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Kenneth J. Doka, M.Div., Ph.D.

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Understanding The Spiritual Needs of the Dying

Posted: 03/06/11 08:42 PM ET

Do individuals become more religious as they die? This question has often been debated among academics who study death. Such debate avoids the central issue that the dying process raises profound spiritual concerns of meaning and connection for individuals. Whether those who are dying reconnect, review, or renew prior religious beliefs -- or are even open to new religious experiences -- they are likely to engage in some form of spiritual searching.

That search may be deeply religious or not, but it is always spiritual, and it can occur whether the person was traditionally religious or followed another belief system, whether the person was a humanist, atheist, or agnostic. Despite this reality, spiritual needs of the dying are often overlooked or ignored by family caregivers, clinicians and even clergy, who may be uncomfortable with spiritual searching by the dying and with conversations that may occur that have strong spiritual significance.

There are certain basic human needs that exist as long as we live -- comfort, connection, and care, but there are also three distinct spiritual needs that arise as individuals become aware of their finitude, or the sense that their life is now severely limited.

The first of those spiritual needs is affirmation that the dying individual's life has had meaning. We all would like to think that our life counted, that it mattered, and that at least in some small way, the world is different and maybe even better, because we were part of it. This often prompts an individual to perform his or her own life review process to affirm that life had meaning and value. For Erik Erikson, a developmental psychologist, a successful life review means that we can view life with "ego integrity," or a satisfaction that we have lived a worthwhile life. The ultimate goal of life review is that one's life should be a "good story." If the life review is not successful, a dying person may perceive that his or her life has been wasted, leaving the individual with a sense of despair as death approaches.

To encourage the reminiscence that is an inevitable part of that life review process, friends and families can offer terminally ill person a gift of sharing old photographs, trading stories, or, if the person's condition allows, facilitating pilgrimages important to the person's shared past. For example, a family whose grandfather served in Korea might take him to the Korean War Memorial. A person who enjoyed the ocean can be driven to the beach to watch and listen to waves crash and smell the surf. Someone who enjoyed a particular tradition of a family feast, such as Thanksgiving, can be treated to flavors and smells that exist with that meal. Yet perhaps the greatest gift that can be shared in the life review process requires only honesty and communication and is achieved by letting the dying person know the ways that he or she influenced or affected our life.

In addition to the need for a life review to be a "good story," the awareness of finitude often engenders concern with a second spiritual need: dying an appropriate death. This need is the desire to die in a way consistent with the individual's values, wishes, or earlier life. On a practical level, this might mean that a dying individual is intent on instructing their adult children about their estate, advance directives, even their wishes about funerals and other rituals. These conversations can be difficult for families and others at the bedside, as it easy to fall into the "mutual pretense" that can accompany dying -- that is, a shared pretense that it is not happening. Yet such a stance can often stifle the legitimate concerns of a dying relative that his or her dying wishes are understood and respected.

It is important to listen to the dying person's needs and not impose one's own fears, beliefs, or biases. There is no one way that we should die, because there is no correct way to die. The dying need not "accept" death, nor utter whatever "magic" words others think we might wish to say. Edwin Shneidman, a leading thanatologist (one who studies death), put it wisely -- "no one has to die in a state of psycho-analytic grace." Each individual will find his or her own way to die -- consistent with the way he or she lived. To some it may be a peaceful, even graceful, acceptance of the inevitable. To others it may be to bitterly fight to the end -- burning and raging, not going gently into that night. Still others will select Woody Allen's dictum; "I don't mind dying -- I just don't want to be there when it happens." We need not impose our beliefs of a good death on those around us.

The third spiritual need of the dying is to find hope beyond the grave. A person may find this in complementary ways by finding comfort in faith, religion, and spirituality. An individual may take comfort in heaven, an afterlife, reincarnation, or some form of transcendence. There may be other ways that the dying reach for a form of symbolic immortality as well, including finding solace in the notion that they will return to the cycle of life or that they will live on in our progeny, work, and accomplishments.

The important thing is to remember the lesson that Dame Cicely Saunders, the founder of the modern hospice movement taught us. Dying is more than a physical event. Rather the experience reaches us on all levels -- psychological, social, and of course, spiritual. We cannot neglect the spiritual needs any more than we can neglect the physical needs. Care for the dying is inherently holistic.

This post is adapted from Living with Grief®: Spirituality and End-of-Life Care, available from the Hospice Foundation of America's bookstore. This book is a companion piece to the Spirituality and End-of-Life Care educational program.

Hospice Foundation of America
is dedicated to helping the millions of Americans each year who cope with terminal illness, death and grief. Our website serves as a well-regarded resource for information end-of-life care and grief.

