End of Life Issues

Caring for the Dying & Physician-Assisted Suicide Issues

Discussing Religious and Spiritual Issues at the End of Life - A Practical Guide for Physicians
Bernard Lo, MD; etc. for the Working Group on Religious and Spiritual Issues at the End of Life
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.
1. 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.
2. 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.
3. 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.
JAMA. Feb. 13, 2002;287:749-754
Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers - Ezekiel J. Emanuel, MD, PhD; Diane L. Fairclough, DPH; Linda L. Emanuel, MD, PhD
JAMA. Nov. 15, 2000;284:2460-2468
Psychiatric Aspects of Excellent End-of-Life Care
Academy of Psychosomatic Medicine - Position Paper
In Search of a Good Death: Observations of Patients, Families, and Providers -Karen E. Steinhauser Ann Intern Med. May 16, 2000;132:825-832.
Assisted Suicide: Finding Common Ground -- L. Snyder and A.L. Caplan
Annals of Internal Medicine, 21 March 2000. 132:468-469
Attitudes and Practices Concerning the End of Life
A Comparison Between Physicians From the United States and From the Netherlands - Dick L. Willems
Arch IM Jan.10, 2000;160:63
Caring for the Dying -- Congressional Mischief
The New England Journal of Medicine -- December 16, 1999 -- Vol. 341, No. 25
The Supreme Court and physician-assisted suicide -- the ultimate right.
The New England Journal of Medicine -- January 2, 1997 -- Vol. 336, No. 1:50
Legalized physician-assisted suicide in Oregon -- the first year's experience.
Chin AE, Hedberg K, Higginson GK, Fleming DW.
The New England Journal of Medicine -- February 18, 1999 -- Vol. 340, No. 7:577-83.
Legalizing assisted suicide -- views of physicians in Oregon.
Lee MA, Nelson HD, Tilden VP, Ganzini L, Schmidt TA, Tolle SW.
The New England Journal of Medicine -- February 1, 1996 -- Vol. 334, No. 5:310-5.
Oregon's Death With Dignity Act - 14 Months and Counting - Howard Wineberg, PhD Arch IM Jan.10, 2000;160:21

Coming to terms with grief and loss
Can skills for dealing with bereavement be learned?
Kathryn J. Zerbe, MD; Deborah L. Steinberg, MD
VOL 108 / NO 6 / NOVEMBER 2000 / POSTGRADUATE MEDICINE

Other Websites:

MD Netguide End-of-Life Medsites
Death and Dying in America
National Hospice Foundation
Hospice Web
Last Acts
Institute for Health Care Improvement: Improving Care at the End of Life
European Journal of Palliative Care Online
Med-Sites

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