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A Practical Guide for Physicians

Bernard Lo, MD; Delaney Ruston, MD; Laura W. Kates; Robert M. Arnold, MD; Cynthia B. Cohen, PhD, JD; Kathy Faber-Langendoen, MD; Steven Z. Pantilat, MD; Christina M. Puchalski, MD; Timothy R. Quill, MD; Michael W. Rabow, MD; Simeon Schreiber; Daniel P. Sulmasy, OSM, MD, PhD; James A. Tulsky, MD; for the Working Group on Religious and Spiritual Issues at the End of Life

JAMA. 2002;287:749-754.

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.

Author Affiliations: Program in Medical Ethics, Division of General Internal Medicine, University of California, San Francisco (Drs Lo, Ruston, Pantilat, and Rabow and Ms Kates); Division of General Internal Medicine, Center for Bioethics and Health Law, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Arnold); Kennedy Institute of Ethics, Georgetown University, Washington, DC (Dr Cohen); Center for Bioethics and Humanities, State University of New York Upstate Medical University, Syracuse (Dr Faber-Langendoen); Division of Aging Studies, Institute for Spirituality and Health, George Washington University School of Medicine, St Louis, Mo (Dr Puchalski); Program for Biopsychosocial Studies, Department of Medicine, University of Rochester School of Medicine, Rochester, NY (Dr Quill); Hackensack University Medical Center, Hackensack, NJ (Rabbi Schreiber); John J. Conley Department of Ethics, Saint Vincent's Manhattan, The Bioethics Institute of New York Medical College, New York, NY (Dr Sulmasy); and Program on the Medical Encounter and Palliative Care, Department of Medicine, Duke University, Durham, NC (Dr Tulsky).

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