Spirituality in Palliative Care: Journeying to the sacred thresholds of death

By Katherine Pettus
IAHPC Senior Director of Advocacy and Partnerships

All major faith traditions affirm the values and practices of palliative care, as documented in the Religions of the World Charters for Palliative Care for Children and for Older Persons. Further, the Essential and Expanded Palliative Care Packages for Adults and Children identify spiritual care providers and local spiritual care counselors as essential members of palliative care teams across all income settings. Through its Faith in Palliative Care webinar series, the IAHPC seeks to support practitioners in carrying out these vital roles and to strengthen advocacy for spiritually integrated palliative care worldwide.

The IAHPC marked World Health Day 2026 with a webinar themed “Together for Health. Stand with Science.” It gathered palliative care clinicians and chaplains online with a global audience to discuss how to bridge the educational and practice gaps between faith and biomedicine that amplify the serious health-related suffering (SHS) of patients and families. This second Faith in Palliative Care webinar glowed with personal and professional reflections on journeying with patients through serious illness to the most intimate and sacred thresholds of death and dying.

The panel, expertly moderated by Chaplain Richard Bauer, who also teaches at George Washington University, comprised Dr. Abhijit Dam, a palliative care physician and author from Jharkhand, India; the Rev. Dr. Francine Hernandez, an author, pastoral counselor, and clinical pastoral educator in Florida; Dr. Bruce Feldstein, an orthopedic surgeon and chaplain at Stanford University; and Dr. Carlos Centeno, a palliative care physician at the University of Navarra in Spain. Each panelist is from a different faith. 

Surprise! Faith in palliative care aligns with science!

Referencing a foundational science-based article¹ on spirituality in serious illness and health, Chaplain Bauer opened the discussion by saying, “I often describe spiritual care as the essential and neglected component of palliative care. That neglect matters, because more and more evidence shows that when we fail to address spiritual concerns, we fail to care for the whole person.”  

There is evidence that spiritual care at the end of life is important to patients. And researchers have found that lack of spiritual support by healthcare teams is associated with poor quality of life, dissatisfaction with care, less hospice utilization, more aggressive treatment, and increased costs—particularly among ethnic minority groups and patients with high levels of religious coping.² 

The webinar touched on questions that sit at the heart of palliative care: how do faith, science, spirituality, and compassionate presence support people living with serious illness and those nearing the end of life? 

A lightbulb moment: faith as encounter 

Dr. Dam, founder of Kosish-the Hospice, for the rural elderly poor, shared that one of his greatest early challenges was learning how to sustain hope in the face of hopelessness.

“I also found myself confronted by existential questions and by spiritual and religious concerns that I was not prepared to answer. I began asking myself what it means to treat pain, and what it means to heal suffering. I began asking about the difference between faith and trust. 

“At that time, I considered myself a strong atheist. But over time, my work with patients changed me. I came to see that faith is not something that can be understood only from a distance. It has to be encountered. It has to be experienced. And in the setting of serious illness, I saw firsthand how faith could sustain people in extraordinary ways.”

He went on to describe how traditional Hindu teachings and ritual can calm existential distress and death anxiety in patients and families. 

Simply being present is meaningful

Rev. Hernandez, author of Cave Walker and Stay in Your Lane, described how her HIV/AIDS patients, often stigmatized and isolated from family and community, sometimes want only presence and loving accompaniment. 

“Faith is not about having all the answers. It is about being present. So often, when someone is seriously ill, what they need most is not an explanation. They need someone with the courage to enter that space with them. I sometimes describe clinicians and chaplains as cave walkers. We walk into dark places with people who are suffering. We do not go there to fix them. We go there to accompany them.”

Ask, ‘What are you afraid of?’

Along similar lines, orthopedic surgeon and founder of the Jewish chaplaincy service at Stanford University, Dr. Feldstein, shared that “When fear is present, especially fear of dying, one of the most important things we can do is ask gently: ‘What is it that you are afraid of?’ Sometimes a person is afraid of pain. Sometimes of suffocation. Sometimes of leaving loved ones behind. Sometimes of the unknown. 

“When we ask, we begin to untangle fear. We move from a vague terror to something that can be named, witnessed, and cared for. And often what helps most is not argument or explanation, but presence. To be there. To be calm. To be unafraid. To allow the person to feel that they are not alone.”

Beyond technique: a place of reverence

And Dr. Centeno, a Catholic palliative care physician reflected that “another important dimension in Christian care: when we care for a suffering person, we do not see only a patient. We also encounter Christ in that person.