 
Do individuals become more religious as they die? This question has often been debated among academics who study death. Such debate avoids the central issue that the dying process raises profound spi...
Do individuals become more religious as they die? This question has often been debated among academics who study death. Such debate avoids the central issue that the dying process raises profound spi...
 
 
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08:16 PM on 03/15/2011
Thank you Kenneth for your article on this most important, and yet so neglected area. The needs of the dying, especially the spiritual needs, are of extreme importance, and yet are so often neglected because of the modern emphasis in medicine of curative care. Because doctors work so hard at trying to cure a person of their illness, even when there may be no cure to be had, the spiritual needs of those facing terminal illness are so often neglected. One of the best gifts we can give a person who is dying is our presence. The power of presence is so amazing in meeting the spiritual needs of a person. From a Christian worldview, I believe this is because we house the presence of God as carriers of His Holy Spirit, and by being present with others, we provide for them the gift of God's presence. For more on this, please read my blog at:
whatjesusdiddo.blogspot.com

Blessings,
-Brandon
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PJsThreeDogLife
"A large lady given to speaking her mind."
08:09 AM on 03/10/2011
Thank you for this very important post. And thanks to all Hospice workers everywhere. What an incredible gift you give on a daily basis.
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Willow712
democratic socialst
10:56 PM on 03/08/2011
Its really very simple. I have been a hospice nurse off and on for over 20 years. and in asking just a few questions, we know how we can help someone. I usually approach it with, "Um, are you a spiritual person?" that opens all kinds of doors and questions. And someone with a terminal illness does not mind discussing it. They can then tell you whether they believe the same as the Dutch Reformed, New Age, atheist, etc. One woman, all she requested of me was , "when I die, please open the window." Sure , can do. she died in january. In Iowa. I opened the window.

I am a kind of Catholic/New Age Spiritual person, its an easy mix. but i don't push my beliefs. We discuss THEIR beliefs. and anyone that attempts to use their job or location in a hospice as an excuse to push their beliefs is most likely a horrible person with no empathy.
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Edward Standley
opinionated jerk
04:05 PM on 03/09/2011
My sister began work as a CNA at a hospice facility about a year ago. One phrase that comes up most often when she talks about her work is "meeting people where they are". I hear that in your post also. Her job is hard, but she finds it rewarding. Thanks for the work that you do.
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french queen13
my beloved is mine and I am his
08:11 PM on 03/08/2011
What this makes me think most of is how these needs are dealt with - if at all - for people whose families have passed before them. If I live this life into my seventies (which I sincerely hope I do not), I will most likely be the last of my kin. Now, I don't have problems with thinking of what lies ahead - I have beliefs and experiences that make the transition something I look forward to - but getting any acknowledgement of that, or just having someone around who knows my past, doesn't seem likely to happen if I'm stuck in a hospital.
researcher
researcher
06:43 PM on 03/08/2011
"I guess I have to be clearer: When you die, you rot. Game over. With luck and a decent life, friends and relatives will remember you kindly. With creativity­, your works may live after you".

this is a statement based in materialism just as much as the statement by bystander is a statement based in religion. two sides of the same coin called unawareness where beliefs overwhelm the rational mind.

each of you stand in front of a mirror or go to a mountain top and state "I know not" then be ready for the depths of depression then slowly inch your way out and be open to the new discoveries that will come into your life.

but this will not happen to either of you because you both already know. your cups are full. besides advice is next to worthless and shows my own ignorance for even giving advice. :-)
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Richard Bartholomew
My micro-bio isn't empty.
07:12 AM on 03/09/2011
'... With creativity­­, your works may live after you..'

'I don't want to achieve immortality through my work;
I want to achieve immortality through not dying.'
-- Woody Allen
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playflute2
flootz
10:00 AM on 03/09/2011
Thanks for the morning chuckle!! :)
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Slate 1947
Lead me not into temptation. I can find it myself.
12:58 PM on 03/08/2011
"I am not afraid of dying and going to Hell or (what would be considerably worse) going to the popularized version of Heaven. I expect death to be nothingness and, for removing me from all possible fears of death, I am thankful to atheism." [Isaac Asimov]
researcher
researcher
06:37 PM on 03/08/2011
such a famous writer but het he knew not.

nothing can come from nothingness. so simple it is missed by all materialists.

think for one moment the materialist paradigm.

one paranormal event they cannot explain crashes every one of their materialistic beliefs.

what is fun to watch is the many different ways they explain away all paranormal events and experiences. perfect example of the paradigm effect doing its thing at its very best.

