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.
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Care at the Close of Life EDUCATION GUIDESAgitation and Delirium at the End of Life
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