The time of death is often heavily invested with cultural and religious ritual
Such rituals frequently
give rise to cross-cultural misunderstandings or frank conflict with standard
hospital procedures. For example, in some cultures only same-sex workers should
touch the body (Hallenbeck 1996; Hallenbeck 1999).
When dealing with a family from an unfamiliar ethnic group or religion, the
clinician should inquire, ideally in advance, if any special accommodations
need to be made for cultural or religious reasons (Hallenbeck
If not done previously, the clinician should ask if the family
wishes to speak with a chaplain or other spiritual advisor.
When in doubt,
seek assistance from someone familiar with that culture or religion (Pickett
1993; Lo 2002).
A tool developed by Pulchalski for addressing spirituality
in patients or families is presented in the table below (Puchalski
Performing a Spiritual Assessment
of Patient or Family
“Do you consider yourself a spiritual
or religious person?” “What do you believe in that gives
Importance and Influence
“How important is your faith (or religion/spirituality)
“Are you part of a religious or spiritual
Address or Application
“How can we help or be of assistance to you
in the practice of your faith at this time?”
Adapted from Puchalski CM. Spirituality and
end-of-life care: a time for listening and caring. J Palliat Med. 2002;5:289-294.
In Mr. Stanton's situation, a history of religious disagreement among members
of his family caused him and his daughter guilt, anxiety, and anger.