yet they know not that is how powerful the paradigm effect is on the human mind. never never underestimate this effect, history gives us millions of examples of those that did.
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Willow712
democratic socialst
10:38 PM on 03/08/2011
I have been a hospice nurse off and on for almost 20 years. And from the things I have heard, what people have said, i suspect that there are a whole lot of surprised souls.
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Slate 1947
Lead me not into temptation. I can find it myself.
07:49 AM on 03/09/2011
"nothing can come from nothingnes­s"

You are correct. From prehistoric beliefs, to the Egyptian gods and the gods of Hinduism, Monotheism and the countless gods since... none of them came from "nothingness", they are all the inventions of man.
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cayuse
Soaring Eagle, soaring to Spirit from the ego self
07:33 PM on 03/08/2011
Hell is symbolic of going away from good action, being evil
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playflute2
flootz
11:44 AM on 03/08/2011
Dear Mr. Doka, Thanks for the fact of Hospice. My Mom was in Hospice care for about 10 months before she died. Her Hospice chaplain was a wonderful, caring, and intuitive woman who cared for her on mother's terms, and cared for me on mine. She conducted the graveside ash sprinkling (my mom's ashes were spread on my dad's grave) and I am grateful for the true caring nature and understanding of the Hospice folk that worked with both of us. I hope this article allows folk to begin to see death with a little less fear.
10:53 PM on 03/07/2011
Having accepted Jesus Christ as my personal Savior, I do not fear nor do I doubt what will happen to my soul when I die. Death is a gift of God that frees believers of their sin and other human frailties for eternity. The Lord has established the exact time and place of our physical death on earth, and knowing that He is omnipotent and faithful in His promises is a source of great joy and comfort.
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Counterglow
Werner Heisenberg may have been right.
01:47 AM on 03/08/2011
LOL.
New Yorker
Roman Catholic, Anti-DEATH, Combat Vet, Sinner
08:38 AM on 03/08/2011
God makes fools of the wise, and raises up the powerless above the powerful. Power, wealth, and knowledge in this world is meaningless to God, Faith is that by which one enters heaven, and escapes the wrath of God. Obey God, do as God commands, Fear God, and Trust in the sacrifice of His only begotten son, and you will Laugh Out Loud in Heaven one day. The alternative is ' Weeping and gnashing of teeth' which I recommend you avoid, but that;s just me.
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COPESTIR3
11:27 PM on 03/08/2011
fanned and faved.
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cayuse
Soaring Eagle, soaring to Spirit from the ego self
07:36 PM on 03/08/2011
Romans:

11
But if the Spirit of him that raised up Jesus from the dead dwell in you, he that raised up Christ from the dead shall also quicken your mortal bodies by his Spirit that dwelleth in you..
14
For as many as are led by the Spirit of God, they are the sons of God.”

That JOY and BLISS awaits you here on earth as Deep Meditation and communion with The Spirit in Christ Consciousness
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Counterglow
Werner Heisenberg may have been right.
12:22 AM on 03/09/2011
Joy and Bliss await me, but I'm starting to wonder whether the cost of hiring both at once is more than my savings account can bear.
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roninroshi
Oni ni Kanabo (鬼に金棒 )
10:01 PM on 03/07/2011
"The Bodhisattva holding on to nothing...is freed from delusive hinderance and fear breed by it and reaches clearest Nirvana"...(Heart of Perfect Wisdom Sutra).
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cayuse
Soaring Eagle, soaring to Spirit from the ego self
07:46 PM on 03/08/2011
The second coming of "Christ" (not Jesus) is when a human being attains "self realization," also called Nirvana, Satori, Samadhi, heaven, the kingdom of God, Tao, etc. This person is now in the "Christ" condition and can therefore be rightly called the son of God, son of Zeus (Greeks), son of Tao (Taoism), Son of Jupiter. This person can also say, "I and my Father are one" as Jesus said or just say, "I am God" (the same as God, in consciousness). In the case of a female she would be and call herself the "divine mother," and be a Christ also. For the "Christ" is not male or female but "spirit" or, pure consciousness spirit in the form of SELF-AWARENESS prior to, and inner witness to the OUTERBODY, mind, and thoughts, which create its own psychological ego. All of Mankind is the Avatar but they fall short.

The second coming of God manifesting and materializing from INSIDE of creation is also called the PAROUSIAor ARRIVAL by the Greek Gnostic schools, it is also called Spiritual-enlightenment, Satori, Nirvana, Samadhi, Heaven, and THE REVELATION.
(-Yogananda, The Second Coming of Christ)
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HUFFPOST COMMUNITY MODERATOR
SShaw490
A man hears what he wants and disregards the rest
09:23 PM on 03/07/2011
My father died in late 2006 from a brutal form of dementia. In the last days, his brain no longer animated his body in any rational way - whatever experience he had of life was indistinguishable to those of us who tried to comfort him.

