buddhists use precept practice (ie, the practice of avoiding taking of a life, the avoidance of taking what is not given, the avoidance of sexual misconduct, lying, consumption of intoxicants in a way similar to the ten commandments) and meditation practice to achieve freedom from suffering, and ultimately nirvana (the end of suffering). When the Buddhist awakens to the ultimate reality of nirvana, desire and craving fall away, and suffering is ended. Nirvana, the end goal of life, is achieved during life but some will not achieve it while alive but will achieve pari-nirvana after death.
**Spiritual practices — Meditation, contemplation, precept practice, Yoga, and chanting provide guidance, comfort, and meaning to Buddhists.
**Dietary restrictions — Different branches of Buddhism have different dietary regulations.
**Death — In Buddhism, there is a belief in rebirth, heaven, hell, and pari-nirvana (nirvana after death).
The dying person's state of mind is very important in the Buddhist religion. To help patients achieve peace of mind, family, friends and monks read religious texts and repeat mantras to the dying person. Some Buddhists believe that the dead person's consciousness remains near to or within the body for several days, so monks chant from sacred texts to assist the dead person's passing into the next life.
**Ethical issues — Buddhists believe that it is good to continue living, but when the mind is no longer alert or the person is in excessive pain, a natural death is preferable. Allowing a person to die a natural and peaceful death is important.
Christianity — Christianity, which originally began as a Jewish sect, is a monotheistic religion that is centered on the life and teachings of Jesus Christ. Christians believe in the doctrine of the Holy Trinity, which affirms that there are actually three persons in one God – Father, Son (Jesus Christ) and Holy Spirit. Most Christians believe that Jesus is both fully divine and fully human. A basic tenet of Christianity is that Jesus, by his life, death, and resurrection (return to the divine), has broken the bonds of death and won eternal life for all. Following Christ's example, Christians strive to develop unconditional love for God and other people.
Guidance and inspiration come from the Scriptures (Old and New Testaments), and from the traditions of the faith community. The words of the Gospels provide a framework for living a good Christian life.
There are several traditions of Christianity, such as Roman Catholic, Anglican, various Protestant denominations, and Evangelical groups.
**Suffering — Jesus Christ provides a different model of suffering, in that His death and suffering is the means of redeeming humankind. This does not mean that suffering is to be endured as if it were a test of one's faith but rather it is accepted because by Jesus' suffering the effects of sin and evil have been removed. By sharing in His suffering, the Christian deepens his or her union with God on a mystical level, as St. Paul wrote: "We are always carrying about in the body the dying of Jesus so that the life of Jesus may also be manifested on our body" (2Cor 4:10). This does not deny that people have pain but it does help them cope with it.
Some Christians see suffering as a punishment for sin, but many others do not see a causal relationship.There are many variations in how Christians come to understand this for themselves. Whether the illness is an opportunity for purification and redemption or whether it is just a part of nature we have to cope with is much debated. In the midst of the debate is the life of Christ, who shows us that pain and suffering, and even death, can be transcended. In that message, there is hope for humanity.
**Spiritual practices — Prayer, sacraments, rituals, meditation, and formal religious services (such as masses) offer comfort and meaning, as well as an opportunity to express community worship.
**Dietary restrictions — In Christianity, diet varies with tradition. Some people choose to fast on particular religious holy days. Catholic Christians fast and abstain from eating meat on Ash Wednesday and Good Friday. Some but not all Catholics also abstain from meat on all the Fridays of the year. Hospitalized or ill patients are excused.
**Death — In Christianity, death is seen as a natural part of life. Because Christians believe that an important goal of living a good Christian life is to achieve "eternal life" with God, some Christians welcome death as the opportunity to realize this full union with God.
The Christian belief in the afterlife is based on the resurrection of Christ - that the Christian will also be raised and united with God in eternity.
Family, friends, priests, or ministers pray or sing at the bedside of the dying person. For Catholic Christians, the sacrament of the Anointing of the Sick or the prayer ritual called Viaticum brings peace and comfort.
