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Where is the soul after death? Do we need to ask?

Caring for patients’ spiritual needs is an explicit goal of the young and growing specialty of palliative medicine. Although emerging literature describes the spiritual concerns of patients and how they prefer these be addressed, clinicians attempting to do so face a number of obstacles. These obstacles include inexperience, lack of training, an absence of consensus about definitions, and their own unresolved spiritual concerns. Compounding this are limitations of time and confusion about the boundaries of their role, of which the latter is often the most critical consideration. For example, physicians are more likely to appreciate the need to address their patients’ belief in miracles, which is interfering with the transition to comfort care, than to understand a reason to explore their patients’ beliefs about the fate of the soul after death. Perkins et al do not offer evidence that beliefs about the soul in the ‘‘afterlife’’ interfere with care or cause distress or that patients want their physicians to engage them. Rather, they describe culturally related differences of opinion on the question and encourage physicians to ask about patients’ ideas as a potential source of comfort near the end of life. Before discounting this argument as unsupported by evidence, it is worth considering two circumstances in which beliefs about the soul are of recognized clinical relevance. First, we know that individuals grappling with whether to commit suicide often have fantasies about the next life, which can either enhance or diminish their risk of acting, and therefore may be important to explore. Second, many recently bereaved individuals believe that their lost loved ones are still near and real (‘‘in the world,’’ in the authors’ terminology). Recognizing the prevalence of such beliefs and experiences and their cultural roots can help clinicians inquire about their patients’ experience in ways that will help them feel more understood and comforted. There may well be more such circumstances, if we are willing to listen.