1. McCurdy, Dennis BSN, RN


Don't substitute your own beliefs for your patient's.


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In The Needs of the Dying, David Kessler writes that the dying person's spiritual approach "should be honored and supported, even if you think it is 'incorrect.' This last exploration is a rite of passage for the soul. It is also a right of the dying to be honored."


Observing death can be powerful, whatever one's beliefs regarding an afterlife or a supreme being. Seeing the "vital spark" extinguished is sobering and stirs many people to contemplate their own mortality. This encourages consideration of spiritual issues, including the purpose of life; the search for meaning; and what, if anything, occurs after death.


Nursing schools and hospitals are addressing the importance of spiritual issues in their programs. The Joint Commission and the American Association of Colleges of Nursing both recommend assessing patients' spiritual beliefs. This helps providers determine the best care options and ensure appropriate support. However, many people find it as difficult to discuss spiritual matters with patients as to address sexual concerns.


People who are firm in their religious beliefs often feel that their pathway is the only one leading to salvation, eternal life, or enlightenment. Caregivers who feel this way could naturally see proselytizing as an extension of their role to provide comfort. This constitutes a subtle, but nonetheless troubling, form of harassment, much as sexual humor and innuendo can create a hostile work environment and constitute sexual harassment. Last year, a Jewish navy veteran threatened to sue the Veterans Affairs Medical Center in Iowa City, Iowa, for attempts to convert him to Christianity. In 2006 the Freedom from Religion Foundation sued Department of Veterans Affairs officials over a spiritual assessment used at their facilities.


Some caregivers, consciously or not, attempt to impose their beliefs on patients and families while they're most vulnerable, which is always inappropriate. Even seemingly harmless statements such as "He's in a better place now" make assumptions about the family's beliefs.

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Topics such as life after death, the existence of God or of the soul, and the greater significance of the patient's life aren't taboo. In fact, such concerns are likely already in the minds of the dying patient, friends, and family. However, caregivers must not use their authority to dominate or direct such discussions.


If patients or family members ask for your thoughts about God or the afterlife, there's nothing wrong with briefly sharing your beliefs. Don't attempt to convert them, but defer to them. Reflect their questions back ("What do you believe happens to us when we die?") and listen to their responses. Then offer to contact their clergyperson or spiritual advisor for further guidance.


Caregivers must realize that a patient's beliefs, even if the patient expresses doubt, are as much a part of the person's identity as our own are for us. True sensitivity to unfamiliar spiritual beliefs is difficult to achieve. To improve your sensitivity, imagine yourself facing imminent death, requiring assistance to meet your most basic needs, and largely dependent on caregivers whose religious traditions and beliefs are dramatically different from your own. How would you feel if such beliefs were frequently mentioned in your presence and discussed as if they were the only correct views?


Our patients who are dying deserve sensitivity, as do their loved ones who struggle to make sense of this process. Religion and spirituality are intensely personal. We must strive to allow our patients to find and travel their own paths to meaning at the end of life.