2 the world as well. Over 19 million Muslims have made their homes in the West. These communities are heterogeneous in many aspects—in terms of dress, diet, language, and ethnic origin [15]. Consequently, more and more doctors and nurses will come across Muslim patients in the course of their work. Building on the existing literature [15–24], this review of the Muslim approach to illness and death and the beliefs and needs of the Muslim patient will open the door to fruitful communication between Muslim patients and their health care professionals with respect to their spiritual beliefs and needs. The outcome will ensure improvement of care and mutual respect while preventing embarrassment and confrontation. Cultural competence of Muslim spiritual and religious beliefs constitutes a critical component of total care. Though there is of course a range of beliefs and religiosity in Islam, as in all religions, strong adherence to the approaches and beliefs outlined here is widespread in our country. Judaism, perhaps more so than Islam, has a wide range of perspectives on almost every issue. Rather than focusing on legal issues, as other recent excellent works have done [25– 27], we will discuss some of the range of beliefs in Judaism regarding questions of illness, treatment, and the end of life. In so doing, we hope to provide the medical practitioner with a deeper understanding of the religious thinking that may underlie a patient or family member’s response to the medical situation, and ease that practitioner’s entry into a conversation about spirituality with the patient or their family, thereby deepening the caring relationship and better understanding the patient as a whole person. Additionally, and perhaps most importantly, we see in our work on a daily basis that just speaking about spirituality is a way for patients to reconnect to and “touch” their own spirituality, and that alone provides a great deal of comfort and strength. It may even be that in speciﬁc cases of spiritual struggle, where a patient or family member is having a hard time reconciling their desire for a more palliative approach to care with their self-perception that Judaism does not allow them to do so, that the perspectives oﬀered in this article will help enable staﬀ to share the perspective with them that such a contradiction might not exist. In general, the principles of palliative care are largely in accord with Jewish, as well as Islamic, tradition [26]. In Israel in particular, the power of traditional beliefs is strong for a considerable majority of the population, many more than those who preserve traditional practices, and of course belief only strengthens in the face of serious illness. We will draw on our experience in the ﬁeld of Israeli professional spiritual care, a young ﬁeld that has developed in the last decade and ongoing research has documented its progress [28, 29]. In this discussion, our goal is not to consider the religious dimensions of end-of-life questions, such as disconnection from a ventilator. Rather, our focus will be on examining Judaism’s and Islam’s attitudes toward illness and the end of life, since these are essential to considering a palliative approach. In that vein, we will consider cultural concerns that arise around end-of-life care, and will examine some approaches to thinking about treatment decisions when medical hope for a cure greatly diminishes. Evidence-Based Complementary and Alternative Medicine 2. Attitudes toward Suffering and Treatment One of the crucial foundations of the palliative approach is the understanding that treatment of serious illness is not only about the tension between life and death, but also includes reducing suﬀering and improving the patient’s quality of life. In Judaism, the Biblical commandment “and you shall return it (a lost object) to him (its owner)” (Deuteronomy 22 : 4) is the source for the doctors’ obligation to heal their patients. If a doctor has it in his power to “return” to the patient that which he has lost, namely, his health, then he must do so. However, there is no reason why this need be limited to his health only. As the medieval scholar Maimonides writes, this commandment broadly obtains to returning “his body, his money, and his mental health.” (translations are the authors’ [30]). In this vein, the obligation to provide healing includes returning to a patient his lost quality of life and returning to him the previous form of life that he had enjoyed—life that was not full of suﬀering. In Islamic belief, suﬀering plays an important role in life. For the Muslim, sickness and suﬀering are a part of life: a matter of coincidence, an attack of the evil eye, or a spiritual test from the creator. Emotional and physical suﬀering caused by illness is regarded as a test of faith in God, expunging the sins of the Muslim [31]. Sickness should wake people up from heedlessness, guide them to give up their sins, make them think about the hereafter, and lead them to pious foundations. It should make people more thankful to Allah and teach them the necessity of taking better care of their health and making better use of their life—something they may not have realized before. Illness should teach them to understand other sick and pained people better, to feel sorry for them, and to help them. Going through suﬀering also raises their ranks and degrees higher in the hereafter. According to the Islamic philosophy of life, there is a transcendental dimension to pain and suﬀering. Pain is a form of test or trial, to conﬁrm a believer’s spiritual station [32]. Suﬀering is considered a part of life, and forbearance of hardship is greatly rewarded in Islam. In particular, forbearance of an illness leads to expiation of sins in Islam [33]. The Quran tells us that those who claim to believe in Allah will not be left alone after a proclamation of their belief and asserts that believers will be put to the test in various ways: “Be sure that we shall test you with something of fear and hunger, some loss in goods or lives or the fruits of your toil, but give glad tidings to those who patiently preserve” [34] (2 : 155). Islam teaches that pain and suﬀering delete sins: “And bear in patience whatever (ill) may befall you: this, behold, is something to set one’s heart upon” [34] (31 : 17). The Prophet (peace be upon him) said that “When the believer is aﬄicted with pain, even that of a prick of a thorn or more, God forgives his sins, and his wrongdoings are discarded as a tree sheds oﬀ its leaves.’’ At the same time, treatment to reduce pain and suﬀering is mandated in Islam. The Islamic teaching encourages Muslims to seek treatment when they fall sick [31], “Seek treatment, because Allah did not send down a sickness but has sent down a medication for it, except for death.” The majority of traditional scholars viewed medical treatment