End-of-life decisions in HIV-positive patients: the role of spiritual beliefs

Lauris C Kaldjian; James F Jekel; Gerald Friedland

doi:10.1097/00002030-199801000-00012

Objective: To describe the role of spiritual beliefs in HIV-positive patients' end-of-life decisions. Design: Inperson, cross-sectional survey. Setting: An HIV/AIDS floor of an urban, university teaching hospital. Patients: Ninety hospitalized HIV-positive patients. Main outcome measures: Prior discussions about advance directives, possession of a living will (written advance directive), fear of death, professions of hope and purpose in life, religious beliefs and practices, guilt about HIV infection, and perception of HIV as punishment. Results: Of 104 eligible patients, 90 agreed to be interviewed. Twenty-four per cent of patients had discussed their resuscitation status with a physician and 17% possessed a living will; 44% of patients felt guilty about their HIV infection, 32% expressed fear of death, and 26% felt their disease was some form of punishment. Prior discussions about resuscitation status were less likely in those who perceived HIV as punishment (P = 0.009) and more likely in those who believed in God's forgiveness (P = 0.043). A living will was more common in those who prayed daily (P = 0.025) and in those whose belief in God helped them when thinking about death (P = 0.065). Fear of death was more likely in those who perceived HIV as punishment (P = 0.01) or felt guilty about having HIV (P = 0.039), and less likely in those who read the Bible frequently (P = 0.01) or attended church regularly (P = 0.015). Outcome measures did not vary significantly according sex, race, HIV risk factors, or education level. Conclusions: In this HIV-positive population, spiritual beliefs and religious practices appeared to play a role in end-of-life decisions. Discussions about end-of-life decisions may be facilitated by a patient's belief in a forgiving God and impeded by a patient's interpretation of HIV infection as punishment. Health-care providers need to recognize patients' spiritual beliefs and incorporate them into discussions about terminal care.

End-of-life decisions in HIV-positive patients: the role of spiritual beliefs

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