End-of-life care and spiritual beliefs

The National Institute for Health and Care Excellence has published new guidance calling on healthcare professionals to ask adults in the final days of life about their religious or spiritual beliefs:

“Care at the end of life should be responsive to the personal needs and preferences of the person who is dying. Discussions with the person can identify any existing expressed preferences for care, such as advance care plans, and explore their goals and wishes, preferred care setting, current and anticipated care needs and any cultural, religious or social preferences.”

The accompanying press statement argues that “knowing if someone holds a religious belief can be important for providing the care they desire. For example, someone who is Catholic may wish to receive the last prayers and ministrations”.

Sam Ahmedzai, Emeritus Professor of Palliative Medicine at the University of Sheffield and a specialist member of the NICE quality standard committee said:

“Control of pain and other distressing symptoms is very important for dying people, but good end of life care goes far beyond that. It includes asking about the dying person’s spiritual, cultural, religious and social preferences. Only by attending to these issues and concerns can we deliver truly individualised care for each person and those important to them.”

Cite this article as: Frank Cranmer, "End-of-life care and spiritual beliefs" in Law & Religion UK, 2 March 2017, http://www.lawandreligionuk.com/2017/03/02/end-of-life-care-and-spiritual-beliefs/

16 thoughts on “End-of-life care and spiritual beliefs

  1. Statistically, hospital is a dangerous place, where many people die who weren’t expecting to die when they got out of bed the day they were admitted to hospital, or when they went under general anaesthetic for low-risk (but never NO risk) surgery.

    Recognition to spiritual needs should not be limited to those who are expected to die soon, in all other circumstances staff members risking being fired from their jobs if (for example) they mention God, or prayer, in conversation with patients, or wear religious emblems on their uniforms, as a silent and subtle sign to patients with whom they come into contact that they are open to conversations or prayers with (at least) patients of the same faith as themselves.

    Every patient in a hospital is at an increased risk of death. There is a continuum between those whose increased risk of death is infinitesimal, and those not expected still to be breathing this time tomorrow, with those in the middle who are thought to have a 50/50 chance of surviving planned surgery. All of these patients have had the hurly-burly of everyday life interrupted by a hospital admission, and have time on their hands to reflect on their own mortality. All deserve equally recognition that they have spiritual needs.

    A god is for life, not just for death.

    • I don’t think that the guidance from NICE has anything to do with wearing religious emblems. The NHS guidance – certainly for England – is very strict on issues such as jewellery (of whatever kind) and the ‘bare below the elbows’ rule. It’s got very little to do with manifesting one’s religion – or indeed, one’s membership of anything else – and much more to do with infection control.

      Given the incidence of (eg) MRSA and clostridium difficile, I reckon as a consumer that infection control must be paramount.

        • When I asked my sister – who is also a nursing sister in orthopaedics – about the ‘bare below the elbows’ rule, she replied that it got very cold wandering around in nothing but a tee-shirt!

          • We have to wear short sleeved shirts – and check on doors (individual rooms) for further info, often have to wear gloves and plastic aprons. Hospital is usually so warm that it is hardly a burden.

  2. I cannot see why these religious care matters should be the responsibility of the State funded NHS. They are surely the responsibility of organised religion. The NHS should facilitate religious care and, in order to ensure the safety of patients, select, employ and manage those providing religious care but the cost of employing such personnel should be carried by the religious organisations who have created the need for such care in the final days of the life of the patient by devising rituals which demand priestly involvement and by the invention of narratives about life and death which may cause unnecessary anxiety and distress.

    My experience is that organised religion is very keen to have priests present in hospitals but extremely reluctant to be responsible for their pay.

      • Frank, I appreciate your efforts. My comment is for those like John Allman who seem to think that the State has a responsibility to provide for and fund the religious care of hospital patients.
        I believe that those who cause the angst should deal with its consequences.
        You are right to confront the carefully cultivated myth of discrimination in the wearing of religious symbols.

    • The position is starting to change. I work in a hospital chaplaincy team as a ‘non-religious’ member. Although all are available to visit any client (and I do see many Christians,) we can pass on specific requests for those who want to see someone who shares their faith. Usually it is just about human contact. Most people will benefit from a ‘damn good listening to.’

      • That’s rather what I would have expected. If I ever find myself in hospital dying at four in the morning, I imagine I’ll accept the ministrations of anyone – Christian, Humanist, Jewish, Muslim, whatever. Chances are, I’ll just want someone to give me their undivided attention and support.

    • “The NHS should … employ and manage those providing religious care but the cost of employing such personnel should be carried by the religious organisations …”

      In practice, how shall the piper who is not permitted to call the tune, be compelled to pay?

      • John, This is simple. I will confine myself to Wales since we have a campaign here which is in progress. We ask the Welsh Government (which gives privileged access to organised religion through twice yearly meetings of the Faith Communities Forum, chaired by the First Minister) to ask the Faith Communities to establish an ecumenical charitable trust to raise the £1.3 million that religious care costs the NHS Wales each year. The chaplaincy service will function exactly as now there will be no change in the T&C of chaplain employment contract. The NHS Wales will bill the putative charitable trust each year. A perfectly straight forward arrangement.

        Paul,
        I have no problem with this if you are a volunteer. You would then cost the NHS nothing. In Wales all chaplains must hold a certificate provided by one of the organised religious bodies. They are in fact all clerics. They are also members of the College of Health Care Chaplains (despite the academic sounding name – a branch of UNITE the union). On average each chaplain Whole Time Equivalent costs between £40,000 and £50,000 per annum.

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