Spirituality leaps to forefront at end of life

Make connection early to build spiritual foundation

"When patients approach the end of life, especially those who know it, the future is no longer a point of concern other than the fear of the process of dying or fear of the pain," says Karen Kent-Metteer, MDiv, lead chaplain at City of Hope National Medical Center in Duarte, CA. What becomes important is the patient’s past, current relationships, and spirituality. The past is the person’s identity; relationships are what is important at the present time; and spirituality provides hope for the future. A person’s particular faith is what gives purpose and meaning to his or her life in this situation, she explains.

Yet spirituality is an aspect of the experience of death and dying that often is overlooked at medical facilities. A chaplain may be called to a patient’s bedside at death, but that relationship should begin with a spiritual assessment at the time of the diagnosis of the terminal illness.

"I always ask, what is your faith background?’ It is a very generic statement and it doesn’t give any indication of religion. People always know what I am talking about," says Kent-Metteer. It’s important to find out where people get their spiritual support, she explains.

At the end of life, if people are not practicing any spirituality at the time of their diagnosis, they usually go back to their roots. Even if they weren’t raised in a family that practiced any kind of religion or spiritual faith, they will often remember an uncle, grandmother, sister, neighbor, or friend who was spiritually influential. This influence can act as a source of comfort, bringing meaning and hope to the situation.

For support, terminally ill patients need people who represent their faith background to be there to reaffirm them, says Kent-Metteer. People often have doubts that God can accept them because they feel they have not been faithful or they are angry with God. "They need a trained chaplain to educate them on the facts of their own theology and to reassure them within the context of their own theology," she says. Family members who are close to the patient experience the same sort of spiritual crisis and require the same type of counseling.

"It is important for patients to come to terms with their death and to figure out what their spiritual beliefs are. It makes a difference between a good death and a bad death," says Kent-Metteer. Spiritual conflict and anger seem to affect physical reactions to pain levels, agitation, and anxiety, she explains. If the patient is at peace, the situation is better for the family as well as the patient.