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  • Sept. 12, 2009

    Blog: How faith affects end-of-life decisions

    By Edward T. Creagan, M.D.

24 comments posted

The intersection of faith, belief systems and health is complex and sometimes bewildering. Nevertheless, it's an important topic and one that deserves further examination.

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The "Journal of the American Medical Association" published an excellent study earlier this year that found an association between religious faith and preferences for aggressive end-of-life care. In other words, individuals with positive religious coping seem more likely to request mechanical ventilation and other types of life-prolonging care, compared with individuals who do not have strong religious faith.

I must admit I was surprised by these findings. In my experience, individuals with deeply rooted faith are often willing to forego some of these measures. This study was an excellent reminder that we can't make assumptions about people's beliefs and desires regarding the end of life.

As I reflected on this, I thought back to one particular patient I cared for. He had advanced intestinal cancer. When asked to indicate his religious preference, he wrote "none at all" on his form. At our initial visit, we discussed the trajectory of his illness. He understood and accepted that cure wasn't likely and expressed the desire to be kept comfortable for the time remaining to him. He shared with me that he wished he had spiritual beliefs to provide comfort and consolation. He said he envied individuals who believed, but added "I just don't." His final days in the hospital were comfortable, but he didn't seem to me to be at peace in the same way as I've seen in individuals who have faith or spiritual beliefs.

The lesson here is a simple one: We need to respect others' beliefs and choices, and learn from one another as we face the decisions that arise at the end of life.

What would you like to add to the discussion?

24 comments posted

blog index
  • November 15, 2009 10:09 p.m.

    My father has been in a nursing home for 4 years with Alzheimer's. He is now to the point that we believe he won't make it to next year. We ask ourselves why God won't take him home as he has no quality of life. He was a devote Christian man and we know he will be whole soon. Go thru this w/o God? No way. We are also watching a sister with stage IV lung cancer fight this battle. Where she is on her faith walk, i don't know. But i know i have peace from trusting in a merciful God. Who is my inspiration? My 88 year old mother who walks with God everyday. Her strength is from the Lord. Faith is what brings us strength, comfort, peace and hope for a better life for all. Dying isn't an ending, it's a beginning. Sadness and grief? Yes, we're human. The end? The end of life in these finite bodies, yes. Everlasting life? Yes. Religion has nothing to do with how we face life or death. Faith does. For now we see in a mirror dimly. No one religion has all the answers. Only God and we will get those answers when we cross over.

    - Liz

  • October 31, 2009 11:55 a.m.

    I was once a devout Christian, but being pragmatic I came to the conclusion that religion is merely a way to try and answer the unanswerable. If it brings peace to the believer that is wonderful for them. However, I am 84 years old and am not afraid of death. I think that it is the end - period. I am not fearful, unhappy, or afraid of the unknown as the religious would like to believe. In fact, I am more at peace than I ever was when I was filled with all of the religious doctrines of heaven and hell. I broke my hip, was not near a phone and was afraid I would not be discovered until after my death. I thought I was probably facing death and was not afraid. Of course, I did not die, but it is proof that I will not be afraid when death comes, as it will sooner than later. I have a living will and it clearly states no heroic measures.

    - Darlene

  • October 29, 2009 1:16 p.m.

    iam a born again preacher and i submit that based on my experience with faith and spirituality,a human being can only have true peace both in this life and at its end if and only if their conviction is based upon a true experience with God,not as a being one has heard about but as a reality with whom he/she is daily in contact and whose fellowship one delights in every day of this life. most people may seem to confess what i can call 'band wagon beliefs'-the kind of faith that stands upon the foundation of numbers and associations not personal relationship with the divine.since death is a one-on-one affair between man and death,it remains true that the hypothetical believer remains lonely and desperate in the face of the sense of 'nowhere' or 'no one' he or she is about to confront.this is the real reason behind the loneliness and desolation in the face of death. genuine faith therefore creates a longing and yearning for the face of the unseen companion through life's weary way.faith in the christian victory over death as a result of the death of jesus christ on the cross completely removes all fear from it,even as paul said"death where is your sting?,o grave,where is your victory?. victory over the fear of death therefore comes only through genuine faith and relationship with jesus christ-the one who has victory over it.

