Religious coping in dying patients

In downtown Los Angeles recently, two very different celebrations went on within walking distance of each other.

On West Temple Street, at the beautiful and contemporary Cathedral of Our Lady of the Angels—a structure with no right angles in its adobe-colored walls—Catholic Mass was offered throughout the morning, in both English and Spanish. Five blocks south, at the stunningly refurbished Millenium Biltmore Hotel on Grand Avenue, the Council for Secular Humanism, whose stated mission is, in part, “to advocate and defend a nonreligious life stance,” was celebrating its 30th Anniversary, with a lineup of speakers that included prominent atheist author Richard Dawkins. The Secular Humanism gathering was sold out; admission to the Cathedral was free.

It would be hard to find two more contradictory congregations anywhere in the country (okay, maybe a UCLA/USC game, but that’s religion of a different stripe). Yet every single attendee at either location had, whether they like it or not, one thing in common: they will all die. The only difference is that some of them will die believing in God, and some will die in disbelief. But die they all will.

A huge chunk of narrative medicine literature deals with death and dying; a future literary prescription of The Literary Doctor will consider Leo Tolstoy’s The Death of Ivan Ilyitch, a novella describing in excruciating detail the fatal illness of a Russian parvenu whose religious indifference gives way to belief and rapture in his final hours.

But do contemporary atheists have the kind of deathbed conversions so rife in traditional literature? Will new age atheists like Richard Dawkins and Sam Harris cry out to Jesus as their blood pressure falls and their lungs fill with fluid? I think not.

During a quarter-century of providing medical care to patients with kidney failure, I have attended numerous dying patients and witnessed dozens of deaths. I recall no eleventh-hour conversions. Nowadays, there are atheists in foxholes. For the most part, it appears to me that the spiritual beliefs or disbeliefs patients hold throughout their lives are the beliefs they leave this world with. The atheists among us do not flinch, nor do the religious renounce God in anger over their disease.

So, are the deaths of those who die believing in God different in any way from those who die in disbelief? The answer is a qualitative yes.

One large study found that positive religious coping improved patients’ psychological adjustment to major illness by affording them a sense of meaning, control, and personal growth.

But another later study concluded that while all the above is true, positive religious coping in patients with advanced cancer resulted in higher utilization of intensive life support at the end of life, with no gain in survival.

The faithful appear to die happier and better adjusted than atheists, but harder.

My personal observations agree with these findings. I have been impressed at how well some of my more deeply spiritual patients are able to endure the horrific diseases they are afflicted with, while detecting in some of my secular humanists a slight whiff of stunned fatalism. Sometimes, though, the religious don’t know when to quit.

Now it’s your turn. What are your thoughts on dying without God?

Richard Barager is a nephrologist who blogs at The Literary Doctor.

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  • John

    “For God so loved the world, that He gave His only begotten Son, that whoever believes in Him shall not perish, but have eternal life.17 “For God did not send the Son into the world to judge the world, but that the world might be saved through Him.18 “He who believes in Him is not judged; he who does not believe has been judged already, because he has not believed in the name of the only begotten Son of God.19 “This is the judgment, that the Light has come into the world, and men loved the darkness rather than the Light, for their deeds were evil.20 “For everyone who does evil hates the Light, and does not come to the Light for fear that his deeds will be exposed. (John, Chapter3)

    Jesus said to him, “I am the way, and the truth, and the life; no one comes to the Father but through Me. (John 14:6)

  • Ben M2

    I loved this post. Our beliefs are part of how we deal with death, how we explain death. Personally, I can’t imagine living without God, let alone dying without him. But then, I’m convinced he exists and lives to influence our lives.

    Maybe the complexity of science and of our understanding of the world has made it easier to deny God’s existence, and to be so completely convinced that even death won’t raise questions. (Personally, I think science reveals God, rather than obscuring him.) Or, maybe traditional literature is just a biased sample of religiously-informed themes and ideas–maybe there were no more death bed conversions in the past than there are now.

    Maybe I’m just a dying breed, and I need to denounce God and progress with the early-adopting atheists.

    But I don’t think so. For Christians (and other religious people, I imagine), death has profound significance, but that’s only because life has profound significance. Death is a concentrated, unadulterated dose of mysticism that eliminates higher thinking for good. But was higher-thinking ever meaningful?

    Religious people say yes.
    Atheists say no.

    If you’re an atheist, and you can manage to fabricate poetry from a godless life (because atheists do write poetry), it doesn’t surprise me that you might not be able to fabricate a meaning for death (“stunned fatalism” as you say). Death is either purely meaningless, or purely meaningful, but it depends on what you believe.

  • gzuckier

    Not surprising that greater religious belief is correlated with higher utilization of intensive life support at the end of life, given that devout branches of religion often require that all possible approaches to extending life be exhausted, anything less being tantamount to euthanasia (i.e. Big Sin).

  • Molly Ciliberti, RN

    After 20 years of intensive care nursing (ICU and CCU) i have seen no difference in the deaths of believers or non-believers, and I have seen many deaths (as I tried my best to be loving and kind to my dying patient and their family.)
    As an atheist I will die without believing in a god. When you say dying without God, you imply that you know for certain that there is a god, but the person dying is not a believer. I do not have an imaginary friend, nor do I need one. I face illness, health, success and failure with my family and friends. It is a comfort to me that when I die, I won’t have to worry about going to heaven or to hell as they are make-believe places that have nothing to do with me. No reward or punishment, just the end of life. My importance to the universe is no more than my cats or a sparrow; I am part of the whole and I am happy that I had this chance to be.

  • BobBapaso

    Dying without God? It can’t be done! What you believe doesn’t change reality. You can be an optimist or a pessimist and at the same time believe anything or nothing. Death is not the end it is only a change. Nothing is disappearing from the Universe, it only change and becomes more complex.

    For further thoughts check out my recent book: God’s Unintended Consequences, at