End-of-Life Issues: Spirituality

  • Cynthiane J. MorgenweckEmail author


There is an increasing emphasis in medicine for healthcare providers to treat the whole patient. Whole patient care includes the physical, psychosocial and spiritual care of the patient. Contemporary medicine has focused on the physical illnesses of the patient, creating a large armamentarium of tools to combat disease processes. In addition, addressing the spiritual needs of critically ill patients is an important part of intensive care, particularly when the patients are dying in the hospital. This chapter will describe some differences between spirituality and religiosity, suggest some self-education tactics for physicians interested in expanding their understanding of spirituality and discuss approaches to some common requests of a spiritual nature in the intensive care unit (ICU).


End-of-Life Spirituality Religion Ethics Prayer 


  1. 1.
    Rothman DJ. Where we die. N Engl J Med. 2014;370(26):2457–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Aslakson RA, Curtis JR, Nelson JE. The changing role of palliative care in the ICU. Crit Care Med. 2014;42(11):2418–28.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cook D, Rocker G. Dying with dignity in the intensive care unit. New Engl J Med. 2014;370(26):2506–14.CrossRefPubMedGoogle Scholar
  4. 4.
    The Joint Commission. Spiritual assessment. 2008. Revised 24 Nov 2008. Accessed 16 May 2015.
  5. 5.
    Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med. 2007;35(2):605–22.CrossRefPubMedGoogle Scholar
  6. 6.
    Jaul E, Zabari Y, Brodsky J. Spiritual background and its association with the medical decision of DNR at terminal life stages. Arch Geron Geriatr. 2014;58(1):25–9.CrossRefGoogle Scholar
  7. 7.
    Kinzbrunner BM. Jewish medical ethics and end-of-life. J Palliat Med. 2004;7(4):558–73.CrossRefPubMedGoogle Scholar
  8. 8.
    United States Conference of Catholic Bishops. Ethical and religious directives for Catholic Health Care services. 5th ed. 2009. Accessed 16 May 2015.
  9. 9.
    Al-Shahri MZ, Al-Khenaizan A. Palliative care for Muslim patients. J Support Oncol. 2005;3(6):432–6.PubMedGoogle Scholar
  10. 10.
    Ankerry RA, Clifford R, Jordens FC, Kerridge IH, Benson R. Religious perspectives on withdrawal of treatment from patients with multiple organ failure. Med J Aust. 2005;183(11/12):616–21.Google Scholar
  11. 11.
    Pew Research Center. “Religious groups” views on end-of-life issues. 2013. Accessed 16 May 2015.
  12. 12.
    Bulow HH, Sprung CL, Reinhart K, Prayag S, Du B, Armaganidis A, Abroug F, Levy MM. The world’s major religions’ points of view on end-of-life decisions in the intensive care unit. Intensive Care Med. 2008;34(3):423–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Puchalski C, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3(1):129–37.CrossRefPubMedGoogle Scholar
  14. 14.
    Sulmasy DP. Spirituality, religion and clinical care. Chest. 2009;135(6):1634–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Groopman J. God at the bedside. N Engl J Med. 2004;350(12):1176–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Richardson P. Spirituality, religion and palliative care. Ann Palliat Med. 2014;3(3):150–9.PubMedGoogle Scholar
  17. 17.
    Pesut B. A conversation on diverse perspectives of spirituality in nursing literature. Nurs Philos. 2008;9(2):98–109.CrossRefPubMedGoogle Scholar
  18. 18.
    Todres DI, Catlin EA, Thiel MM. The intensivist in a spiritual care training program adapted for clinicians. Crit Care Med. 2005;33(12):2733–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Saguil A, Phelps K. The spiritual assessment. Am Fam Physician. 2012;86(6):546–50.PubMedGoogle Scholar
  20. 20.
    Sulmasy DP. Spiritual issues in the care of dying patients: “…it’s okay between me and God. JAMA. 2006;296(11):1385–92.CrossRefPubMedGoogle Scholar
  21. 21.
    Fitchett G. Next steps for spiritual assessment in healthcare. In: Cobb M, Pulchalski CM, Rumbold B, editors. Oxford textbook of spirituality in healthcare. New York: Oxford University Press; 2012. p. 299–305.CrossRefGoogle Scholar
  22. 22.
    Yardley SJ, Walshe CE, Parr A. Improving training in spiritual care: a qualitative study exploring patient perceptions of professional educational requirements. Palliat Med. 2009;23(7):601–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Marie Curie Cancer Care. Spiritual and religious care competencies for specialist palliative care. 2003. Accessed 6 Jan 2015. p. 4–8.
  24. 24.
    Coulehan JL, Platt FW, Egener B, Frankel B, Lin C, Lown B, Salazar WH. “Let me see if I have this right…”: words that help build empathy. Ann Intern Med. 2001;135(3):221–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Quill TE, Arnold R, Back AL. Discussing treatment preferences with patients who want “everything”. Ann Intern Med. 2009;151(5):345–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Brett AS, Jersild P. “Inappropriate” treatment near the end of life: conflict between religious convictions and clinical judgment. Arch Intern Med. 2003;163(14):1645–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Eck DL. Chapter 7: Is our god listening? In: Encountering god: a spiritual journey from Bozeman to Banaras. Boston: Beacon Press; 1993. p. 166–99.Google Scholar
  28. 28.
    Sulmasy DP. Ethical principles for spiritual care. In: Cobb M, Pulchalski CM, Rumbold B, editors. Oxford textbook of spirituality in healthcare. New York: Oxford University Press; 2012. p. 465–70.CrossRefGoogle Scholar
  29. 29.
    Pinches C. Miracles: a Christian theological overview. South Med J. 2007;100(12):1236–42.CrossRefPubMedGoogle Scholar
  30. 30.
    Yu C. Eye on religion: miracles in the Chinese Buddhist tradition. South Med J. 2007;100(12):1243–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Khan F. Miraculous medical recoveries and the Islamic tradition. South Med J. 2007;100(12):1246–51.CrossRefPubMedGoogle Scholar
  32. 32.
    Mackler AL. Eye on religion: a Jewish view on miracles of healing. South Med J. 2007;100(12):1252–4.CrossRefPubMedGoogle Scholar
  33. 33.
    DeLisser HM. A practical approach to the family that expect a miracle. Chest. 2009;135(6):1643–7.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Sulmasy DP. Distinguishing denial from authentic faith in miracles: a clinical-pastoral approach. South Med J. 2007;100(12):1268–72.CrossRefPubMedGoogle Scholar
  35. 35.
    Orr RD. Responding to patient beliefs in miracles. South Med J. 2007;100(12):1263–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Center for Bioethics and Medical HumanitiesMedical College of WisconsinMilwaukeeUSA

Personalised recommendations