Religious and Spiritual Beliefs: An Avenue to Explore End-of-Life Issues.

This literature review highlights the relationship between spirituality and/or religion and how people respond in the face of impending death. Attitudes toward physician-assisted suicide and hospice are explored. The author also offers recommendations to counselors for addressing religious and spiritual concerns. ********** Finally, we may all achieve peace--our own inner peace as well as peace between nations--by facing and accepting the reality of our own death. --Kubler-Ross, 1969, p. 31 The human condition is bound by the laws of nature: life and death. Each person born into the world will eventually die, and even though each person is aware of this fate, it is still difficult to comprehend. To deal with this inevitability, many turn to religion and spirituality. In fact, according to a CBS news poll in 2006 (PollingReport.com, 2007), 82% of Americans believe in God, 9% believe in a universal spirit, 8% believe in neither, and 1% is undecided. Religion and spirituality are believed to increase with age (Emery & Pargament, 2004; Krause, 2001; Lewis, 2001; Moreman, 2005) and are seen as developmental across the life span (Hill et al., 2000). In the 2000 and 2001 Gallup Polls (The Gallup Poll, 2007), religion was "very important" to 60% of 50- to 64-year-olds, 67% of 65- to 74-year-olds, and 75% of 75-year-olds and greater. Church attendance also increased across the adult life span, with 44% of 50- to 64-year-olds attending church regularly, 50% of 65- to 74-year-olds, and 60% of 75-year-olds and greater attending church at least one time per week (Koenig, George, & Titus, 2004). Increased religiosity in older age may be attributed to the recognition that death is approaching (Moreman, 2005) or with the diagnosis of a terminal illness (Breitbart, Gibson, Poppito, & Berg, 2004; Koenig et al., 2004; McGrath, 2003; Shepard-Johnson, 2003; Siegel & Schrimshaw, 2002). In some cases, however, religion and spirituality decreased with a diagnosis of a terminal illness (McGrath, 2003). Religion and spirituality have both been recognized as having an important connection to mental health. Krause (2001) suggested that the longevity of religion in human society suggests that it has social and psychological functions. Hill and Pargament (2003) indicated that those who feel a "secure tie with God" have lower levels of psychological stress and loneliness, less depression, higher self-esteem, greater relational maturity, and greater psychosocial competence. They also stated that spiritual strivings are empowering and provide a sense of purpose and meaning. Krause highlighted six dimensions as contributing to better mental and physical health for older people involved in religion: church attendance, prayer, religious coping responses, forgiveness, church-based social support, and religious meaning. Meisenhelder and Chandler (2002) found that depression and anxiety were negatively correlated with faith. Lewis (2001) emphasized that both spirituality and religion were found to buffer against depression, to initiate the search for meaning in life, and to prepare one for death. Okon (2005) stated that several studies have demonstrated that spiritual well-being protects against end-of-life despair, depression, hastened death, suicidal ideation, and hopelessness in the face of terminal illness. Hill and Pargament (2003) reported that a religious system is similar to Kahn and Antonucci's (1980) support convoy, which is present across the entire life span. According to Hill and Pargament, although support networks, including family; can change over time, a religious convoy is a stable support. A similar idea was expressed by Emery and Pargament (2004) and Dillon, Wink, and Fay (2003), who were influenced by Iannaconne's (1990) idea of religious human capital. Iannaconne proposed that a person invests in religion across the life span and, therefore, has more to draw on in later life when coping resources are needed. …