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.
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