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Posted: July 23, 2004

Spiritual Caregiving

At the End, Spiritual Well-Being Really Matters

In southwest Broward County, Florida, an 82-year old man lay pondering the ethics of ending his life. Some 18 months earlier he'd been participating in the community and attending temple, but now he was in palliative care for mesothelioma, his lungs failing miserably, debilitated from years of inhaling asbestos as an engineer during World War II.

He was a member of the Hemlock Society, which offered a quick and painless alternative to the painful death he feared. Yet ultimately his decision had little to do with physical pain.

According to a new study published in the British medical journal The Lancet, a person's sense of spiritual well-being makes a huge difference for those facing such decisions. From December 2000 to June 2002, researchers at Calvary Hospital in New York City surveyed 160 cancer patients with less than three months to live who sought palliative care. The patients' attitudes toward death were assessed through scales for spiritual well-being, depression, hopelessness, and suicidality.

The researchers found that patients with a strong sense of spiritual well-being were less likely to desire a hastened death, to feel hopeless, or to be suicidal. Patients with the greatest sense of peace and meaning, as opposed to those who found comfort in religious beliefs, reported the strongest sense of spiritual well-being.

For the man in Florida, that spiritual connection was aided by his hospital chaplain, Thom McLeod. McLeod, who is now the clinical resource for psychosocial spiritual care for VITAS, the nation's largest hospice care provider, spoke with the elderly man repeatedly.

Their initial intellectual conversations gave way to what most pained the man: His born-again Christian daughter feared that he would go to hell and that she would never see him again. "We talked about how both faiths allowed for an afterlife and how through the love and mercy of God, a father and daughter could never be separated," McLeod says. "After that, he began to relax. Even though he was deteriorating, he required less pain medication."

"Seeing psychological distress as a palliative care issue is a novel idea for a lot of people. Many still think in terms of physical symptoms only," says Barry Rosenfeld, Ph.D., associate professor of clinical psychology and one of the study's authors. Rosenfeld is now researching the effectiveness of meaning-centered group therapy, a spiritual intervention to help the terminally ill find peace and meaning before dying.

About two weeks after the calming conversation with McLeod, the man from Broward County died in the most peaceful of settings: at home in his own bed.

This article originally appeared in Spirituality & Health magazine, For subscriptions call 1-800-876-8202 or see Editor Stephen Kiesling and his staff contribute weekly columns, features and articles published every Friday as "Spiritual Caregiving" at Contact staff directly via email at

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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