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Spirituality key to the dying patient’s ‘quality of life,’ says Catholic doctor

SAN FRANCISCO, CA (Catholic San Francisco) - Medicine shrinks from caring for the spiritual needs of dying patients, even though spirituality is what most people yearn for most at the end of life, Dr. Daniel Sulmasy, a physician, philosopher and Franciscan Brother, told an audience at the University of San Francisco April 28.

DIGNIFIED DEATH - A detail from a Giotto painting of a dying St. Francis of Assisi shows a monk kissing the saint’s stigmatic wounds and provides an example of a dying person surrounded by friends and watched over by God, Dr. Daniel Sulmasy, OFM, Ph.D., told a University of San Francisco audience April 28.

DIGNIFIED DEATH - A detail from a Giotto painting of a dying St. Francis of Assisi shows a monk kissing the saint’s stigmatic wounds and provides an example of a dying person surrounded by friends and watched over by God, Dr. Daniel Sulmasy, OFM, Ph.D., told a University of San Francisco audience April 28.

Doctors tend to ignore spiritual care or back away from it out of fear of inadequacy or invading patients’ privacy, Dr. Sulmasy said. Often they think they are helping, but underserve patients by turning spiritual questions into technical problems, he said.

For dying patients, the impulse is the reverse, he said: the terminal patient whose spiritual life is outstanding despite great physical distress reports having an outstanding quality of life.

The split is so large that a new model for medical education may be needed, he said. The model would integrate biological, social and spiritual issues in training doctors.

In the short run, doctors must be alert to ways to engage patients spiritually while still letting the medical facts decide the course of care, Dr. Sulmasy said. They should be mindful that patients’ spiritual questions are fundamental — deeper than the biological, moral and ethical issues that concern clinicians and hospital ethics advisory boards, said Dr. Sulmasy, who holds the Sisters of Charity Chair in Ethics at St. Vincent’s Hospital in Manhattan.

“Spirituality is incredibly important in the care of patients and it’s shocking how we do wind up ignoring so much of it,” he said.

When ‘spiritual care’ falls short

The author of four books and an advisor to former New York Gov. George Pataki, Dr. Sulmasy wrote an eye-opening article on spiritual issues in the care of dying patients for a Journal of the American Medical Association series called “Perspectives on Care at the End of Life.” He gave talks at the University of California at San Francisco, which produced the series, and at USF to elaborate on the paper for medical professionals and students.

Dr. Sulmasy opened his USF talk with the case of a 54-year-old man, Mr. “W.” Dying of cancer, the patient was Christian and believed in the possibility of miracles, but also accepted that God might not grant one in his case. In reviewing the transcripts of interviews with the patient’s caregivers, Dr. Sulmasy found that despite the patient’s outspoken spirituality, his spiritual care fell short.

He paraphrased the patient’s primary doctor: “I had deep conversations with him but we never spoke explicitly. I didn’t feel that opening. We tread the line between being disrespectful and probing. I wonder now why I didn’t ask the patient these questions.”‘

Mr. W’s belief in miracles caused some confusion for the medical team. As a result he was transferred to a nursing home rather than to hospice care, where he would have received better treatment for his pain.

“It was stunning the way this man was treated,” Dr. Sulmasy said. “There’s nothing that says the patient who believes in miracles is ineligible for hospice, but somehow the hospice care team felt that belief was an issue.”

A chaplain, though, had correctly diagnosed the underlying problem. As Dr. Sulmasy paraphrased the chaplain: “When I look at a patient I look at the primary, core spiritual need. Is it a request for meaning to try to determine what their life meant? Or are they looking validation of their life? Or trying to reconcile broken relationships?”‘

Meaning, value, relationship

Meaning, value and relationship are the ingredients of spiritual health and become urgent in the last months of life as patients strive for dignity and hope despite losing their productivity and appearance, Dr. Sulmasy said.

