Skip to main content
. Author manuscript; available in PMC: 2017 Apr 1.
Published in final edited form as: South Med J. 2016 Apr;109(4):200–206. doi: 10.14423/SMJ.0000000000000439

Table 1.

Brief guide to potential religious dimensions of suffering at the end of life

Religion Origin/sacred text/
exemplar of
suffering		 Core principles Potential issues affecting meaical care at the
end of life		 Afterlife
Judaism Monotheistic
Torah
Job		 There is one God who is transcendent and omnipresent
The Hebrews are God’s chosen people
Failure to obey God is a sin
Life is sacred		 Belief in the sanctity of life may lead to
continued aggressive care
Belief in the sanctity of the body at death may
lead to avoidance of interventions (eg, surgery,
feeding tubes)		 Because of intense debate
among Rabbinical scholars, fear
of the afterlife generally
revolved around its uncertainty
Christianity Monotheistic
Bible
Jesus		 Humans are sinful
Jesus Christ is the Savior, who died on the cross and
was resurrected
Salvation is obtained through either faith or good deeds		 The belief in the possibility of a miracle
sometimes leads to decisions to prolong
aggressive medical interventions		 Guilt, unresolved sin, and issues
of forgiveness and absolution
can affect how the soul
experiences the afterlife
Islam Monotheistic
Koran
Job		 Islam means submission (to the will of God)
There is one God, Allah, the creator of all; Mohammed
is his prophet
5 Pillars of Islam:

  1. Shahada: Confession of faith

  2. Salat: Prayer toward Mecca (5 times/day)

  3. Zakat: Almsgiving

  4. Sawm: Fasting during the month of Ramadan

  5. Hajj: Pilgrimage to Mecca

 Sanctity of life is paramount and its importance
overrides obligations to the 5 Pillars of Islam		 After death, humans rest in the
grave until the day of judgment,
when Allah determines who will
go to Paradise or Hell
Hinduism Polytheistic
Vedas
Yogis		 Basic principles:

  1. Samsara: All beings are reincarnated until they reach nirvana

  2. Karma: Deeds of prior lives affect future lives

  3. Dukkha: Suffering infuses reincarnated lives

  4. Moksha: Enlightenment (spiritual knowledge) is the only means to become free from suffering

 Some patients may fear anything that may
cloud judgment at the end of life because they
should focus on sacred things at the moment of
death to ensure rebirth to a higher form of being

Disease states such as delirium or medications
such as opioids or benzodiazepines may be
concerning to patient/family		 Fear of rebirth to a lower order
because of bad karma or clouded
state of mind at time of death
Buddhism Nontheistic
Mahayana sutras
Boddhisattva		 Ultimate goal is to end the cycle of suffering
4 Noble Truths of Buddhism:

  1. Life means suffering

  2. The origin of suffering is attachment

  3. The cessation of suffering is attainable through nirodha (disengagement)

  4. The path to ending suffering is by the “middle road” between self-indulgence and asceticism, the Eightfold Path

 Patients may fear lack of clarity of mind during
the dying process because the soul may get lost
in the transition to the next life
Concerns may arise around opioids,
benzodiazepines, and disease states such as
delirium and dementia		 Fear of the soul getting lost in
transition from this life to the
next, especially if delirious; after
death, Buddhists believe the soul
waits rebirth in 1 of 6 different
states of being