Very good article! http://www.medscape.com/viewarticle/721360

Medscape: What spiritual issues do patients typically face in end-of-life settings?

Dr. Levy: When approaching death, some patients face loss of control, loss of identity, and loss of self-esteem and self-worth. People wonder about what's next and if they have lived a good life. They may become so debilitated that they feel useless, but this should not be confused with "worthless."

Medscape: Have you observed any differences in the way patients approach terminal illness and impending death based on the role that faith and spirituality have played in their lives?

Dr. Levy: Loss of control is an important determinant of how a patient reacts to terminal illness. The more "in control" a person was throughout life, the harder time he or she will have dying, all other things being equal. "Control freaks" will probably have more difficulty with their own mortality than Mother Theresa. When a person has a better-developed spiritual side, there is a tendency for less anxiety, fear, and apprehension at life's end.

Medscape: What role should the physician play in ministering to the spiritual needs of patients in end-of-life settings?

Dr. Levy: Physicians can assist in ministering to the spiritual needs of patients to the extent they feel comfortable. The more physicians are aware of and comfortable with their own spirituality, the more assistance they can provide.

Medscape: What role should family, friends, clergy, and other healthcare providers play in ministering to the spiritual needs of patients in end-of-life settings? How can the physician best coordinate input?

Dr. Levy: We are called to be ministers to one another. Family and friends are potential sources of comfort. Experts are available in the form of clergy. Regardless of who ministers, this type of assistance is not something that can be generated suddenly, on the spot. People need to have a certain orientation, to come from a certain background in order to have something valuable to offer.

Medscape: When spirituality is appropriately addressed in end-of-life care, what positive benefits can be expected?

Dr. Levy: People find a source of peace and comfort. Robert Frost said that "hope does not always lie in a way out, but in a way through."

Medscape: Are there any harms associated with addressing spirituality in end-of-life care?

Dr. Levy: There may be, but I can't think of any. However, spirituality should not be forced on the unspiritual.

Medscape: What barriers currently exist to physicians and other healthcare providers playing an optimal role in managing spirituality in end-of-life care?

Dr. Levy: The main barriers are lack of knowledge, lack of interest, and lack of time. Many physicians go through at least part of their career believing that they alone are in tight control of themselves, their patients, and their patients' illnesses. This sets very high expectations for the physician of himself or herself, and for our patients.

Medscape: How can these barriers best be overcome?

Dr. Levy: Training in medical school and residency should address the management of spirituality in end-of-life care. Physicians need to learn that not every therapeutic intervention comes from the prescription pad; they gain an additional tool in their therapeutic armamentarium when they recognize the healing power of spirituality.

Medscape: What additional research needs to be done?

Dr. Levy: Future studies should examine how to best use spirituality to enhance not just end-of-life issues, but also other critical life-threatening illnesses.