After death, practices vary among the different Christian traditions, such as wake services, funeral masses, and graveside blessings. In Catholicism, people offer masses in remembrance of loved ones for many years after the person has died, particularly on the anniversary of their death.
**Ethical issues — The influence of religious tenets on end of life care and organ donation decisions vary. Most Christians place emphasis on respect for and value of life but also view quality of life and dignity of the human person as central to decision making.
Islam — Islam is a monotheistic religion that is based on the teachings of the Prophet Muhammed. Muslims believe in one God (Allah) who is all-powerful, compassionate, and immortal, and that Muhammed is his last messenger. As in Christianity, after death, the soul is judged by Allah and remains in either heaven or hell. Guidance is provided by the Koran, prayer, rituals and fasting.
**Meaning of suffering — Suffering is caused by alienation from the will of Allah and relieved by total surrender to His will, as embodied in the Koran.
**Spiritual practices — Muslims believe in the Five Pillars of Islam (the testimony of faith, ritual prayer several times daily, obligatory almsgiving, fasting and pilgrimage to Mecca, designated as the holy city of Islam by Muhammed). The Ten Commandments, and the Golden Rule as principles to live by. The daily required periods of prayer are important for the spiritual well-being of Muslims.
When a patient is ill, he is still required to perform the five daily prayers by prostration and bowing as long as his condition allows. When he becomes too ill for physical exertion, prayer can be performed in the best position that is allowed by his condition.
Mosques are places of worship, learning and meditation. Moslems are encouraged rather than mandated to attend mosque services not only to attain a higher level of spirituality but to also share a sense of community with their fellow Moslems.
**Dietary restrictions — Most Muslims follow rigid dietary guidelines (no pork, no alcohol) and are required to wash specific parts of the body before each of the required daily periods of prayer.
**Death — Creation, death, and resurrection are linked. Life is viewed as a time of preparation for the soul to pass into life after death. To struggle against death is viewed as resisting the will of Allah.
Muslims who are dying usually want to lie facing toward Mecca. When a Muslim is dying, family members repeat prayers, read Islamic scripture, and encourage the patient to repeat the statement of faith. Islam encourages attending funeral services as a meritorious act, whether or not those who participate in the services personally knew the deceased. Many services may be held at the same time in different places for the same person. These services are considered spiritually beneficial for the dead, as well as for the people who participate in them.
The dead are buried without unnecessary delay, and burial rites are simple and austere. The dead are buried so that their heads are directed toward the city of Mecca. When entering the cemetery one recites a special greeting to the deceased: "Peace be upon all of you, all people of graves!".
**Ethical issues — Human life is of the highest value in Islam. It is permissible to use life support to save and extend life. The purpose of aggressive medical intervention is to maintain life but not to cross the line and clearly interfere with the will of God and the natural course of life and death. Physician-assisted suicide is prohibited. While it is not permissible to disconnect life support, it is also not permissible to cause harm to the patient with equipment or drugs when the futility of such treatment is established by the medical team.
Hinduism — Hinduism is a very complex faith. It encompasses a wide variety of beliefs, practices, and mythological stories of gods and goddesses, all of which have deep meaning and significance for Hindus. Hinduism is the majority religion in India, Nepal, and in the island of Bali (Indonesia). There is a substantial minority population of Hindus in Malaysia, Singapore, Fiji, Mauritius, Trinidad, Guyana, and Surinam.
A basic tenet of Hinduism is that the true core of every individual being is a spiritual entity called the soul. This soul is not created by a God but is considered to be co-eternal with Him. The soul, because of its primal ignorance about things spiritual, is drawn toward the material world. This ignorant materialistic orientation of the soul creates desires, which in turn make the soul commit selfish deeds.