But I remember a couple of interesting things. The first was that he began making long, exagerated stepping motions with his legs, as if he was climbing a mountain. Well, the love of my father's life was the Rocky Mountains, and I kept remembering a particular hike he and I took many years before. He'd start stepping up and out, up and out, and I'd think, "He thinks he's climbing Missionary Ridge with me again."

One other thing that I remember: Toward the end, we were talking to his hospice nurse and asked the question all hospice people hate to answer - "How long do you think he has?" A wise and kind woman, she said, "I don't know. But if he was the life of the party and loved having people around, he'll die when people are around him. If he was a loner, he'll wait until he's alone and that's when he'll die." Sure enough, about 4 days later, very early in the morning, all alone in the quiet of the coming dawn, my dad's soul slipped its way out of his body and left. In his favorite time of day, in his morning quiet and still, he slipped away.
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roninroshi
Oni ni Kanabo (鬼に金棒 )
09:55 PM on 03/07/2011
Beautifully written...f/f
New Yorker
Roman Catholic, Anti-DEATH, Combat Vet, Sinner
08:32 AM on 03/08/2011
The most innocent man who will ever exist was Jesus the only son of God. He died in agony as was exhaulted to sit at the Right Hand of God. Do not imagine that the end of life suffering your father endured was for no purpose. This brought him closer to God as we all do when we suffer and it mimics the suffering of Christ. Suffering also atones for sin, and it may very well be the last necessary penance to wash the stain of sin from a man's soul so he may enjoy a 'Happy Death' and so immediately enter heaven. We do not understand the wisdom and mercy of God beyond knowing that it surpasses our understanding. Trust in Jesus to make the suffering of of a loved one something wonderful, even if you can't see it now, one day you will.
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edgraham
There is no magic
09:31 AM on 03/08/2011
Good to know. Being without sin, I guess I'll just pop into heaven.

Hope there's a duckpin bowling lane and some great burgers.
researcher
researcher
09:07 PM on 03/07/2011
It's interestin­g how we get older we think about our own mortality. I will be 50 this year and it is starting to dawn on me this ride doesn't last forever, I guess as it should. You and your wife will always be together, enjoy each other every day."

this 50 year old age appears to be a time when many men start thinging about such things as meaning and purpose to their lives and materialism has often ran its course and not brought the things in life that they had hoped for.
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cayuse
Soaring Eagle, soaring to Spirit from the ego self
07:58 PM on 03/08/2011
I reach mortality awareness at my fathers death, It prepared me for not only mine but the passing of a brother, son and now a mother.

Yogananda prepared me for my sons death speaking of the loss of his own Guru who was so dear to his heart and mind. It help me be what he taught as my life lost as son. GOD BLESS HIM and his teachings.

The light and energy that came to me twice without asking gave me the answers of the light and energy my son and knew in our hearts.
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gregory57
Micro-bio, was one of my favorite classes.
06:55 PM on 03/07/2011
Death doesn't bother me so much. It's the dying that has me frightened.
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cayuse
Soaring Eagle, soaring to Spirit from the ego self
08:00 PM on 03/08/2011
I hope it comes for me with the boots off in my sleep. But I think when it comes it will be all fine.

I thank GOD for a good life and I am ready. Definitely becoming more work for the wife than the benefit.

I can tell by the volume and duration
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hayness
A wise man proportions his belief to the evidence
06:51 PM on 03/07/2011
Thank you for acknowledging that spirituality does not require religion. Now if we could just get more people to recognize this is true in life as well as death...
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Whistlejackett
Hey stop doing that
09:46 PM on 03/07/2011
Like the author said, try not to impose your will on others.
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cayuse
Soaring Eagle, soaring to Spirit from the ego self
08:03 PM on 03/08/2011
You know my Yogi called it religion, but to me that is Church. Which he called Churchianity. But I think you and I understand your meaning well. I use it both ways but understand here on HP religion means Churchianity
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Tabuism
06:14 PM on 03/07/2011
Shaolin Temple...

Life is a corridor, and death is a door and behind every door, there is a corridor.

"We can not know, before we wake, that what we dream, does not exist".

"We can not know, before we die, that death is not, the greatest joy...
04:25 PM on 03/07/2011
a wise man once said, "what's upsetting about death is not that some day we'll all be tapped on the shoulder and told not just that the party's over, but slightly worse, that the party is going on but we have to leave."

"would you rather be told that the party is going on forever, that you can't ever leave, that you've got to stay because the boss says so, and ...that he also insists you have a good time?"
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gregory57
Micro-bio, was one of my favorite classes.
07:00 PM on 03/07/2011
I Dunno about death, but I sure do equate that whole ego trip with the religious' fascination with Armageddon-type end o' the world scenario in their own lifetimes. Anybody a Harold Camping fan?