Spirituality Presents a Paradox in End-of-Life Care

Cheryl Clark, for HealthLeaders Media , May 9, 2013

In her practice at Dana Farber, Balboni says she's seen many times when "this fixation on the possibility of a miracle by both patients and their religious communities makes it difficult to change the focus of care" to deal with symptoms like pain, and to make end of life as comfortable as possible, and away from getting cured.

Medicine as Divine Intervention
"It's like they're saying, 'God is a God of miracles. We'll pray for you that you will be healed of this illness.' And there might be concerns whether choosing not to undergo certain therapies is potentially violating the sanctity of life, and that somehow continuing these therapies is choosing life, as opposed to the assumption—and I've actually heard this from patients—that it would be going against God's will to stop therapies.

"One patient was concerned that stopping chemotherapy would be equivalent to committing suicide, which was against that person's religious beliefs."

Balboni emphasizes that it's not categorically wrong for a terminally ill patient with advanced stage cancer to try experimental drugs, particularly if they are very young. "Often it's very appropriate to choose medical technologies and interventions with the hope of providing better quality of life and better survival," she says.

But if it's at the expense of embracing the kind of spiritual preparation that people need to prepare for at the end of life, well, that's probably not what the patient would want if they could appreciate the gravity of their situation.

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4 comments on "Spirituality Presents a Paradox in End-of-Life Care"

David Dismas (5/14/2013 at 2:16 PM)
Sadly I think that clergy are no more comfortable with death than the rest of the population ... what may appear to be pushing for the miracle may actually be avoiding the obvious at all costs. Fortunately, the hospital and hospice chaplains have [hopefully] worked through their issues with death and are in a better place to help the dying. Alas, I wish there was more outreach by those chaplains to help parish clergy process their issues around death and dying with an end towards better pastoral care.

Rev. Porch (5/10/2013 at 11:36 PM)
It has been my experience as a pastor, that families seeking aggressive care are the same ones who aggressively seek the pastor to be there. Are the researchers making a false assumption about cause and effect? Is there an underlying cause that effects the level of spiritual support and the level of medical care? Does aggressive medical care cause the pastor to show up more often? In my experience the answer is yes. I believe the level of pastor care and medical care are related, but both are the results, not the cause.

Peggy Salvatore (5/9/2013 at 5:11 PM)
This exactly corresponds to an experience I am having right now with my dying uncle. We have a faith-based family, and they are taking extraordinary measures. I found this perplexing, but this explains it.




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