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Abstract: The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). 

Introduction: The spiritual, religious, and existential aspects of care constitute one of the eight core domains of palliative care (National Consensus Project for Quality Palliative Care, 2013; Kelley & Morrison, 2015). Multiple studies have shown religion and spirituality (R/S) to be important factors that influence medical decision making in the event of a terminal illness, especially in non-Caucasian populations (Ehman et al., 1999; Koenig, 1998; Balboni et al., 2007; MacLean et al., 2003). About half of the patients in ambulatory settings express wishes to interact with their physicians regarding R/S beliefs in a near-death scenario (MacLean et al., 2003). Lack of R/S support has been shown to be widespread in cancer patients of diverse backgrounds (Balboni et al., 2007), which is associated with a significantly lower quality of life (QoL) compared to those whose spiritual needs are adequately addressed. Less than a fifth of the goals-of-care conversations in intensive care units (ICUs) include discussions regarding R/S (Ernecoff et al., 2015). One study of patients with advanced cancer showed a significantly increased likelihood of aggressive EoL measures in patients who received spiritual support primarily provided by religious communities (Balboni et al., 2013). In contrast, patients receiving R/S care from a medical team had higher rates of hospice utilization, fewer ICU deaths, and underwent fewer aggressive interventions. Spiritual support from a medical team is also associated with a better QoL near death (Balboni et al., 2010) and lower costs of care (Balboni et al., 2011).

Despite the overwhelming evidence on the positive impact of appropriate R/S EoL care (El Nawawi et al., 2012), its routine incorporation in clinical practice is lacking. While abundant data are available on the spiritual aspects of the end of life, a gap in the literature has been identified in peer-reviewed scientific publications when it comes to addressing religious beliefs at the end of life. To address this issue, we conducted a systematic review of the empirical evidence on EoL beliefs and practices of those belonging to the five major world religions: Christianity, Islam, Hinduism, Buddhism, and Judaism. To our knowledge, this is the first systematic review on the religious aspects of EoL care that could help clinicians in any specialty (e.g., internists, psychiatrists, oncologists, palliative medicine experts, ICU specialists, psychologists) as well as chaplains and social workers to analyze the specific belief systems of the world’s five major religions.

About the journal:  Palliative & Supportive Care is an international journal of palliative medicine that focuses on the psychiatric, psychosocial, spiritual, existential, ethical, and philosophical aspects of palliative care. Its aim is to serve as an educational resource for practitioners from a wide array of disciplines engaged in the delivery of care to those with life threatening illnesses along the entire continuum of care from diagnosis to the end of life. The journal's scope is broad and relates to all aspects of palliative medicine that do not directly or exclusively deal with the administration of palliative care or hospice services, or with the primary management of pain and physical symptoms in palliative care.

Keywords: End of life, religion, advance directives, euthanasia, artificial nutrition and hydration, autopsy, pain management