    - achilla

  • October 28, 2009 8:31 p.m.

    21 years ago I did hospice care for my mother. I could not have done this work without the grace and strength provided by the Lord God Almighty. I truely know what it "tastes" like to be "carried," as the Footprints poem says. I Know that I will se my mom again because we are both born again Christians. This gives me great comfort.

    - Janice

  • October 28, 2009 11:02 a.m.

    I was involved in caring for my best friend's physical needs during her dying time of uterine cancer. She never accepted that she was dying and her death was excruciatingly and agonizingly painful, yet, she attended church every Sunday and even had a Penacostal preacher and accompaning parishioners pray over her. However, they also told her on her death bed that if she did not repent of her "sins" she would surely die. Her oncologist did not put her on an IV as he said it would "feed the cancer". The oral morphine we administered was ineffective because she could not swallow and her rasping death rattle filled the house for three days. I am haunted by her horrific dying process and the lack of real hospice empathetic care. The day before her passing, I began to read to her from St. John, and her breathing became loud and laboured and I took that as a sign that she did not want to hear it. She was in a coma. Next night she mercifully died.

    - Kaye

  • October 27, 2009 9:38 p.m.

    As a nursing home social worker I must accept all of the different choices that people make about end of life. I would have thought that those whose spirituality leads them to believe that there is something after life might be more accepting of death. More often than not I see children so distressed and guilt ridden that instead of staying true to their parents wishes that they will make choices that even go against what has been put in writing. Personally I believe that if we as a culture talked about death instead of hiding these discussions we would be more accepting that with life comes death. Dr Robert Martensen in his book A Life Worthe Living speaks about the the mortality rate of an 80 year old in the year 1400 AD being exactly the same as the mortality rate of an 80 year old today, despite all of the advances in technology. Death will not evade us.

    - Julie

  • October 25, 2009 9:13 a.m.

    My father passed away 4 wks ago. He was a staunch Christian. Five years ago, he wrote a living will stating he wanted "everything done". Being a nurse, I helped him understand what that meant. He understood and kept it that way. Six months ago, he quit eating for 3 days. It was a scary situation. I approached him about his living will, since the doctors asked me to. He said "it was important then and is important now". He said that if he couldn't eat anymore, he wanted a feeding tube. The doctors kept mentioning that he was becoming more demented, and I should seriously consider making him a "no code". I thought long and hard, and decided that the living will is for those that can't speak for themselves anymore, and I felt I should honor his wishes. When dad went into respiratory arrest on Sept 8, clutching his chest, trying to breathe and voicing fear. I made the decision to take him to the ER. He died one week later. While he was in the hospital, I made decisions about his living will based on his unconsciousness. I got so much harassment from the physicians that it made me heartsick. They were upset that I even brought him to the ER, "I should have left him go". You are right that "we need to respect others' beliefs and choices" and that's what I did for my dad. I will never regret that I tried to honor his requests. I understood the physicians viewpoint...Dad was 92...but dad's decision was that he wanted someone to try. W

    - NJ

  • October 8, 2009 2:29 p.m.

    Dear Anne, Your friend needs someone who will get her to talk about her fears and get them out in the open. Once she can share, the nightmares should stop. We all need to know that someone who loves us shares our concerns and fears. I am having to prepare to leave my family who still needs me, but I have seen them to adulthood and I am so proud of them. The good we have done is what really defines us. I think your friend has so much to celebrate. Remind her of this.

    - Kathryn

  • October 2, 2009 3:24 p.m.

    I have to say that I am not surprised by the findings. I am an ex-Christian who is now a non-believer. I think some Christians focus a lot on the afterlife, and I have often wondered if this mindset could lead to regrets. I also think that the deeply religious also are the least acceptant towards others beliefs. I have no idea what happens after we die, but I'm not afraid of it. The non-religous man sounds like he managed okay, even if he wasn't outwardly accepting.

    - Amy

  • October 1, 2009 8:31 a.m.

    Hamlet: "...Who would fardels bear to grunt and sweat under a weary life, but that the dread of something after death, the undiscovered country from whose bourn no traveler returns, puzzles the will and makes us rather bear those ills we have than fly to others that we know not of?"