The effects of these deeds (karma) accrue to the soul, and upon the death of the body, cause it to be reborn into another body in order to experience the consequences of its past deeds. Since the soul is gifted with free will by God, it ignorantly commits more selfish acts, thereby ensuring its rebirth again and again. To break from this seemingly endless cycle of births and deaths, the soul has to become spiritually oriented. This is called enlightenment (viveka). When this is achieved, the soul performs only selfless deeds which do not accrue any new karma to the soul. Once the previously accrued karma is exhausted, the soul is forever freed from the cycle of rebirths and deaths. According to a major school of Hindu thought, the freed soul then merges with God, just like a drop of water merges into the ocean.
**Meaning of suffering — Hindus believe that suffering is caused by karma, and is the direct result of an individual's bad deeds that were carried out either in this life or in a past life. Suffering can be either physical or mental.
**Spiritual practices — Hindus have four types of spiritual practices. These are: Devotion to God or gods (bhakti) Performing selfless good deeds (karma) Studying holy texts (jnana) Meditating on God or gods (dhyana)
A combination of these four is also acceptable.
**Dietary restrictions — Most Hindus are vegetarian, avoiding all meat and fish. They believe that the taking of another life for one's own nourishment is wrong, and that making another living being suffer is creating bad karma for oneself. Furthermore, the bad "vibes" emanating from another living being that is about to die will have an effect upon one's own spiritual well-being. Some Hindus will not even eat onions or garlic, not only because of their odor (which is viewed as unpleasant), but also because these foods are said to be unwholesome to one's spiritual progress.
**Death — Death signifies only death of the body, and separation of the eternal soul from the body. Depending upon the spiritual state of the deceased individual, the soul will either reenter another body or attain salvation. The mind accompanies the soul from one lifetime to the next. Because of the mind's ignorance about the soul, it is unable to know its past lives. However, when the soul is about to attain salvation, it gets permanently separated from the mind as well. To summarize: In life — soul plus mind plus body At death — soul plus mind are separated from the body In salvation — soul separated forever from mind and body
At the death of a Hindu, it is important to do the following: Remove the dead or dying individual from the bed; place him/her on the ground Pour holy water (previously brought from the temple and kept in a bottle on the bedside table) into the mouth of the dying individual Recite the mantra of the favorite god of the dying individual Light a lamp at the head of the corpse when the person dies
Orthodox Hindus consider death and touching of the corpse as highly polluting. Death rites are performed by the priest. Funeral rites last for 3, 10, or 13 days, or a full year depending on the orthodoxy of the family.
**Ethical issues — Mercy killing, assisted suicide, and suicide are disapproved of, but allowing "nature to take its course" is acceptable. Having a living will and organ donation are both individual choices.
Judaism — One of the oldest world religions, dating back to Abraham in 1700 BCE, Judaism believes that every person is created in the image of God and carries that divine worth throughout life. All people are part of the Covenant God made with Noah; Jews are additionally part of the Covenant God made with the People Israel. God's commandments, announced first in the Torah (the Five Books of Moses) and then interpreted and applied by rabbis throughout the generations, help Jews to live a holy life dedicated to God and to God's mission for them. They seek to repair the world (tikkun olam) in all the ways it is broken – illness, poverty, ignorance, prejudice, etc.
**Meaning of suffering — Suffering has no particular spiritual connotation. It is to be avoided as much as possible. Part of the way Jews attempt to repair the world, in fact, is by alleviating pain and suffering, their own and that of all other humans.
**Spiritual practices — Whether selected from the traditional prayer book (the Siddur) or created on one's own, prayer is a staple of Jewish spiritual life. Another is study of Jewish sacred texts – the Bible, Mishnah, Talmud, or other Jewish literature. People visiting the ill may help them create a Jewish ethical will, which can be in writing or on audiotape or videotape, in which the person tells the family story, describes what is important to him or her (hence the name "ethical will"), articulates hopes for the future of the family and the world, and expresses love. Visitors can help patients create one by asking questions that call up memories of the patient's family, values, and life.
