The impact of religion and spirituality on medical decision making by patients at the end of life

The May 2026 issue of Annals of Palliative Medicine featured three editorials, six original articles, one brief report, one surgical technique paper, one case series, seven review articles, one case report, and one editorial commentary. This message from the editor-in-chief focuses on a narrative review conducted by Mercier and colleagues from Brown University on religious believes at the end of life and their implications for palliative care providers (1).

The definitions of palliative care have evolved and broadened over time, paralleling the growing scope of the field (2). In the World Health Organization definition, “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (3). The humanistic approach to palliative care is unique in medicine in focusing on the role of spirituality and religiosity in patient treatment planning and decision making, and palliative care providers routinely address the spiritual and religious needs of patients.

Spirituality, a “dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred” (4), is often complimentary to religion, which is beliefs, behaviors, or practices that facilitate communication, closeness, or alignment with the transcendent, originating from established traditions (5). The role of spirituality in palliative care has long been a focus on this journal (6,7), and healing and spirituality have been the topic of a prior special issue in Annals of Palliative Medicine (8).

In the article by Mercier et al., the authors highlight the prevalence of religious beliefs and impact on health care outcomes, and they discuss the importance of religion in health. The authors detail that the spiritual and religious beliefs and behaviors of patients and their families should be attended to as closely as their physical and emotional concerns, particularly as they approach their end of life. Mercier and colleagues performed a literature search of published articles that reviewed the religiosity of patients, patient religious beliefs, and how those beliefs impacted end-of-life situations (1).

Based on that literature search, the authors reviewed various aspects of the impact of religion and spirituality on palliative care. They detail how religious beliefs impact medical decision making, and how those decisions in turn impact the palliative care team. They also describe the relationship between religious beliefs and health control. Patients who associated as being of high religiosity are more likely defer control to God or believe that care decisions belong to God instead of themselves or their treatment team. Conversely, however, some families invoke religious beliefs in order to regain control during times when they feel powerless (9). Mercier and colleagues also discuss how clergy influence the impact of religious beliefs for patients approaching the end of life. This is particularly relevant, as approximately half of all terminally ill patients are visited by clergy or religious leaders, and prior evidence suggests that the religious values of clergy may decrease end-of-life discussions (10). This points to a potential beneficial role for the medical field to provide education and training to clergy seeing patients at the end of their lives.

Mercier and colleagues call for palliative care providers to provide comprehensive spiritual care at the end of life given the importance religion and spirituality have for so many. This is particularly impactful since it has been shown that comprehensive, patient-centered spiritual support from the palliative care team can increase patient quality of life and decrease medical costs at the end of life (11,12). The authors also discuss patients and families with a belief in the possibility of miraculous healing. The literature on medical aid in dying and on spiritual resolution, acceptance, and peace is also summarized.

As this work had a particular emphasis on Christian religions and practices within the United States, which have been most commonly reported in the medical literature, more research is needed to understand the impacts of other religions on patient decision making and interactions with palliative care teams at the end of life. The article by Mercier and colleagues, however, is quite timely, as religious believes can hold significant sway over the decisions that patients and their families make when facing terminal illnesses, and they can also impact how the treatment teams should optimally interact with these patients. This article reinforces the importance of members of the palliative care team to use spiritual screening tools and to actively engage with their patient and family regarding their religious and spiritual concerns and beliefs.

Acknowledgements

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-2026-03/coif). C.B.S. serves as the co-Editor-in-Chief of Annals of Palliative Medicine from April 2014 to April 2027. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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