    - Carlos

  • September 28, 2009 11:36 p.m.

    I'm pleased to see that there is surprise related to these research findings. I reminds us that we really can't make sweeping assumptions about people - even if we have attached a 'label' them. Thank you for the posting.

    - Kathy

  • September 21, 2009 12:38 p.m.

    Mom (76) has been in hospital/rehab/nursing for 1 year now due to intestinal surgeries and related issues. She and the rest of our huge family are believers and have a strong faith. Doesn't make the decisions any less difficult though. We believe this time on earth is temporary but still live it to it's fullest. Have to trust her wishes and trust that God is in control. It's been hard but peaceful at the same time.

    - Tia

  • September 17, 2009 10:20 a.m.

    "To each his own." We are all going to the same place but on different roads and means of transportation. As Max Erhman wrote: "With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy."

    - Roberta

  • September 16, 2009 10:02 p.m.

    My best friend/"sister of the heart" died on May 13, of this year. I think her faith made mine stronger. She never questioned or spoke much about an afterlife. She just knew that God would be ready to embrace her. It has been difficult for me. I made a special garden for her. I can go there and talk to her like we did on the phone! I feel like I pray deeper because of her. She will always live on through her children, grandchildren, etc...I think God sent some people here as angels. She was one. Why does the most beautiful, colored butterfly flitter around our gardens?

    - Anne

  • September 16, 2009 9:41 p.m.

    I am a relatively healthy 67-year-old woman and I am glad I am "over the hill". I look forward to being in heaven with my Lord who died for my sins and I look forward to being with my friends and family who are already there. I am afraid of pain and suffering, but I am not afraid of dying.

    - Sharon

  • September 16, 2009 8:38 p.m.

    Interesting. I can feel myself changing and feel increasingly tired. I can care for myself, slowly, and have one strong desire yet to do. However, I'm beginning to have doubts about my ability to accomplish my dream. Too many people tell me I can't do it...its too late. Well, I'm not dead yet. God willing and the creek don't rise, I will take this dream trip before I let go... Faith in God...oh, my, yes.

    - Shar

  • September 16, 2009 5:22 p.m.

    As Christians our Faith is everything.For nonbelievers there is no hope and they live in constant fear of the unknown and with lots of insecurities.Fear is not an emotions that God gives us,it comes from the enemy that is why when a Christian leaves this world they go in peace with the hope of eternal life.That and with hope, hope of no more pain,sorrow,fear,illnesses,etc. God Bless You All, Sally

    - Sally

  • September 16, 2009 5:21 p.m.

    My friend Carol is dying from advanced lung Cancer. Initially she had no faith-related beliefs and found acceptance difficult. Later on she found a place of religious faith and seemed to find acceptance easier. The Cancer has now spread into her brain and death is quickly approaching. She now has a calm grace about dying that I admire.

    - Tillie

  • September 16, 2009 4:38 p.m.

    We are all different and our own peace is also whatever in this time of life brings comfort to our mind each of us must decide. The lord put us here and he will help and finally make that choice for us and we will rest. dxydxf

    - connie

  • September 16, 2009 3:11 p.m.

    I have SLE and overlap/IBS/RA etc and great faith in God.I want no medical intervention because when God takes me in his arms then thats ok with me and I don't want to be snatched back.I am not depressed just accepting and loving.

    - sandy

  • September 16, 2009 1:38 p.m.

    I am a Christian and death is the only door to heaven. And heaven is my home. Why in the world would I want to linger in this decaying body when I could be in the arms of my Savior Jesus Christ. Turn the machine off for me!

    - Archie

  • September 16, 2009 10:44 a.m.

    I'm 81 and if I can't take of myself I want to check out.

    - VeracnUvPY

  • September 15, 2009 2:45 p.m.

    Dear Anne, I can offer to you that listening to her, accepting her without providing advice. She may get back on her feet and return to doing what she wants. Believe that she will be alright, everything will be alright.

    - Diane

  • September 13, 2009 11:06 p.m.

    I have been surprised by my friend's nightmares. She is 93, entered a nursing home 35 days ago with a growth on her pancreas. She had a bile duct stent a month ago. As her collegue/friend how can I help ease her anxiety. She still worked until 8/4/09.

    - Anne

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