Fasting is practiced during the solemn holy day of Yom Kippur, but is excused for severely ill patients, if intake of food is essential to life and well being (the concept of pikuach nefesh, or saving of the specific life, which supersedes all other religious mandates).
**Dietary restrictions — Traditional Jews observe the dietary restrictions known as Kashrut; they "keep Kosher." That means that they eat only those fish, fowl, and animals allowed in Leviticus 11 and Deuteronomy 14 – specifically, fish with scales and fins (no shell fish), domestic fowl (chicken, turkey, etc. – no birds of prey), and animals whose hooves are parted and who chew their cud. Moreover, fowl and animals must be slaughtered in a specific way, the blood must be drained from the meat, and no dairy products may be served with a meat meal. Typically in a hospital setting this means that Jews who keep kosher must be given meals certified as kosher by a rabbinic authority. Not all Jews keep kosher. Some are vegetarian.
**Death — "There is a time to be born and a time to die" (Ecclesiastes 3:2). Although Judaism demands that everything be done medically to save life and health, it recognizes that death is a natural part of life. Jews focus on improving things in this life, but Judaism does include beliefs about life after death, in which good will be rewarded and evil punished.
After death, the Hevrah Kaddisha ("the holy society") prepares the body for burial. Men deal with male bodies, and women with female bodies; modesty is preserved even in death. The body is washed and clothed in linen shrouds (the same clothing for everyone, indicating equality in death). Someone stays with the body from the moment of death until burial, reciting Psalms. The body is ideally buried the same day before sundown, or as soon thereafter as is possible.
Traditional Judaism does not permit embalming or cremation. Autopsy is also prohibited unless required by law, or in situations where there is clear and direct evidence that the resulting information would provide benefit to the deceased. In other words, for traditional Jews, an autopsy to "benefit future patients" or medical science in general would not be acceptable.
The funeral service consists of eulogies and prayers. After the funeral a seven-day period of mourning (Shivah, seven) ensues, during which time people come to the mourners' home both morning and evening to pray and share with the mourners memories of the deceased. Traditional Jews do not leave the house during that time, and mirrors in the home are covered.
After burial, mourners are required to recite the kaddish prayer twice a day for 11 months, and this requires a minyan, or congregation of at least 10 adult Jews. During these 11 months, traditional Jews will not attend joyous or entertaining events where music is being played (eg, concerts, movies, wedding receptions).
**Ethical issues — Rabbis differ on issues of medical ethics at the end of life. Most prohibit assisted suicide but allow the withholding or withdrawal of life support systems. For some, that includes the removal of artificial nutrition and hydration. Donation of a person's organs for transplant is encouraged.
SUMMARY — Spiritual and religious beliefs, values, and practices play a significant role in the lives of patients who are seriously ill and dying.
Some important considerations for physicians and other healthcare professionals regarding spirituality include the following: A spiritual history should be recorded as part of a new patient evaluation, and spiritual issues readdressed periodically through the course of the illness. A spiritual history tool such as FICA (show figure 1) can be a helpful starting point to open a conversation with patients about spiritual issues. For patients facing the end of life, spiritual care is interdisciplinary collaborative care, and requires the participation of all members of the healthcare team. Clinicians should clarify the patient's concerns, beliefs, fears, and spiritual needs, and be sensitive to comments that may indicate spiritual distress. Active listening and supportive dialogue may help patients work through existential issues and find peace. Patients who are in spiritual distress should be referred to certified and trained spiritual care professionals such as chaplains, spiritual directors, pastoral counselors and clergy. All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. This includes being fully present and attentive to the needs of the patient and all aspects of the patient's suffering—the physical, emotional, social and spiritual, and creating an atmosphere of trust where patients can share their deepest concerns. Clinicians should be knowledgeable about and sensitive to the individual death practices and customs that characterize the major world faiths. Attending funeral services for patients who have died may mean a great deal to the family, but may also bring closure to the healthcare professional.
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eace:You answered my reply!