“That does not mean we impose belief. It means that care becomes a place of reverence. Spiritual care requires interior life from the professional. We need reflection. We need space within ourselves. We need to be connected to something beyond technique.

“Sometimes in a patient’s room, you can sense that something is happening that you did not produce: forgiveness, reconciliation, peace, love, return, release. Our role is not to control that. Our role is to make room for it.”

These are just snippets from the rich conversation that could have continued for hours, and indeed participants requested more webinars and suggested other topics. You can watch the recording here. 

Faith in PC on the margins of the WHA 

The growing network’s next convening will be a working group meeting during the upcoming World Health Assembly. The meeting will be held at the headquarters of the International Federation of the Red Cross in Geneva on May 20. We are inviting leaders of faith-based organizations with offices in Geneva to come and brainstorm with our team, which will also include Dr. Lacey Ahern, program director of Partners In Care, about how to co-create an educational and advocacy network to serve and support religious and palliative care practitioners of all faiths. Stay tuned for my report in the June issue of Pallinews.

Preparing for the World Health Assembly 

IAHPC’s official delegation to the 70th WHA includes myself, Richard Bauer, Dr. Elizabeth Persad, a pediatric palliative care physician from Trinidad and Tobago, Dr. Serena Cruz, founder and director of the Global Surgery Umbrella, and Dr. Sherin Paul, a family doctor and palliative care physician from Kerala who is now based in Geneva. 

Together with our sister organization, the Worldwide Hospice Palliative Care Association, we will deliver statements on WHA agenda items relevant to palliative care, including primary healthcare, universal healthcare, the World Health Organization’s work in emergencies, and social care. 

In the leadup to the WHA, we will participate in a policy debate on the UN80 initiative (the United Nations’ “comprehensive reform effort…to address global challenges amid declining resources”) and the WHO’s recent call for a “new global health architecture.” IAHPC’s focus will be on ensuring inclusion of palliative care services for the hardest to reach—“last mile” populations—experiencing serious health-related suffering, particularly incarcerated persons. 

Dr. Laura Musselman, executive director of the Humane Prison Hospice Project will talk about in-prison training of inmate peer caregivers. Other speakers include Tsion Yohannes, an expert on gender-based dimensions of palliative care delivery in Rwanda, and Jorge Edmundo Rivadeneyra Andi, a leader of the Amazonian Kichwa Añangu community in Ecuador. We will share the link to view the policy debate on IAHPC social media channels, so be sure to follow us on Instagram, LinkedIn, Facebook, or Blue Sky. 

Taking Steps to Entrench Care for Older Persons

The need for binding standards and enforceable legal protections for older persons became frighteningly clear during the first years of COVID-19. As the 2020 IAHPC member survey showed, palliative care was often sidelined during COVID and serious health-related suffering grew exponentially. 

A binding convention on the rights of older persons is to be drafted by the Human Rights Council Intergovernmental Working Group in Geneva. Read IAHPC’s submission to the Office of the High Commimssioner for Human Rights. This week, officers of the Spanish Palliative Care Association (SECPAL), the director of the Latin American Association for Palliative Care (ALCP), and I met with Dr. María Teresa Sancho Castiello, director general at Spain’s Institute for the Elderly and Social Services, to demonstrate our collective institutional support for the convention, and to ask that the Spanish delegation negotiate to include a right to palliative care as part of the right to health. 

Such advocacy is particularly impactful when representatives of international, regional, and national associations combine forces to meet with the public authorities who make the crucial decisions on high-level issues. 

The Spanish government has already expressed its strong support for the convention. My role is to represent IAHPC to ensure that palliative care is explicitly included in the text of the treaty. Since it is important to make the case about why it should be included, I have committed to presenting the Dr. Sancho with an IAHPC policy brief on how including palliative care in the treaty aligns with both the new Spanish Palliative Care Strategy and the goals of the United Nations’ 2030 Agenda for Sustainable Development. 

To amplify our impact, I will share that policy brief with the ALCP, which they in turn will share with their national associations, whose advocacy point persons will advocate with their delegations in Geneva. I will share the text in my May column for Pallinews.

References

1. Balboni TA, Vanderweele TJ, Doan-Soares SD, Long KNG et al. Spirituality in Serious Health and Illness. JAMA 2022; 328(2). 
2. Gijsberts M-JHE, Liefbroer AI, Otten R, Olsman E. Spiritual Care in Palliative Care: A systematic review of the recent European literature. Med Sci 2019.