“People who were able to find meaning in their illness, meaning in their dying, are people who understand what it is to hope in a deep way,” Dr. Sulmasy said.

Dr. Sulmasy stressed how important it is for dying patients to reconcile relationships with family, friends and God. “The brokenness of their bodies reminds patients in a deep way about the brokenness of their relationships,” he said. “They’re looking perhaps to express their own forgiveness of someone who had hurt them or to try to be reconcile to those they had hurt, to try to bring families and friends together in ways that arise as they’re dying in a very salient way.”

Dr. Sulmasy said patients want their doctors to ask these questions. “We commit ourselves to treating whole persons,” he said. “In fact we have a moral commitment to at least address these questions in a practical way.”

Dr. Sulmasy displayed a detail from a Giotto painting of the dying St. Francis of Assisi. The detail shows a monk kissing the saint’s stigmatic wounds. It is a part of a scene in which St. Francis is dying at home surrounding by his friends and watched over by God. The scene embodies the three ingredients of spiritual health for the dying person — meaning, value and relationship.

“You see a picture of somebody who is surrounded by people who love him, who are supremely present to him, who care about him, care about him as a whole person,” he said. “They are praying with him, engaged with him as a whole person in this experience.

“I think this is death with dignity,” Dr. Sulmasy said. “If it was possible in the 14th century, why isn’t it possible for us in the 21st?”


This story was made available to Catholic Online by permission of Catholic San Francisco (,official newspaper of the Archdiocese of San Francisco, Calif.



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1 - 3 of 3 Comments

  1. Jennifer Fussell-Patrick
    4 years ago

    Wonderful article. As this applied to losing my just turned 63-year old Mother less than two years ago to cancer. All of her life she wanted to become Catholic as she was raised Baptist. Both my Father and myself are Catholic and she followed the religion, against her Mother's wishes. The Catholic Nuns put my Mother through nursing school and she treasured the religion for the unrelenting help for the poor as she was raised. While given the grim news of Stage IV at prognosis she fought a great fight, but something was missing..She wanted to become Catholic. Mom was always a woman of faith, but her life just wasn't complete without being baptized. We finally had the blessing of a new Dr. to come in to start helping her (her oncologist disappeared on us at UAB when she was re-admitted in the ER the same day he released her). Needless to say, he too was Catholic and made the arrangements that we as a family were not able to do..He arranged for her to become baptized and came up to the hospital for it on his mini vacation. This just so happened to fall on my 35th anniversary of my baptism and my 36th birthday (August 1, 2008). One day I will never forget!! The happiest day of her life!! She automatically showed a sense of well-being and peace (although she already showed this prior to..this just increased). Sadly enough, she went to the Lord a few days later on August 16, 2008. With this being said, I believe she was able to "let go" and had "closer" with her life. She definitely couldn't thank her "new" Dr enough. The sweetness of her taking communion was by far, the most sincere, purest, humblest I've ever witnessed. God or any religion of the patients choice needs to be a medical standard in the sick and dying, just like placing an IV in an arm, you need to counsel the spirit as well. No matter what belief, comfort needs to be there. May God bless all.........Jennifer in Alabama

  2. Rev. Terrence P McGillicuddy
    5 years ago

    After 20 years as a hospice chaplain, the more advanced medical technology becomes,the more depersonalizing it is to the patients soul. My hospice patients hunger for spiritual hope, meaning and purpose in the midst of illness, yet many of their physicians add to their "soul-isolation" out of their own unresolved death anxiety. It is time to integrate "soul" much more deeply into medicine and in the training of doctors. We are much more than just "our bodies"; more than an illness to be diagnosed and prognosed.

  3. Sylvia Hicks
    6 years ago

    Wonderful article! We really need this synthesis of care for the whole person. I*'m afraid most doctors see death as failure, where as it is the ultimate care we can give - like 'Cure rarely, heal sometimes but comfort always.' Thanks for your ideas!

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