Intended for healthcare professionals

Spotlight Spotlight: Palliative Care Beyond Cancer

Spiritual dimensions of dying in pluralist societies

BMJ 2010; 341 doi: (Published 16 September 2010) Cite this as: BMJ 2010;341:c4859
  1. Liz Grant, senior lecturer,
  2. Scott A Murray, St Columba’s Hospice professor of primary palliative care,
  3. Aziz Sheikh, professor of primary care research and development
  1. 1Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh
  1. Correspondence to: A Sheikh aziz.sheikh{at}
  • Accepted 15 May 2010

Despite the decline of formal religion many people still regard the idea of spirituality as essential to their sense of self, especially at times of inner turbulence. We explore how the spiritual needs of dying patients can be understood and met in pluralist and secular societies.

“Man is not destroyed by suffering; he is destroyed by suffering without meaning.”

VE Frankl1

Palliative care is about helping people die well, but how do we know how to “die well”? In all cultures, sacred stories, proverbs, and rituals around death exist to help people prepare to die. Death and dying were keystones of the grand narrative of religion. But religions, in Western cultures, are disappearing, and grand narratives have been replaced by worldviews driven by individual success that are not so much death denying as blind to death.

In this article, we reflect on the spiritual needs of the dying and on how these needs can best be understood and met in pluralist societies. An assumption underpinning our approach is that the core aspects of spirituality are common to all people, although the external manifestations of spirituality and spiritual need are many and varied. Where appropriate, key issues are illustrated with data from our qualitative studies investigating the end of life experiences of patients and their social and professional carers in a range of populations.2 3 4

Understanding spirituality

Cecily Saunders proposed the concept of “total pain” to capture the complex effects of physical, emotional, and spiritual pain experienced by patients with advanced illnesses, thus introducing the idea of spiritual distress and suffering to the palliative care discourse. Spirituality, in the context of end of life care, is now incorporated into international health policies, clinical guidelines, cultural training initiatives, and quality of life measures.5 Recognition is increasing among health professionals that …

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