Spiritual Concerns

Patients who are dying often ask what their life means, who they really are, why illness has affected them, and what will happen to them when they die. Patients may question God's existence and love or may feel abandoned by God. Some feel guilty or worry that their behavior is what caused their illness. Thus, dying can precipitate a spiritual crisis. Unresolved spiritual distress can lead to despair and hopelessness, which in turn can lead to anxiety, depression, and, for some, a desire to die or to commit suicide. Patients need help working through this distress so that despair can be transformed into hope and serenity. Dying patients do not always need to hope for a cure; instead, they can hope for having time to reconcile with loved ones, sharing time with family and friends, finishing a personally important project, or making peace with God or a higher power. When spiritual distress is relieved, patients can die more peacefully.

Dying patients may review their life; this process may elicit positive and negative emotions as they try to resolve past hurts, reexamine relationships, and recount accomplished goals. Belief in an afterlife and possible reunion with loved ones can comfort patients and their family members and friends. Physicians, nurses, other health care practitioners, social workers, chaplains, family members, and friends can listen and offer support; doing so may help them deal with their own feelings of loss.

Patients who are religious need opportunities for prayer, devotional reading, and religious ritual, such as receiving a chaplain's blessing. Other spiritual resources may include meditation, guided imagery, music, and art. Patients may need physical space and privacy for these practices. Hospice provides an excellent environment for spiritual practices. Each hospice team includes chaplains and others who are skilled at helping patients, family members, and friends with their spiritual needs.

The serious matter of a patient's medical condition should be discussed openly so that religious and cultural traditions are respected and can be accommodated if possible. The discussion may include particular rites before and at the time of death and cleaning and preparing the body after death. Health care practitioners should enquire sensitively about these traditions because such traditions vary greatly in modern society and members of the care team cannot be familiar with all of them.

This topic was last updated July 2006.