Spiritual distress at life's end: finding meaning in the maelstrom

Recent trends in social research indicate a decline in church attendance and a corresponding increased interest in spirituality. With the aging of the population, attention to end of life care, with its corresponding spiritual concerns and distress, has become a prominent issue. Spiritual distress can be difficult to distinguish from psychological and physical distress and indicates the need for differential diagnostic markers to distinguish between genuine spiritual experience and psychosis related to the physical death process. Further, for hospice patients who are in genuine need of amelioration through pharmacologic suppression, the question of when and how to medicate becomes paramount as the distinction between spiritual process and physchosis becomes less evident. This article is an exploratory attempt to encourage dialogue across interdisciplinary lines and foster participation from alternative therapies representing the spiritual context of the patient. Anecdotal data from hospice professionals representing a variety of disciplines are presented to illustrate and emphasize the need for continued dialogue and research in this important area.